Showing papers by "Debbie A Lawlor published in 2005"

Birth weight is inversely associated with incident coronary heart disease and stroke among individuals born in the 1950s: findings from the Aberdeen Children of the 1950s prospective cohort study.

Abstract: Background— Birth weight is inversely associated with cardiovascular disease risk factors, but few studies have examined the association with disease end points, in particular with stroke risk. Furthermore, previous studies demonstrating an inverse association between birth weight and coronary heart disease (CHD) risk have been conducted on populations born in the early part of the 20th century, when infant mortality rates were high. If the environmental factors associated with improvements in infant mortality rates over the last century explain the inverse association between birth weight and CHD risk, one would expect weaker associations in more contemporary birth cohorts. Methods and Results— We have examined the association in a large birth cohort of 10 803 (with an average of 239 000 person-years of follow-up) singleton births that occurred between 1950 and 1956. Our outcomes were hospital admissions for, and fatalities from, CHD (n=296) and stroke (n=107). Birth weight was inversely associated with ...

Plasma adiponectin levels are associated with insulin resistance, but do not predict future risk of coronary heart disease in women

Abstract: Context: Low adiponectin levels predict type 2 diabetes, and one prospective study in men reported its independent prediction of vascular events. Many observers thus already consider adiponectin to be a major part of the “common soil” underpinning diabetes and vascular disease. Objective: The objective of this study was to assess the association between adiponectin and incident coronary heart disease (CHD) risk in the British Women’s Heart and Health Study. Design: This was a prospective (4 yr) case (n = 167) control (n = 334) study nested within the 4286 women in British Women’s Heart and Health Study. Setting: The study was performed in a primary care setting. Participants: The study consisted of women (n = 4286) randomly selected from 23 British towns between 1999 and 2001, who were 60–79 yr of age at baseline. Main Outcome Measures: Association of adiponectin with CHD risk factors and incident CHD events were the main outcome measures. Results: Among both cases and controls, adiponectin positively cor...

Association of C-Reactive Protein With Blood Pressure and Hypertension Life Course Confounding and Mendelian Randomization Tests of Causality

Abstract: Background— C-reactive protein (CRP) has repeatedly been associated with blood pressure and prevalent and incident hypertension, but whether a causal link exists is uncertain. Methods and Results— We assessed the cross-sectional relations of CRP to systolic blood pressure, pulse pressure, and prevalent hypertension in a representative sample of >3500 British women aged 60 to 79 years. For both outcomes, substantial associations were observed. However, these associations were greatly attenuated by adjustment for a wide range of confounding factors acting over the life course. We further investigated causality using a Mendelian randomization approach by examining the association of the 1059G/C polymorphism in the human CRP gene with CRP and with blood pressure, pulse pressure, and hypertension. The polymorphism was associated with a robust difference in CRP, and the expectation would be for higher blood pressure and pulse pressure and greater prevalence of hypertension among those carrying the genetic varia...

Association of birth weight with adult lung function: findings from the British Women's Heart and Health Study and a meta-analysis.

Abstract: BACKGROUND: The aim of this study was to examine the associations between birth weight and lung function in a cohort of women aged 60-79 years and to combine these results with those from other published studies in a systematic review and meta-analysis. METHODS: The associations of self-reported birth weight with adult lung function (forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and forced expiratory flow rate during mid expiration (FEF(25-75)), all measured using standard procedures, were assessed in a cross sectional study of 2257 British women aged 60-79 years. A detailed literature search was used to identify all published studies of the association, and meta-analysis was used to pool the results from our study and all published studies. RESULTS: There were positive linear associations between birth weight and all three measures of lung function in simple age and examining nurse adjusted regression models. However, with adjustment for height (squared), all three associations attenuated towards the null: adjusted (age, nurse, height2) change in FEV1 per 1 kg birth weight was 0.01 l (95% CI -0.02 to 0.04); in FVC was 0.02 l (95% CI -0.02 to 0.07), and in FEF(25-75) was 0.00 l (95% CI -0.04 to 0.04). Further adjustment for life course socioeconomic position, adult body mass index, and smoking did not alter these associations. The results were similar among life long non-smokers and those who had ever smoked. A meta-analysis of eight studies of adults suggested that there was a positive association between birth weight and FEV1: pooled increase in FEV1 per 1 kg in birth weight 0.048 l (95% CI 0.026 to 0.070) adjusted for age, smoking, and height (or height squared). There was no evidence of small study bias in this meta-analysis. CONCLUSIONS: There is a modest positive association between birth weight and lung function which indicates that intrauterine factors might have a role in lung development.

Reasons for and consequences of missed appointments in general practice in the UK: questionnaire survey and prospective review of medical records

Abstract: Background: Missed appointments are a common occurrence in primary care in the UK, yet little is known about the reasons for them, or the consequences of missing an appointment. This paper aims to determine the reasons for missed appointments and whether patients who miss an appointment subsequently consult their general practitioner (GP). Secondary aims are to compare psychological morbidity, and the previous appointments with GPs between subjects and a comparison group. Methods: Postal questionnaire survey and prospective medical notes review of adult patients missing an appointment and the comparison group who attended appointments over a three week period in seven general practices in West Yorkshire. Results: Of the 386 who missed appointments 122 (32%) responded. Of the 386 in the comparison group 223 (58%) responded, resulting in 23 case-control matched pairs with complete data collection. Over 40% of individuals who missed an appointment and participated said that they forgot the appointment and a quarter said that they tried very hard to cancel the appointment or that it was at an inconvenient time. A fifth reported family commitments or being too ill to attend. Over 90% of the patients who missed an appointment subsequently consulted within three months and of these nearly 60% consulted for the stated problem that was going to be presented in the missed consultation. The odds of missing an appointment decreased with increasing age and were greater among those who had missed at least one appointment in the previous 12 months. However, estimates for comparisons between those who missed appointments and the comparison group were imprecise due to the low response rate. Conclusion: Patients who miss appointments tend to cite practice factors and their own forgetfulness as the main reasons for doing so, and most attend within three months of a missed appointment. This study highlights a number of implications for future research. More work needs to be done to engage people who miss appointments into research in a meaningful way.

The Associations of Physical Activity and Adiposity with Alanine Aminotransferase and Gamma-Glutamyltransferase

Abstract: The mechanisms linking obesity and inactivity to diabetes mellitus are unclear. Recent studies have shown associations of alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) with diabetes. In a random sample of 3,789 British women aged 60-79 years, the authors examined the associations of obesity and physical activity with ALT and GGT (1999-2001). Both body mass index and waist:hip ratio were independently (of each other, physical activity, alcohol consumption, smoking, and childhood and adulthood social class) positively and linearly associated with ALT and GGT. In adjusted models, a one-standard-deviation increase in body mass index was associated with a 0.46-units/liter (95% confidence interval (CI): 0.16, 0.75) increase in ALT and a 2.14-units/liter (95% CI: 0.99, 3.30) increase in GGT. Similar results for a one-standard-deviation increase in waist:hip ratio were 13.96 (95% CI: 10.44, 17.48) for ALT and 39.44 (95% CI: 25.89, 52.98) for GGT. Frequency of physical activity was inversely and linearly associated with GGT in fully adjusted models, but the inverse association with ALT was attenuated towards the null after adjustment for body mass index and waist:hip ratio. Adjustment for ALT and GGT resulted in some attenuation of the strong linear associations of body mass index and waist:hip ratio with diabetes. These findings provide some support for the suggestion that the relation between obesity and diabetes is, at least in part, mediated by liver pathology.

Early life determinants of adult blood pressure.

Abstract: Purpose of reviewWhile treating high blood pressure in middle age is beneficial in terms of reducing the occurrence of cardiovascular disease, treated and well controlled hypertensive adults still have a substantial excess mortality and reduced survival compared with normotensives. Therefore, identi

Accuracy of adults’ recall of childhood social class: findings from the Aberdeen children of the 1950s study

Abstract: Background: Although adult reported childhood socioeconomic position has been related to health outcomes in many studies, little is known about the validity of such distantly recalled information. This study evaluated the validity of adults' reports of childhood paternal social class. Methods: Data are drawn from the Aberdeen children of the 1950s study, a cohort of 12 150 people born in Aberdeen (Scotland) who took part in a school based survey in 1962. In this survey, two indices of early life socioeconomic position were collected: occupational social class at birth (abstracted from maternity records) and occupational social class in childhood (reported during the 1962 survey by the study participants). Between 2000 and 2003, a questionnaire was mailed to traced middle aged cohort members in which inquiries were made about their fathers' occupation when they were aged 12 years. The level of agreement between these reports and prospectively collected data on occupational social class was assessed. Results: In total, 7183 (63.7%) persons responded to the mid-life questionnaire. Agreement was moderate between social class of father recalled in adulthood and that measured in early life (κ statistics were 0.47 for social class measured at birth, and 0.56 for social class reported by the child). The relation of occupational social class to birth weight and childhood intelligence was in the expected directions, although weaker for adults' reports in comparison with prospectively gathered data. Conclusions: In studies of adult disease aetiology, associations between childhood social class based on adult recall of parental occupation and health outcomes are likely to underestimate real effects.

Association of Body Mass Index and Obesity Measured in Early Childhood With Risk of Coronary Heart Disease and Stroke in Middle Age: Findings From the Aberdeen Children of the 1950s Prospective Cohort Study

Abstract: Background-There is concern that the childhood epidemic of obesity will result in increases in the risk of cardiovascular disease in the future; however, there is currently little direct evidence on this issue. Methods and Results-We assessed the association of body mass index, measured when subjects were a mean age of 4.9 years old, with the future risk of coronary heart disease (CHD) and stroke in a large Scottish birth cohort (born in the 1950s) who have been linked to hospital admissions and mortality data. At the start of the follow-up period (1981), there were 11 106 (91%) members of the cohort alive and believed to be resident in Scotland. Over the follow-up period, they contributed 245 000 person-years of risk. Among these subjects, there were 302 (53 fatal) cases of CHD, 109 (4 fatal) cases of stroke, and 397 (57 fatal) cases of either a CHD or stroke. There was no association between childhood body mass index and CHD risk. There was no linear association between childhood body mass index and stroke risk, but those who were obese in childhood (top 2.5% of the body mass index distribution) compared with all others had an increased risk of stroke; the adjusted (for gender, father's occupational social class at birth, number of siblings, and birth weight) hazards ratio was 2.41 (95% CI 1.00 to 5.86). Conclusions-Body mass index in early childhood does not appear to be associated with increased CHD risk in later life.

Birth weight of offspring and subsequent cardiovascular mortality of the parents.

Abstract: Background: Restricted fetal growth has been associated with increased blood pressure, insulin resistance, and cardiovascular disease in later life. These associations may be due to processes during fetal development with long-term consequences for metabolic and cardiovascular function (the fetal origins hypothesis). However, it has also been hypothesized that common genetic factors could underlie both restricted fetal development and disease risk (the fetal insulin hypothesis). Methods: We have investigated associations between offspring size at birth and parental mortality in a record linkage study including all 783,814 children born in Sweden between 1973 and 1980. The deaths of 10,368 mothers and 22,807 fathers had been recorded by date and causes of death. Data were analyzed using Cox proportional hazards regression models, with parents' age as the time axis. Results: Offspring birth weight (adjusted for gestational age) was inversely associated with all-cause mortality and cardiovascular mortality in the parents, with weaker associations for fathers than for mothers. The inverse association between birth weight and cardiovascular disease mortality was greatest for parents who died at younger ages. Cancer and alcohol-related causes of death were also related to offspring birth weight. A sensitivity analysis suggests that confounding by smoking is unlikely to entirely explain the associations. Conclusion: Associations between offspring birth characteristics and parents' mortality could, at least in part, reflect genetic factors that influence both birth weight and cardiovascular disease risk.

Childhood Socioeconomic Position, Educational Attainment, and Adult Cardiovascular Risk Factors: The Aberdeen Children of the 1950s Cohort Study

Abstract: Objectives. We assessed the associations of childhood socioeconomic position with cardiovascular disease risk factors (smoking, binge alcohol drinking, and being overweight) and examined the roles of educational attainment and cognitive functioning in these associations.Methods. Data were derived from a cohort study involving 7184 individuals who were born in Aberdeen, Scotland, between 1950 and 1956; had detailed records on perinatal characteristics, childhood anthropometry, and cognitive functioning; and responded to a mailed questionnaire when they were aged 45 to 52 years.Results. Strong graded associations existed between social class at birth and smoking, binge drinking, and being overweight. Adjustment for educational attainment completely attenuated these associations. However, after control for adult social class, adult income and other potential confounding or mediating factors, some association remained.Conclusions. Educational attainment is an important mediating factor in the relation between...

Is there really a 'J-shaped' curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater-University Study of Pregnancy and its outcomes.

Abstract: Aims To determine the nature of the association between alcohol consumption and symptoms of anxiety and depression in women. Design Prospective cohort study of women (n = 4527) who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane between 1981 and 1984 and who have follow-up data on alcohol use, depressive and anxiety symptoms over a 14-year period. Findings At the 5-year follow-up there was a 'J-shaped' association between alcohol Consumption and both symptoms of depression and of anxiety. However, at the baseline assessment and the 14-year follow-up alcohol consumption was linearly and positively associated with depressive symptoms with increasing prevalence of symptoms with greater consumption. At the 5-year follow-up the prevalence of depressive and anxiety symptoms among those who were abstainers at both baseline and 5-year follow-up was similar to that among those who had been previous drinkers and then become abstainers (P = 0.67). Similarly, the prevalence of these symptoms was the same at the 14-year followup comparing those who had been abstainers at baseline, 5-year and 14-year follow-up to those who had previously consumed alcohol but were then abstainers. Conclusions The nature of the association between alcohol consumption and symptoms of depression and anxiety may vary across their life course in women. Previous drinkers who become abstainers do not appear to be at any higher risk of symptoms of depression or anxiety compared to those who always abstained, suggesting that increased symptoms in abstainers at age 30 is not due to 'sick quitters'. The association of high alcohol consumption with symptoms of depression and anxiety may be confounded by low income and smoking.

Life-course socioeconomic position, area deprivation, and coronary heart disease: findings from the British Women's Heart and Health Study.

Abstract: Objectives. We sought to determine whether residential area deprivation, over and above the effect of life-course socioeconomic status or position (SEP), is associated with coronary heart disease. Methods. We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years from 457 British electoral wards. Results. After adjustment for age and 10 indicators of individual life-course SEP, the odds of coronary heart disease was 27% greater among those living in wards with a deprivation score above the median compared with those living in a ward with a deprivation score equal to or below the median (odds ratio=1.27; 95% confidence interval=1.02, 1.57). Conclusions. Adverse area-level socioeconomic characteristics, over and above individual life-course SEP, are associated with increased coronary heart disease.

Adverse socioeconomic position across the lifecourse increases coronary heart disease risk cumulatively: findings from the British women’s heart and health study

Abstract: Objective: To examine the associations of childhood and adult measurements of socioeconomic position with coronary heart disease (CHD) risk. Methods: Cross sectional and prospective analysis of a cohort of 4286 British women who were aged 60–79 years at baseline. Among these women there were 694 prevalent cases of CHD and 182 new incident cases among 13 217 person years of follow up of women who were free of CHD at baseline. Results: All measurements of socioeconomic position were associated with increased prevalent and incident CHD in simple age adjusted models. There was a cumulative effect, on prevalent and incident CHD, of socioeconomic position across the lifecourse. This effect was not fully explained by adult CHD risk factors. The adjusted odds ratio of prevalent CHD for each additional adverse (out of 10) lifecourse socioeconomic indicator was 1.11 (95% confidence interval: 1.06, 1.16). The magnitude of the effect of lifecourse socioeconomic position was the same in women who were lifelong non-smokers as in those who had been or were smokers. Conclusion: Adverse socioeconomic position across the lifecourse increases CHD risk cumulatively and this effect is not fully explained by adult risk factors. Specifically in this cohort of women cigarette smoking does not seem to explain the association between adverse lifecourse socioeconomic position and CHD risk.

Family and early life factors associated with changes in overweight status between ages 5 and 14 years: findings from the Mater University Study of Pregnancy and its outcomes.

Abstract: Objective To describe different patterns of overweight status between ages 5 and 14 y and examine the role of modifiable family and early life characteristics in explaining different patterns of change between these two ages. Design A population-based prospective birth cohort. Subjects A total of 2934 children (52% males) who were participants in the Mater-University study of pregnancy, Brisbane, and who were examined at ages 5 and 14 y. Main outcome measures Four patterns of change in overweight/obesity status between ages 5 and 14 y: (i) normal at both ages; (ii) normal at 5 y and overweight/obese at 14 y; (iii) overweight/obese at 5 y and normal at 14 y; (iv) overweight/obese at both ages. Results Of the 2934 participants, 2018 (68.8%) had a normal body mass index (BMI) at ages 5 and 14 y, 425 (14.5%) changed from a normal BMI at age 5 y to overweight or obese at age 14 y, 175 (6.0%) changed from being overweight or obese at age 5 y to normal weight at age 14 y and 316 (10.8%) were overweight or obese at both ages 5 and 14 y. Girls were more likely to make the transition from overweight or obese at age 5 y to normal at 14 y than their boy counterparts. Children whose parents were overweight or obese were more likely to change from having a normal BMI at age 5 y to being overweight at 14 y (fully adjusted RR: 6.17 (95% CI: 3.97, 9.59)) and were more likely to be overweight at both ages (7.44 (95% CI: 4.60, 12.02)). Birth weight and increase in weight over the first 6 months of life were both positively associated with being overweight at both ages. Other explanatory factors were not associated with the different overweight status transitions. Conclusions Parental overweight status is an important determinant of whether a child is overweight at either stage or changes from being not overweight at 5 y to becoming so at 14 y.

Early life predictors of childhood intelligence: evidence from the Aberdeen children of the 1950s study

Abstract: Objective: To identify the early life predictors of childhood intelligence. Design: Cohort study of 10 424 children who were born in Aberdeen (Scotland) between 1950 and 1956. Results: Social class of father around the time of birth, gravidity, maternal age, maternal physical condition, whether the child was born outside of marriage, prematurity, intrauterine growth, and childhood height were all independently associated with childhood intelligence at ages 7, 9, and 11. The effect of social class at birth was particularly pronounced, with a graded linear association across the distribution even with adjustment for all other covariates (p<0.001 for linear trend). Those from the lowest social class (V) had intelligence scores that were on average 0.9–1.0 of a standard deviation lower than those from the higher groups (I and II) at each of the three ages of intelligence testing. Collectively, the early life predictors that were examined explained 16% of the variation in intelligence at each age. Conclusions: Father's social class around the time of birth was an important predictor of childhood intelligence, even after adjustment for maternal characteristics and perinatal and childhood factors. Studies of the association of childhood intelligence with future adult disease need to ensure that the association is not fully explained by socioeconomic position.

Lifecourse Socioeconomic Position, C-Reactive Protein, and Carotid Intima-Media Thickness in Young Adults The Cardiovascular Risk in Young Finns Study

Abstract: Objective— It has been suggested that confounding by socioeconomic position from across the lifecourse together with adult risk factors explain the association between C-reactive protein (CRP) and coronary heart disease, but the evidence for this is limited to elderly subjects. We examined associations between socioeconomic position in childhood and adulthood, adult CRP, and carotid intima-media thickness (IMT), a presymptomatic predictor of coronary heart disease, in a population of young adults. Methods and Results— The association of socioeconomic indicators at age 3 to 18 and in adulthood with CRP and IMT at age 24 to 39 were examined in a prospective cohort study of 2290 (1030 men and 1260 women) participants in the Young Finns Study. After adjustment for age and sex, both childhood and adulthood socioeconomic position were inversely associated with CRP ( p s≤0.02). There was also a direct correlation between CRP and IMT ( P Conclusions— In young adults, the interrelations between socioeconomic position, CRP, and carotid atherosclerosis are accounted for by adiposity.

Infant feeding and components of the metabolic syndrome: findings from the European Youth Heart Study

Abstract: Aims: To assess the associations of type and duration of infant feeding with components of the metabolic syndrome in children aged 9 and 15. Methods: A total of 2192 randomly selected schoolchildren aged 9 and 15 years from Estonia (n = 1174) and Denmark (n = 1018) were studied. Insulin resistance (homoeostasis model assessment), triglyceride levels, high density lipoprotein cholesterol, and systolic blood pressure were measured. Results: Children who had ever been exclusively breast fed had lower systolic blood pressures than those who were not. With full adjustment for age, sex, country, birth weight, pubertal stage, body mass index, height, maternal and paternal education, income, smoking, and body mass index the mean systolic blood pressure of children who had ever been breast fed was 1.7 mm Hg (95% CI −3.0 to −0.5) lower than those who had never been exclusively breast fed. There was a dose-response in this association with decreasing mean systolic blood pressure across categories from never exclusively breast fed to breast fed for more than six months. Exclusive breast feeding was not associated with other components of the metabolic syndrome. Results were similar when examined separately in each country. Conclusions: The magnitude of the association, its independence of important confounding factors, and the dose-response suggest that exclusive breast feeding is causally associated with reduced systolic blood pressure. The magnitude of the effect we found with blood pressure is comparable to the published effects of salt restriction and physical activity on blood pressure in adult populations, suggesting that it is of public health importance.

Asthma and internalizing behavior problems in adolescence: a longitudinal study.

Abstract: Objective: Clinical studies of asthmatic children have found an association between lung disease and internalizing behavior problems. The causal direction of this association is, however, unclear. This article examines the nature of the relationship between behavior and asthma problems in childhood and adolescence. Methods: Data were analyzed on 5135 children from the Mater University Study of Pregnancy and its outcomes (MUSP), a large birth cohort of mothers and children started in Brisbane, Australia, in 1981. Lung disease was measured from maternal reports of asthma/bronchitis when the children were aged 5 and maternal reports of asthma symptoms when the children were aged 14. Symptoms of internalizing behaviors were obtained by maternal reports (Child Behavior Checklist) at 5 years and by maternal and children's reports at 14 years (Child Behavior Checklist and Youth Self Report). Results: Although there was no association between prevalence of asthma and externalizing symptoms, asthma and internalizing symptoms were significantly associated in cross-sectional analyses at 5 and 14 years. In prospective analyses, after excluding children with asthma at 5 years, internalizing symptoms at age 5 were not associated with the development of asthma symptoms at age 14. After excluding children with internalizing symptoms at 5 years, those who had asthma at 5 years had greater odds of developing internalizing symptoms at age 14. Conclusion: Children who have asthma/bronchitis by the age of 5 are at greater risk of having internalizing behavior problems in adolescence.

Avoiding milk is associated with a reduced risk of insulin resistance and the metabolic syndrome: findings from the British Women's Heart and Health Study

Abstract: Objective To examine the association of milk consumption with insulin resistance and the metabolic syndrome. Methods The association was examined in 4024 British women aged 60–79 who were randomly selected from primary care centres in 23 towns. Results Women who never drank milk had lower homeostasis model assessment insulin resistance (HOMA) scores, triglyceride concentrations and body mass indices, and higher high-density lipoprotein (HDL)-cholesterol concentrations, than those who drank milk. The age-adjusted odds ratio for the metabolic syndrome comparing non-milk drinkers with drinkers was 0.55 (0.33, 0.94), which did not attenuate with adjustment for potential confounders. Diabetes was less common in non-milk drinkers. Conclusion Individuals who do not drink milk may be protected against insulin resistance and the metabolic syndrome. However, randomized controlled trials are required to establish whether milk avoidance is causally associated with these outcomes.

Associations of fibrinogen and C-reactive protein with prevalent and incident coronary heart disease are attenuated by adjustment for confounding factors. British Women's Heart and Health Study.

Abstract: A cross sectional and prospective analysis of 3,745 British women aged 60–79 years at baseline was undertaken.Among these women there were 570 prevalent cases of coronary heart disease (CHD) and 151 new cases among 12,641 person-years of follow up of women who were free of CHD at baseline.Both fibrinogen and CRP were associated with indicators of socioeconomic position in childhood and adulthood and there was a cumulative effect of socioeconomic position from across the life course.The age-adjusted odds ratio (95%confidence interval) of prevalent CHD for a 1 unit (1 g/L) increase in fibrinogen was 1.29 (1.12, 1.49);with full adjustment for all potential confound ing factors this attenuated to 1.09 (0.93, 1.28).The hazards ratio for incident CHD among those free of disease at baseline was 1.28 (1.00, 1.64);with full adjustment for all potential confounding factors this attenuated to 1.09 (0.84, 1.44). Similar effects of adjustment for confounding factors were seen for the associations between CRP and both prevalent and incident CHD. By contrast, the strong positive association between smoking (an established causal risk factor for CHD) and CHD was not attenuated by adjustment for life course socioeconomic position or other risk factors.We conclude that fibrinogen and CRP predict CHD but may not be causally related to it.

Socioeconomic position, cognitive function, and clustering of cardiovascular risk factors in adolescence: findings from the Mater University Study of Pregnancy and its outcomes.

Abstract: Objectives: The objectives of this study were to examine the extent of clustering of smoking, high levels of television watching, overweight, and high blood pressure among adolescents and whether this clustering varies by socioeconomic position and Cognitive function. Methods: This study was a cross-sectional analysis of 3613 (1742 females) participants of an Australian birth cohort who were examined at age 14. Results: Three hundred fifty-three (9.8%) of the participants had co-occurrence of three or four risk factors. Risk factors clustered in these adolescents with a greater number of participants than would be predicted by assumptions of independence having no risk factors and three or four risk factors. The extent of clustering tended to be greater in those from lower-income families and among those with lower cognitive function. The age-adjusted ratio of observed to expected cooccurrence of three or four risk factors was 2.70 (95% confidence interval [Cl], 1.80-4.06) among those from low-income families and 1.70 (95% Cl, 1.34-2.16) among those from more affluent families. The ratio among those with low Raven's scores (nonverbal reasoning) was 2.36 (95% Cl, 1.69-3.30) and among those with higher scores was 1.51 (95% Cl, 1.19-1.92); similar results for the WRAT 3 score (reading ability) were 2.69 (95% Cl, 1.85-3.94) and 1.68 (95% Cl, 1.34-2.11). Clustering did not differ by sex. Conclusion: Among adolescents, coronary heart disease risk factors cluster, and there is some evidence that this clustering is greater among those from families with low income and those who have lower cognitive function.

(Mis) use of factor analysis in the study of insulin resistance syndrome: the authors respond (Correspondence)

Abstract: Over the last decade, factor analysis has been used increasingly to describe patterns of simultaneous occurrence of the central components of the insulin resistance syndrome. In this paper, the authors describe factor analysis, review studies that have used factor analysis to examine the insulin resistance syndrome, and explore how factor analysis might be used to increase our understanding of this syndrome. Most studies that they reviewed gave vague reasons for using factor analysis and did not demonstrate an understanding of the use and limitations of this statistical method. Confirmatory factor analysis based on sound theoretical concepts and a clear understanding of the statistical methods may provide some insights into the pathophysiology of the syndrome. However, to date none of the studies has adopted this approach, and other statistical approaches and study designs are likely to provide greater understanding of the syndrome.

Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study

Abstract: Objectives To examine the association between socioeconomic position and insulin resistance in children from three countries in northern Europe (Denmark), eastern Europe (Estonia), and southern Europe (Portugal) that have different physical, economic, and cultural environments. Design Cross sectional study. Participants 3189 randomly selected schoolchildren aged 9 and 15 years from Denmark (n = 933), Estonia (n = 1103), and Portugal (n = 1153). Main outcome measure Insulin resistance (homoeostasis model assessment). Results Family income and parental education were inversely associated with insulin resistance in Danish children but were positively associated with insulin resistance in Estonian and Portuguese children. Among Danish children, insulin resistance was 24% lower (95% confidence interval −38% to −10%) in those whose fathers had the most education compared with those with the least education. The equivalent results were 15% (2% to 28%) higher for Estonia and 19% (2% to 36%) higher for Portugal. These associations remained after adjustment for a range of covariates: −20% (−36% to −5%) for Denmark, 10% (−4% to 24%) for Estonia, and 18% (−1% to 31%) for Portugal. Strong statistical evidence supported differences between the associations in Denmark and those in the other two countries in both unadjusted and adjusted models (all P Conclusions Among Danish children, those with the most educated and highest earning parents had least insulin resistance, whereas the opposite was true for children from Estonia and Portugal.

Insulin resistance and depressive symptoms in middle aged men: findings from the Caerphilly prospective cohort study

Abstract: Insulin resistance may protect against depression, possibly through an effect on circulating free fatty acid concentrations and brain serotonin concentration,1 2 although a recent study contradicted these findings.3 Studies to date have either used indirect measures of insulin resistance,1 or they have been cross sectional.2 3 We assessed the association of insulin resistance with depressive symptoms in a prospective cohort. The Caerphilly cohort study has been described in detail before.4 In phase I (1979-83), 2512 (89% of eligible) men aged 45-59 years from Caerphilly in Wales provided fasting blood samples. Insulin resistance (homoeostasis model assessment (HOMA) score) was derived from fasting insulin and glucose.5 HOMA scores were not calculated for men with diabetes or high fasting glucose (≥ 7.0 mmol/l). In phases II (1984-88), III (1989-93), and IV (1993-7), depressive symptoms were measured by the 30 item general household questionnaire (GHQ). This was validated at phase II in a subgroup (n = 97) by comparison with a clinical interview schedule given by a psychiatrist blinded to the …

Prevalence of undiagnosed Type 2 diabetes and impaired fasting glucose in older British men and women.

Abstract: Aim To estimate the prevalence of undiagnosed diabetes and impaired fasting glucose in older British men and women, using the 1999 World Health Organization (WHO) thresholds based on fasting glucose measurements.Methods Participants in the British Regional Heart Study and the British Women's Heart and Health Study were selected from one socially representative general practice in 24 British towns. Included in this analysis were 3736 men and 3642 women aged 60-79 years (predominantly white), who provided a single fasting blood sample at a clinical examination between 1998 and 2001, and who had no previous diagnosis of diabetes.Results Two hundred and eleven men (5.7%) and 190 women (5.2%) had a fasting blood glucose level consistent with the WHO threshold for a diagnosis of diabetes (>= 7.0 mmol/l), whilst a further 667 men (17.9%) and 642 women (17.6%) had impaired fasting glucose levels (6.1 <= 7 mmol/l). When analyses were restricted to subjects who had fasted for at least 8 h, and whose blood sample was taken before 12.00 h, the predicted prevalence of undiagnosed diabetes (based on two separate measurements) was 6.7% in men and 6.0% in women. The predicted prevalence of impaired fasting glucose (based on two separate measurements) was approximately 20% in both sexes.Conclusions More than one-fifth of older white British men and women have either undiagnosed diabetes or impaired fasting glucose according to new WHO criteria. Strategies for the primary and secondary prevention of Type 2 diabetes among older individuals are urgently needed.

Effect of Body Mass Index Changes Between Ages 5 and 14 on Blood Pressure at Age 14 Findings From a Birth Cohort Study

Abstract: Weight reduction in clinical populations of severely obese children has been shown to have beneficial effects on blood pressure, but little is known about the effect of weight gain among children in the general population. This study compares the mean blood pressure at 14 years of age with the change in overweight status between ages 5 and 14. Information from 2794 children born in Brisbane, Australia, and who were followed up since birth and had body mass index (BMI) and blood pressure measurements at ages 5 and 14 were used. Systolic and diastolic blood pressure at age 14 was the main outcomes and different patterns of change in BMI from age 5 to 14 were the main exposure. Those who changed from being overweight at age 5 to having normal BMI at age 14 had similar mean blood pressures to those who had a normal BMI at both time points: age- and sex-adjusted mean difference in systolic blood pressure 1.54 (-0.38, 3.45) mm Hg and in diastolic blood pressure 0.43 (-0.95, 1.81) mm Hg. In contrast, those who were overweight at both ages or who had a normal BMI at age 5 and were overweight at age 14 had higher blood pressure at age 14 than those who had a normal BMI at both times. These effects were independent of a range of potential confounding factors. Our findings suggest that programs that successfully result in children changing from overweight to normal-BMI status for their age may have important beneficial effects on subsequent blood pressure.