Associations between concentrations of alpha- and gamma-tocopherol and concentrations of glucose, glycosylated haemoglobin, insulin and C-peptide among US adults

Our objective was to study the cross-sectional associations between concentrations of alpha- and gamma-tocopherol and concentrations of glucose, glycosylated haemoglobin, insulin and C-peptide among US adults. We used data for 1289 participants without self-reported diabetes who were aged > or =20 years in the National Health and Nutrition Examination Survey 1999-2000. Alpha-tocopherol concentration was inversely associated with glucose concentration (beta per mmol/l=-0.01064, SE 0.00356, P=0.004) after adjusting for age, sex, race or ethnicity, education, smoking status, concentrations of total cholesterol and triacylglycerols, systolic blood pressure, waist circumference, alcohol use, physical activity, time watching television or videos or using a computer, and use of vitamin/mineral/dietary supplements. Among 659 participants who did not report using supplements, this association was no longer significant whereas the concentration of alpha-tocopherol was inversely associated with concentration of C-peptide (beta per mmol/l=-0.01121, SE 0.00497, P=0.024). Gamma-tocopherol concentration was positively associated with concentration of glucose (beta per mmol/l=0.09169, SE 0.02711, P=0.001) and glycosylated haemoglobin (beta per mmol/l=0.04954, SE 0.01284, P<0.001), but not insulin or C-peptide. The relationships between physiologic concentrations of the various forms of vitamin E and measures of glucose intolerance deserve additional investigation.     

Mental and physical distress and high-risk behaviors among reproductive-age women

OBJECTIVE: To examine the prevalence of mental and physical distress indicators among women of reproductive age and the association of these indicators with cigarette smoking and alcohol use, by pregnancy status. METHODS: The Behavioral Risk Factor Surveillance System data for several years were aggregated across states and weighted for this analysis. Seven measures of self-reported mental and physical distress and general health were examined along with demographic variables. RESULTS: Overall, 6.7% (95% confidence interval [CI] 6.5-6.9) of women reported frequent physical distress, 12.3% (95% CI 12.0-12.6) reported frequent mental distress, 9.9% (95% CI 9.4-10.4) reported frequent depression, 18.4% (95% CI 17.8-19.1) reported feeling anxious, and 34.3% (95% CI 33.5-35.1) reported that they frequently did not get enough rest. At the time of the survey 4.6% of the women were pregnant. Pregnant women were less likely than nonpregnant women to report frequent mental distress. Although there was attenuation of cigarette smoking and alcohol use during pregnancy, those with mental and physical distress were more likely to consume cigarettes and alcohol than were those without such experiences. CONCLUSION: High proportions of reproductive-age women report frequent mental and physical distress. Women experiencing mental and physical distress were more likely to report consuming cigarettes and alcohol than women without such experiences.     

Actual causes of death in the United States, 2000

Ali H. Mokdad, PhD; James S. Marks, MD, MPH; Donna F. Stroup, PhD, MSc; Julie L. Gerberding, MD, MPH

JAMA. 2004;291:1238-1245.

Context  Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.

Objectives  To identify and quantify the leading causes of mortality in the United States.

Design  Comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.

Main Outcome Measures  Actual causes of death.

Results  The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400 000 deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).

Conclusions  These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.

     

Trends in cigarette smoking among US adults with diabetes: findings from the Behavioral Risk Factor Surveillance System

BACKGROUND: Smoking substantially increases morbidity and mortality rates in people with diabetes. Previous studies have shown that the prevalence of smoking among people with diabetes is similar to that among people without diabetes. We sought to examine temporal trends in the prevalence of smoking among people with diabetes since 1990. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System for 1990-2001. RESULTS: The age-adjusted prevalence of smoking among adults with diabetes was 23.6% (men, 25.4%; women, 22.2%) in 1990 and 23.2% (men, 24.8%; women, 21.9%) in 2001. In comparison, the prevalence among participants without diabetes was 24.2% (men, 25.7%; women, 22.8%) in 1990 and 23.2% (men, 24.8%; women, 21.5%) in 2001. Thus, the prevalence of cigarette smoking was similar and remained stable from 1990 through 2001. Among participants with diabetes, significant decreases in the prevalence of smoking occurred among African Americans and those aged >/=65 years. CONCLUSIONS: New efforts and commitments to promote smoking cessation among people with diabetes are needed.     

Sad,blue, or depressed days,health behaviors and health-related quality of life,Behavioral Risk Factor Surveillance System, 1995–2000

Background  

Mood disorders are a major public health problem in the United States as well as globally. Less information exists however, about the health burden resulting from subsyndromal levels of depressive symptomatology, such as feeling sad, blue or depressed, among the general U.S. population.     

Visceral leishmaniasis: consequences to women in a Bangladeshi community

Visceral leishmaniasis (VL) or kala-azar (KA) affects the rural poor, causing significant morbidity and mortality. We examined the epidemiological and social impact of KA in an affected village in Bangladesh. A population-based survey of the village residents showed a case fatality rate of 14.7% among females and 5.3% among males. Before initiation of the study, female patients were ill longer than males before they received treatment. Future work needs to focus on understanding the implications of KA on women and to develop sustainable strategies for appropriate and timely access to treatment.