Weight loss: a determinant of hip bone loss in older men and women. The Rancho Bernardo Study

The sex-specific effect of weight change on change in total hip bone mineral density was evaluated over 4 years (1992-1996) in 1,214 community-dwelling adults whose mean age at baseline was 71 years. Weight and bone mineral density (by dual-energy x-ray absorptiometry) were assessed at two study visits. The average bone loss was 0.5% per year in both sexes; 29% of men and 28% of women lost at least 1% of bone mineral density per year. More than one in five participants lost at least 1% of their body weight per year (21% of men and 23% of women). These weight losers were twice as likely as others to lose bone at the rate of at least 1% per year. In analyses controlling for age, baseline weight, and lifestyle, weight loss was the strongest independent predictor of bone loss (odds ratios were 1.53 for men and 1.56 for women). Persons with weight loss of at least 1% per year were more likely to report fair or poor health and functional limitation at the second visit and to die within 2 years of the second visit; however, most did not report declining health, and most survived for at least 2 additional years.     

Behavioral covariates of waist-to-hip ratio in Rancho Bernardo.

We examined lifestyle and dietary habits in 685 men and 943 women (mean age 67 years) who completed an interview, examination, and food frequency questionnaire in 1984-87. Waist-to-hip ratio increased with age and body mass index in both men and women. In multiple regression, waist-to-hip ratio was independently associated with smoking, alcohol consumption, and exercise in men, and with smoking and alcohol consumption in women. The data suggest that waist-to-hip ratio is affected, at least in part, by behavioral, and potentially modifiable, factors.     

Lower extremity arterial disease in older women: the Rancho Bernardo Study

Most studies of lower extremity arterial disease (LEAD) have not included women. To study the frequency of LEAD and its association with cardiovascular disease risk factors and estrogen use in community-dwelling postmenopausal women, we conducted a cross-sectional study of LEAD in 826 women whose average age was 74 years. Cardiovascular disease risk factors and medical history, body mass index (BMI), blood pressure, glucose tolerance, lipids and lipoproteins, and current and past medication use were determined using a standard protocol. Ankle-brachial artery index (ABI) of systolic blood pressure was measured by a trained technician using Doppler ultrasound. LEAD was defined as ABI <0.8. LEAD prevalence increased with age from nearly 5% in the 60-69-year-old group to >25% in women aged 90 and older. In age-adjusted analyses, women with LEAD had significantly lower levels of high-density lipoprotein (HDL) cholesterol, were less likely to exercise regularly, and were less likely to have ever used estrogen replacement therapy. They also had significantly higher levels of blood pressure, low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, and insulin. In multivariate analyses, high HDL cholesterol, regular exercise, and estrogen use were each associated with a reduced risk of LEAD, whereas age, high blood pressure, and abnormal glucose tolerance were each associated with increased risk. Few women (6%) were smokers, but they had twice the risk of LEAD compared with nonsmokers. Estrogen was independently associated with LEAD in a model containing all covariates except LDL and HDL, and this association was no longer significant in a second model adjusting for these lipoproteins. LEAD is common in older women and associated with modifiable risk factors. The apparent protection associated with estrogen should be studied in clinical trials.     

Five-year stability in associations of health-related quality of life measures in community-dwelling older adults: the Rancho Bernardo Study

Objective  

This study examines the five-year stability of the association of SF-12 and SF-6D scores with scores on the longer SF-36 and its domains in community-dwelling older men and women.     

Employment status and heart disease risk factors in middle-aged women: the Rancho Bernardo Study.

BACKGROUND. In recent years, an increasing number of women have been entering the labor force. It is known that in men, employment is related to heart disease risk, but there are few studies examining this association among women. METHODS. The relation between employment status and heart disease risk factors including lipid and lipoprotein levels, systolic and diastolic blood pressure, fasting and postchallenge plasma glucose and insulin levels, was examined in 242 women aged 40 to 59 years, who were participants in the Rancho Bernardo Heart and Chronic Disease Survey. At the time of a follow-up clinic visit between 1984 and 1987, 46.7% were employed, primarily in managerial positions. RESULTS. Employed women smoked fewer cigarettes, drank less alcohol, and exercised more than unemployed women, but these differences were not statistically significant. After adjustment for covariates, employed women had significantly lower total cholesterol and fasting plasma glucose levels than unemployed women. Differences on other biological variables, although not statistically significant, also favored the employed women. CONCLUSIONS. Results of this study suggest that middle-aged women employed in managerial positions are healthier than unemployed women.     

Protein consumption and bone mineral density in the elderly : the Rancho Bernardo Study

The role of dietary protein in osteoporosis is unclear, with previous studies having suggested both protection and harm. The associations of total, animal, and vegetable protein with bone mineral density (BMD) and the variations in these associations with calcium intake were studied in a community-dwelling cohort of 572 women and 388 men aged 55-92 years (Rancho Bernardo, California). Multiple linear regression analyses adjusted for standard osteoporosis covariates showed a positive association between animal protein consumption, assessed by food frequency questionnaires in 1988-1992, and BMD, measured 4 years later. This association was statistically significant in women. For every 15-g/day increase in animal protein intake, BMD increased by 0.016 g/cm2 at the hip (p = 0.005), 0.012 g/cm2 at the femoral neck (p = 0.02), 0.015 g/cm2 at the spine (p = 0.08), and 0.010 g/cm2 for the total body (p = 0.04). Conversely, a negative association between vegetable protein and BMD was observed in both sexes. Some suggestion of effect modification by calcium was seen in women, with increasing protein consumption appearing to be more beneficial for women with lower calcium intakes, but evidence for this interaction was not consistently strong. This study supports a protective role for dietary animal protein in the skeletal health of elderly women.     

Ratio of n-6 to n-3 fatty acids and bone mineral density in older adults: the Rancho Bernardo Study

BACKGROUND: Several lines of evidence suggest that n-3 fatty acids reduce the risk of some chronic diseases, including heart disease, diabetes, and cancer. Other research, mainly in animals, also suggests a role in bone health. OBJECTIVE: We aimed to investigate the association between the ratio of dietary n-6 to n-3 fatty acids and bone mineral density (BMD) in 1532 community-dwelling men and women aged 45-90 y. DESIGN: Between 1988 and 1992, dietary data were obtained through self-administered food-frequency questionnaires, and BMD was measured at the hip and spine with the use of dual-energy X-ray absorptiometry. A medical history was obtained and current medication use was validated. Age- and multiple-adjusted linear regression analyses were performed. RESULTS: There was a significant inverse association between the ratio of dietary linoleic acid to alpha-linolenic acid and BMD at the hip in 642 men, 564 women not using hormone therapy, and 326 women using hormone therapy; these results were independent of age, body mass index, and lifestyle factors. An increasing ratio of total dietary n-6 to n-3 fatty acids was also significantly and independently associated with lower BMD at the hip in all women and at the spine in women not using hormone therapy. CONCLUSIONS: A higher ratio of n-6 to n-3 fatty acids is associated with lower BMD at the hip in both sexes. These findings suggest that the relative amounts of dietary polyunsaturated fatty acids may play a vital role in preserving skeletal integrity in older age.     

Zinc intakes and plasma concentrations in men with osteoporosis: the Rancho Bernardo Study

BACKGROUND: Low zinc intakes and reduced blood zinc concentrations have been reported to be associated with osteoporosis in women. OBJECTIVE: The objective was to examine the independent association between dietary zinc and plasma zinc and the association of each with bone mineral density (BMD) and 4-y bone loss in community-dwelling older men. DESIGN: Of the original Rancho Bernardo Study subjects, 396 men (age: 45-92 y) completed BMD measurements at baseline in 1988-1992 and 4 y later. Osteoporosis was defined as a BMD > or = 2.5 SDs below the mean for young women (a T-score < or = -2.5). At baseline, dietary intake data were collected by using a standard food-frequency questionnaire, and plasma zinc concentrations were measured by using inductively coupled plasma spectroscopy. RESULTS: The mean dietary zinc intake was 11.2 mg, and the mean plasma zinc concentration was 12.7 micromol/L. Plasma zinc was correlated with total zinc intake (diet plus supplements). Dietary zinc intake and plasma zinc concentrations were lower in men with osteoporosis at the hip and spine than in men without osteoporosis at those locations. BMDs for the hip, spine, and distal wrist were significantly lower in men in the lowest plasma zinc quartile (<11.3 micromol/L) than in men with higher plasma zinc concentrations. The association between plasma zinc and BMD was cross-sectional, longitudinal, and independent of age or body mass index. However, plasma zinc did not predict bone loss during the 4-y interval. CONCLUSION: Dietary zinc intake and plasma zinc each have a positive association with BMD in men.     

Sarcopenia in elderly men and women: the Rancho Bernardo study

BACKGROUND: Sarcopenia risk factors are poorly understood. METHODS: This study examines sarcopenia prevalence and risk factors in community-dwelling men (694) and women (1006) aged 55-98 years (mean=73) who attended a 1988-1992 Rancho Bernardo Study clinic visit. Height, weight, muscle strength, fat-free mass (FFM), fat mass by bioelectric impedance analysis, and grip strength were measured; alcohol and medication use, smoking, and physical activity were ascertained. RESULTS: Mean FFM was 43.5 kg for women and 61.7 kg for men. Sarcopenia, defined as FFM of > or =2.0 standard deviations below the gender-specific mean of a young reference population, was present in 6.0% overall. Prevalence increased dramatically from 4% of men and 3% of women aged 70-75 to 16% of men and 13% of women aged 85 and older. Both men and women with sarcopenia had a significantly lower fat mass and body mass index than those without sarcopenia. Men with sarcopenia were twice as likely to have fallen in the past year compared with those without sarcopenia. Grip strength, but not quadriceps strength, was lower in men and women with sarcopenia. Physically active women were about half as likely to have sarcopenia, but no association was found in men. Few men and women were current smokers, but they were more likely to have sarcopenia. Comorbidities (heart disease, diabetes, pulmonary disease, arthritis, cancer) and medications (thyroid hormones, corticosteroids, and hormone replacement therapy) were not associated with sarcopenia. CONCLUSIONS: Sarcopenia increases with age. This study also identified lack of physical activity and current smoking as reversible risk factors for sarcopenia.     

Carbonated beverage consumption and bone mineral density among older women: the Rancho Bernardo Study.

OBJECTIVES: The association between carbonated beverage consumption and bone mineral density was examined in a community-based cohort of older White women. METHODS: One thousand women 44 to 98 years of age had bone mineral density measured at four sites and provided medical and behavioral histories, including type and quantity of carbonated beverages consumed. RESULTS: Bone mineral density levels were not associated with intake of any type of carbonated beverage after adjustment for age, obesity, calcium intake, exercise, and current use of tobacco and alcohol, thiazides, estrogen, or thyroid hormone. CONCLUSIONS: Modest intake of carbonated beverages does not appear to have adverse effects on bone mineral density in older women.     

Obesity, weight change, fasting insulin, proinsulin, C-peptide, and insulin-like growth factor-1 levels in women with and without breast cancer: the Rancho Bernardo Study

Postmenopausal overweight women have an increased risk of breast cancer. The link between obesity and breast cancer could be mediated through hyperinsulinemia. Insulin and insulin-like growth factor-1 (IGF-1) stimulate mammary cell proliferation in vitro, and cell proliferation is directly linked to the risk of breast cancer. Our objective was to investigate the relationship between breast cancer and body composition, IGF-1, proinsulin, C-peptide, and fasting insulin. A case-control study was conducted of 438 community-dwelling women aged 53-90 years in 1992-1994 who had no history of cancer at the baseline visit in 1972-1974. Women were excluded who were using estrogen replacement therapy (ERT) or tamoxifen at the 1992-1994 visit, when IGF-1, proinsulin, fasting insulin, and C-peptide levels were measured. Prior ERT, alcohol and tobacco use, exercise, and reproductive history were recorded. Weight, height, and waist/hip ratio were measured. The 45 women with breast cancer had similar baseline body mass indices to the 393 women without breast cancer but had gained significantly more weight between the baseline visit in 1972-1974 and 1992-1994, (age-adjusted relative risk [RR] 1.05/kg, 95% confidence interval [CI] 1.01-1.09, p = 0.016). Proinsulin, fasting insulin, and C-peptide were each significantly positively correlated with both current weight and weight gain. However, levels of these hormones and IGF-1 did not differ significantly between women with and without breast cancer (all 95% CI within 0.996-1.004). Past ERT was significantly more common among women with breast cancer (p = 0.015), and duration of use was significantly longer (age-adjusted RR 1.13 per year of use, 95% CI 1.08-1.18, p = 0.000). The risk of breast cancer was significantly increased in women who had gained weight or used ERT. This increased risk was not associated with circulating levels of IGF-1, fasting insulin, proinsulin, or C-peptide.     

Ghrelin, adiponectin, and leptin do not predict long-term changes in weight and body mass index in older adults: longitudinal analysis of the Rancho Bernardo cohort

Ghrelin, leptin, and adiponectin are associated with body size in cross-sectional studies; it is unknown whether these hormones predict long-term changes in body size. Multilevel models were used to study associations between fasting serum hormones, measured in 698 men and 619 women (60-91 years) in samples collected at baseline (1984-1987), and changes in weight and body mass index, assessed repeatedly over a follow-up period of up to 18 years (median, 4.7 years). Baseline weight was -1.5 kg lower for a one-standard-deviation increment in ghrelin and -3.3 kg lower for a one-standard-deviation increment in adiponectin, similar in men and women. For leptin, baseline weight was 12.1 kg higher for a one-standard-deviation increment in men, compared with 5.7 kg in women (sex-interaction p < or = 0.0001). Ghrelin and adiponectin did not affect weight change; their associations with weight were constant over time, indicated by nonsignificant hormone-by-time interactions. The positive association between leptin and weight became slightly weaker over time. Results were similar when investigating repeated measures of body mass index. From this analysis of Rancho Bernardo Study data, the authors conclude that ghrelin, adiponectin, and leptin do not predict weight gain beyond reflecting the influence of attained body size on future changes in weight or body mass index.     

Vasomotor symptoms are not associated with reduced bone mass in postmenopausal women: the Rancho Bernardo Study

The association of menopause-related vasomotor symptoms with later bone mineral density (BMD) at axial and appendicular sites was examined in community-dwelling older women. Subjects were 894 postmenopausal women from the Rancho Bernardo Study who had BMD measured in 1988-1991 and responded to a 1989 mailed survey that included questions about menopause symptoms. Mean age was 73 years (SE +/- 9.5, range 47-97), and mean age at menopause was 47 years (SD +/- 6.8, range 21-62). Vasomotor symptoms were recalled by two thirds (68%) and night sweats by 36% of all women, with no significant differences in symptom frequency by age or type of menopause. Postmenopausal estrogen (PME) had been used by 644 women (72%) for an average duration of 12.3 (+/-11) years. Among women who reported current estrogen use with a duration >3 years, those who experienced vasomotor symptoms had significantly higher BMD at the lumbar spine (p = 0.01), femoral neck (p = 0.05) and midshaft radius (p = 0.05) compared with women who did not experience symptoms. Vasomotor symptoms were not associated with BMD among past or never PME users or among women who reported current PME use for 3 or fewer years. Analyses stratified by age, type of menopause, or when PME use began showed similar results. Women who reported night sweats also had no difference in BMD compared with women without night sweats. In conclusion, vasomotor symptoms are not a marker for low BMD years after menopause in women with access to healthcare. Vasomotor symptoms significantly increased the likelihood of continued use of PME, which was in turn associated with higher BMD levels.     

Relation of weight gain and weight loss on subsequent diabetes risk in overweight adults

STUDY OBJECTIVE: To determine whether long term weight gain and weight loss are associated with subsequent risk of type 2 diabetes in overweight, non-diabetic adults. DESIGN: Prospective cohort. Baseline overweight was defined as BMI>/=27.3 for women and BMI>/=27. 8 for men. Annual weight change (kg/year) over 10 years was calculated using measured weight at subjects' baseline and first follow up examinations. In the 10 years after measurement of weight change, incident cases of diabetes were ascertained by self report, hospital discharge records, and death certificates. SETTING: Community. PARTICIPANTS: 1929 overweight, non-diabetic adults. MAIN RESULTS: Incident diabetes was ascertained in 251 subjects. Age adjusted cumulative incidence increased from 9.6% for BMI<29 to 26. 2% for BMI>/=37. Annual weight change over 10 years was higher in subjects who become diabetic compared with those who did not for all BMI<35. Relative to overweight people with stable weight, each kg of weight gained annually over 10 years was associated with a 49% increase in risk of developing diabetes in the subsequent 10 years. Each kg of weight lost annually over 10 years was associated with a 33% lower risk of diabetes in the subsequent 10 years. CONCLUSIONS: Weight gain was associated with substantially increased risk of diabetes among overweight adults, and even modest weight loss was associated with significantly reduced diabetes risk. Minor weight reductions may have major beneficial effects on subsequent diabetes risk in overweight adults at high risk of developing diabetes.     

Association of adiponectin with coronary heart disease and mortality: the Rancho Bernardo study

Hypoadiponectinemia has been implicated in the development of obesity-related conditions, including dyslipidemia and coronary heart disease (CHD). In this study, the authors examined the association of adiponectin with CHD prevalence, incidence, and mortality among 1,513 community-dwelling men and women aged 50-91 years who were followed from 1984-1987 through 2004. In cross-sectional analyses, adiponectin concentrations were positively related to female sex, age, and high density lipoprotein cholesterol level and inversely related to waist girth, triglyceride level, and fasting plasma glucose level (all p's < 0.001). Adiponectin levels in the highest sex-specific quintile, as compared with the lowest, were associated with 44% decreased odds of prevalent CHD (p for trend = 0.03); adjustment for high density lipoprotein cholesterol and/or triglycerides eliminated this association. In 20-year prospective analyses, higher adiponectin concentrations predicted reduced risk of nonfatal myocardial infarction in men only; adiponectin was not associated with fatal incident CHD events or 20-year CHD mortality (n = 215 deaths) in either sex. Adiponectin levels in the highest sex-specific quintile, as compared with lower levels, were associated with almost 40% increased risks of cardiovascular disease death (n = 441) and death from all causes (n = 925), independent of age, sex, waist girth, lipid levels, and glucose level (both p's < 0.001). These results suggest that use of adiponectin for cardiovascular disease risk stratification is premature.     

Hypercholesterolemia predicts early death from coronary heart disease in elderly men but not women. The Rancho Bernardo Study.

In a 3-year follow-up study of 761 elderly men and 983 elderly women, total plasma cholesterol levels predicted fatal coronary heart disease (CHD) in men but not women. Low-density lipoprotein level was no better a predictor of fatal CHD than total cholesterol in either sex. Women had higher levels of high-density lipoprotein than men, which explains most of their usual higher total cholesterol levels. These data suggest that cholesterol screening of elderly women would have little value without a lipoprotein evaluation.     

Cross-sectional and prospective study of exercise and depressed mood in the elderly : the Rancho Bernardo study

This study examined cross-sectional and prospective associations of exercise with depressed mood in a community-based sample of older men and women (aged 50--89 years in 1984--1987) in southern California. Regular strenuous exercise and exercise > or =3 times per week were reported; depressed mood was assessed by using the Beck Depression Inventory (BDI). After exclusion of persons with categorical depression and those rating themselves largely or extremely physically limited during the previous month, data on 932 men and 1,097 women were available for cross-sectional analysis. Exercise and depressed mood were reassessed for 404 men and 540 women in 1992--1995; these data were the focus of prospective analyses. In 1984--1987, exercise rates were high (>80%), and average BDI scores were low. Cross-sectional analyses indicated that before and after adjustment for covariates, exercise was significantly associated with less depressed mood. However, prospective analyses of the 944 persons who attended both clinic visits indicated no association between baseline exercise and either follow-up BDI score (p > 0.10) or change in BDI score between baseline and follow-up (p > 0.10). Results confirm that exercisers have less depressed mood. However, exercise does not protect against future depressed mood for those not clinically depressed at baseline.     

Weight loss attempts in adults: goals, duration, and rate of weight loss.

OBJECTIVES: Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population. METHODS. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight. RESULTS. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. CONCLUSIONS. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States.