Peer Reviewed: Control of Risk Factors Among People With Diagnosed Diabetes,by Lower Extremity Disease Status

Introduction

We examined the control of modifiable risk factors among a national sample of diabetic people with and without lower extremity disease (LED).

Methods

The sample from the 1999-2004 National Health and Nutrition Examination Survey consisted of 948 adults aged 40 years or older with diagnosed diabetes and who had been assessed for LED. LED was defined as peripheral arterial disease (ankle-brachial index <0.9), peripheral neuropathy (≥1 insensate area), or presence of foot ulcer. Good control of modifiable risk factors, based on American Diabetes Association recommendations, included being a nonsmoker and having the following measurements: HbA1c less than 7%, systolic blood pressure less than or equal to 130 mm Hg, diastolic blood pressure less than or equal to 80 mm Hg, high density lipoprotein (HDL) cholesterol greater than 50 mg/dL, and body mass index (BMI) between 18.5 kg/m² and 24.9 kg/m².

Results

Diabetic people with LED were less likely than were people without LED to have recommended levels of HbA1c (39.3% vs 53.5%) and HDL cholesterol (29.7% vs 41.1%), but there were no differences in systolic or diastolic blood pressure, BMI classification, or smoking status between people with and without LED. Control of some risk factors differed among population subgroups. Notably, among diabetic people with LED, non-Hispanic blacks were more likely to have improper control of HbA1c (adjusted odds ratio [AOR] = 2.0; 95% confidence interval [CI], 1.1-3.9), systolic blood pressure (AOR = 1.9; 95% CI, 1.1-3.2), and diastolic blood pressure (AOR = 2.6; 95% CI, 1.1-5.8), compared with non-Hispanic whites.

Conclusion

Control of 2 of 6 modifiable risk factors was worse in diabetic adults with LED compared with diabetic adults without LED. Among diabetic people with LED, non-Hispanic blacks had worse control of 3 of 6 risk factors compared with non-Hispanic whites.     

High blood pressure and cardiovascular disease mortality risk among U.S. adults: the third National Health and Nutrition Examination Survey mortality follow-up study

PURPOSE: We sought to examine whether prehypertension is associated with increased cardiovascular disease (CVD) mortality risk and whether the association of blood pressure with CVD outcome is modified by social demographics or hypertension treatment and control. METHODS: Data from the Third National Health and Nutrition Examination Survey and mortality follow-up through 2000 were used to estimate the relative risk of death from CVD associated with hypertension and prehypertension, after adjusting for confounding and modifying factors. RESULTS: Compared with normotension, the relative risks of CVD mortality were 1.23 (95% confidence interval [95% CI] 0.85-1.79, p=0.26) for prehypertension, 1.64 (95% CI 1.11-2.41, p=0.01) for hypertension, 1.74 (95% CI 1.28-2.49, p=0.007) for uncontrolled hypertension, and 1.15 (95% CI 0.79-1.80, p=0.53) for controlled hypertension. Hypertensive adults <65 years and non-Hispanic blacks had a 3.86-fold and a 4.65-fold increased CVD mortality risk respectively. Age, gender, and race/ethnicity stratified analyses showed no associations between prehypertension and CVD mortality. However, blood pressure at a high range of prehypertension (130-139/84-89 mmHg) was associated with increased risk of CVD mortality (hazard ratio 1.41, p<0.05) relative to blood pressure less than 120/80 mmHg. CONCLUSIONS: This study supports a strong, significant, and independent association of elevated blood pressure with CVD mortality risk. Hypertension continued to greatly increase CVD morality risk, particularly among persons <65 years and non-Hispanic blacks. Treatment and control of hypertension eliminated the excess CVD mortality risk observed among the hypertension population.     

Race/ethnicity and self-reported diabetes among adults in the National Health Interview Survey: 2000-2003

OBJECTIVE: We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors. METHODS: Using the National Health Interview Survey 2000-2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents). RESULTS: The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03). CONCLUSIONS: This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.     

Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults.

OBJECTIVES: This study assessed the impact of diabetes on mortality associated with pneumonia and influenza among non-Hispanic Black and White US adults. METHODS: Data were derived from the National Mortality Followback Survey (1986) and the National Health Interview Survey (1987-1989). RESULTS: Regardless of race, sex, and socioeconomic status, people with diabetes who died at 25 to 64 years of age were more likely to have pneumonia and influenza recorded on the death certificate than people without diabetes who died at comparable ages (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 2.3, 7.7). For those 65 years and older, the risk remained elevated among Whites with diabetes (OR = 2.2, 95% CI = 1.7, 2.7) but not among Blacks with diabetes (OR = 1.0, 95% CI = 0.6, 1.7). It was estimated that about 17,000 (10.3%) of the 167,000 deaths associated with pneumonia and influenza that occurred in 1986 were attributable to diabetes. CONCLUSIONS: The impact of diabetes on deaths associated with pneumonia and influenza is substantial. Targeted immunizations among people with diabetes may reduce unnecessary deaths associated with pneumonia and influenza.     

Fruit and vegetable consumption and diabetes mellitus incidence among U.S. adults

BACKGROUND: Adequate fruit and vegetable intake may lower the risk of several chronic diseases, but little is known about how it affects the risk of diabetes mellitus. METHODS: We examined whether fruit and vegetable consumption was associated with diabetes incidence in a cohort of U. S. adults aged 25-74 years who were followed for about 20 years. RESULTS: In the analytic sample of 9,665 participants, 1,018 developed diabetes mellitus. The mean daily intake of fruits and vegetables as well as the percentage of participants consuming five or more fruits and vegetables per day was lower among persons who developed diabetes than among persons who remained free of this disease (P < 0.001). After adjustments for age, race or ethnicity, cigarette smoking, systolic blood pressure, use of antihypertensive medication, serum cholesterol concentration, body mass index, recreational exercise, nonrecreational exercise, and alcohol consumption, the hazard ratio for participants consuming five or more servings of fruits and vegetables per day compared with those consuming none was 0.73 (95% confidence interval (CI), 0.54-0.98) for all participants, 0.54 (95% CI, 0.36-0.81) for women, and 1.09 (95% CI, 0.63-1.87) for men. Adding education to the model changed the hazard ratios to 0.79 (95% CI, 0.59-1.06) for all participants, 0.61 (95% CI, 0.42-0.88) for women, and 1.14 (95% CI, 0.67-1.93) for men. CONCLUSIONS: Fruit and vegetable intake may be inversely associated with diabetes incidence particularly among women. Education may explain partly this association.     

Incidence of hypertension and educational attainment: the NHANES I epidemiologic followup study. First National Health and Nutrition Examination Survey

Previous research has demonstrated the association between cardiovascular disease and education. However, few studies have described the incidence of hypertension, a risk factor for cardiovascular disease, by education or other socioeconomic status indicators. To examine the association between hypertension incidence and education, the authors analyzed data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study (NHEFS) (1971-1984). The relative risk of hypertension incidence (blood pressure > or =160/95 and/or using antihypertensive medication) by education was calculated for non-Hispanic Whites (aged 25-64 years) and non-Hispanic Blacks (aged 25-44 years) normotensive at baseline using Cox proportional hazards models. The age-adjusted relative risk of hypertension incidence among persons with less than 12 years of education compared with those with more than 12 years was significant among non-Hispanic Whites aged 25-44 years (men: relative risk (RR) = 2.14, 95% confidence interval (CI): 1.29, 3.54; women: RR = 2.06, 95% CI: 1.39, 3.05) but not among non-Hispanic Blacks (RR = 1.16, 95% CI: 0.63, 2.14). Relative risks for non-Hispanic White men remained stable after adjusting for age, systolic blood pressure, body mass index, and region of residence; relative risks for non-Hispanic White women were reduced but remained significant. Non-Hispanic White men and women aged 45-64 years with less than 12 years of education were not at higher risk of developing hypertension compared with their more educated counterparts. These results demonstrate a significant interaction between age and education with an independent association between education and hypertension incidence among younger but not older non-Hispanic White men and women.     

Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999-2004

PURPOSE: This study aimed to examine the trends in prevalence, treatment, and control of diagnosed diabetes in United States adults 20 years of age or older. METHODS: Data from the National Health and Nutrition Examination Survey 1999-2004 were used. Glycemic, blood pressure, and total cholesterol target levels were defined as having glycosylated hemoglobin <7.0%, blood pressure <130/80 mm Hg, and total cholesterol <200 mg/dL, respectively. RESULTS: The prevalence of diagnosed diabetes was 7.8% in 2003-2004 and increased significantly in people aged 40-59 years, women, non-Hispanic whites, and obese people in the period 1999-2004. Although there was no significant change in the pattern of antidiabetic treatment, the age-adjusted percentage of people with diagnosed diabetes achieving glycemic and blood pressure target levels increased from 35.8% to 57.1% (p = 0.002) and from 35.7% to 48.3% (p = 0.04), respectively. However, there were only insignificant increases in percentages of those persons achieving total cholesterol target level (from 48.8% to 50.4%) and those achieving all 3 target levels (from 7.5% to 13.2%). CONCLUSIONS: In 1999-2004, the prevalence of diagnosed diabetes increased significantly in some subgroups of the population. However, the increases in percentages of people with diabetes achieving glycemic and blood pressure targets are encouraging, although there is room for improvement.     

Use of diabetes preventive care and complications risk in two African-American communities

BACKGROUND: We examined levels of diabetes preventive care services and glycemic and lipid control among African Americans with diabetes in two North Carolina communities. METHODS: Cross-sectional, population-based study of 625 African-American adults with diagnosed diabetes. Participants had a household interview to determine receipt of preventive care services including glycosylated hemoglobin (HbA(1c)), blood pressure, lipid, foot, dilated eye, and dental examinations; diabetes education; and health promotion counseling. A total of 383 gave blood samples to determine HbA(1c) and lipid values. RESULTS: Annual dilated eye, foot, and lipid examinations were reported by 70% to 80% of the population, but only 46% reported HbA(1c) tests. Rates of regular physical activity (31%) and daily self-monitoring of blood glucose (40%) were low. Sixty percent of the population had an HbA(1c) level >8% and one fourth had an HbA(1c) level >10%. Half of the population had a low-density lipoprotein value >130 mg/dL. Lack of insurance was the most consistent correlate of inadequate care (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.3-3.9), having HbA(1c) >9.5% (OR=2.1, 95% CI=1.1-4.2), and LDL levels >130 mg/dL (OR=2.1; 95% CI=1.0-4.5). CONCLUSIONS: Levels of diabetes preventive care services were comparable to U.S. estimates, but glycemic and lipid control and levels of self-management behaviors were poor. These findings indicate a need to understand barriers to achieving and implementing good glycemic and lipid control among African Americans with diabetes.     

Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000

OBJECTIVE: To examine trends in walking among adults in 31 states. METHODS: Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4-5.2), from 26.2% (95% CI=25.1-25.3) in 1987 to 30.1% (95% CI=29.4-30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4-7.8), from 40.4% (95% CI=-39.4-41.1) to 46.9% (95% CI=46.2-47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2-14.2) in Hispanic women, 8.5% (95% CI=4.4-12.6) non-Hispanic black women, and 7.0% (95% CI=2.3-11.7) in non-Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for > or =30 minutes per session). CONCLUSIONS: Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.     

Racial and ethnic disparities in the prevalence and management of cardiovascular risk factors in the United States workforce

OBJECTIVE: To assess racial or ethnic differences in workers with respect to awareness, treatment, and control of hypertension, diabetes, and dyslipidemia, and to identify factors associated with these disparities. METHODS: Analysis of nationally representative data collected from employed persons participating in the National Health and Nutrition Examination Survey 1999 to 2002, with sub-analyses by race and ethnicity. RESULTS: Mexican-American workers are less likely than non-Hispanic whites to be aware of their hypertension (odds ratio [OR] = 0.60; 95% confidence interval [CI] = 0.39-0.94) and less likely to be treated (OR = 0.45; 95% CI = 0.23-0.85); less likely to be aware (OR = 0.56; 95% CI = 0.33-0.93) and treated (OR = 0.33; 95% CI = 0.14-0.78) for dyslipidemia; and more likely to be aware of diabetes (OR = 3.01; 95% CI = 1.14-7.95). Non-Hispanic blacks treated for hypertension are less likely than whites to reach blood pressure goal (OR = 0.47; 95% CI = 0.33-0.66). Having a usual place of care is independently associated with awareness and treatment for hypertension, and treatment for dyslipidemia. CONCLUSION: Understanding cardiovascular health disparities in the workforce can help employers structure appropriate workplace screening and prevention programs.     

2型糖尿病视网膜病变影响因素的巢式病例对照研究

目的 探讨2型糖尿病患者中糖尿病视网膜病变(diabetic retinopathy,DR)的影响因素.方法 以2013-2014年"社区糖尿病综合干预及应用项目"淮安市35岁以上2型糖尿病人群队列为基础,对其开展问卷调查、身体测量,实验室检测,并将随访期间发生DR的1 544人作为病例组,按照性别,年龄(±4岁)随机...     

Prevalence of self-rated visual impairment among adults with diabetes.

OBJECTIVES: This study estimated the prevalence of self-rated visual impairment among US adults with diabetes and identified correlates of such impairment. METHODS: Self-reported data from the 1995 Behavioral Risk Factor Surveillance System survey of adults 18 years and older with diabetes were analyzed. Correlates of visual impairment were examined by multiple logistic regression analysis. RESULTS: The prevalence of self-rated visual impairment was 24.8% (95% confidence interval [CI] = 22.3%, 27.3%). Among insulin users, multivariable-adjusted odds ratios were 4.9 (95% CI = 2.6, 9.2) for those who had not completed high school and 1.8 (95% CI = 1.0, 2.8) for those who had completed high school compared with those with higher levels of education. Comparable estimates of odds ratios for nonusers of insulin were 2.2 (95% CI = 1.4, 3.4) and 1.3 (95% CI = 0.9, 2.0), respectively. Among nonusers, the adjusted odds for minority adults were 2.4 (95% CI = 1.0, 3.7) times the odds for non-Hispanic Whites. CONCLUSIONS: By these data, 1.6 million US adults with diabetes reported having some degree of visual impairment. Future research on the specific causes of visual impairment may help in estimating the avoidable public health burden.     

Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands.

OBJECTIVES: To determine the frequency of the metabolic syndrome (MS) among four subpopulations in the United States Virgin Islands and to estimate the risk for the MS that is associated with waist circumference cutpoints among overweight and obese individuals. METHODS: In a study undertaken from 1995 to 1999, data on demographic characteristics, anthropometric measurements, blood pressure measurements, and a blood sample were obtained from a population-based cohort of 893 Caribbean-born persons from four population subgroups who were living on Saint Croix (the largest island of the U.S. Virgin Islands) and who did not have a history of diagnosed diabetes. The four subpopulations were: (1) Hispanic white, (2) Hispanic black, (3) non-Hispanic black born in the U.S. Virgin Islands, and (4) non-Hispanic black born elsewhere in the Caribbean. Fasting blood samples were analyzed for glucose, insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C). National Cholesterol Education Program Adult Treatment Panel III guidelines were used to identify the MS. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR) method. RESULTS: The overall prevalence of the MS in the sample was 20.5% (95% confidence interval (CI) = 15.3%-25.7%). Persons who had classified themselves as both Hispanic and black had the highest frequency (27.8% (95% CI = 16.3%-39.3%)) of the MS and the highest HOMA-IR scores. After controlling for lifestyle factors and HOMA-IR, Hispanic ethnicity was independently associated with an increased risk of having the MS (odds ratio (OR) = 1.82, (95% CI = 1.07-3.07)), high triglycerides (OR = 3.66 (95% CI = 2.18-6.15)), and low HDL-C (OR = 1.60 (95% CI = 1.04-2.45)). A waist circumference of > 88 cm was associated with an increased risk of metabolic abnormalities among overweight and obese women. CONCLUSIONS: The frequency of the MS among Caribbean-born persons in the U. S. Virgin Islands is comparable to the frequency of the MS among the general population on the mainland of the United States. Among Caribbean-born persons living in the U.S. Virgin Islands, those who are Hispanic blacks may have a greater risk of cardiovascular disease than do other groups.     

Effectiveness of lifestyle modification programs for control of blood pressure: a non-randomized controlled trial in Komatsu, Japan

PURPOSE: A non-randomized controlled trial was conducted to evaluate the effectiveness of three lifestyle modification programs to reduce blood pressure: individual counseling only; counseling using group dynamics; and individual support using mail. METHODS: We enrolled men and women ages 20-69 with a systolic blood pressure (SBP) of 130-159 mmHg and/or a diastolic blood pressure of 85-99 mmHg (high-normal or mild hypertension). Participants were assigned to one of 4 groups: individual counseling (n = 134); group counseling (n = 79); mailing support (n = 127); and controls (with usual care) (n = 178). The three intervention programs included behavioral support for each person's lifestyle problems once a month for 6 months. Sex and age adjusted net blood pressure change (and 95% confidence intervals [CIs]) compared with the control group was calculated for each of the intervention groups. RESULTS: Net SBP change was the largest for the group counseling group: sex and age adjusted net SBP change was -6.5 mmHg (95% CI: -10.0, -3.0). Net SBP change for the mailing support group was also significant (-4.3 mmHg [95% CI: -7.3, -1.3]). Net SBP change for the individual counseling group was -2.5 mmHg (95% CI: -5.5, 0.5). Looking at the results separately by sex, net SBP reduction was also largest in women of the group counseling group, whereas improvement in men was similar among 3 groups (approximately 4 mmHg). Body weights were reduced by about 1 kg in all 3 groups. CONCLUSIONS: Lifestyle modification programs using group dynamics or using individual support by mail, in addition to individual behavioral support, appear to be effective for blood pressure reduction. Group counseling may be more effective in women.     

Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence

BACKGROUND: Observational evidence suggests that having been breastfed in infancy may reduce the prevalence of type 2 diabetes in later life. OBJECTIVE: The objective was to examine the influence of initial breastfeeding on type 2 diabetes and blood glucose and insulin concentrations. DESIGN: A systematic review of published studies identified 1010 reports; 23 examined the relation between infant feeding and type 2 diabetes in later life or risk factors for diabetes. Risk factors in infants were examined separately from those in children and adults. All estimates were pooled by using fixed-effect models; differences <0 and ratios <1 imply a beneficial effect of breastfeeding. RESULTS: Subjects who were breastfed had a lower risk of type 2 diabetes in later life than did those who were formula fed (7 studies; 76 744 subjects; odds ratio: 0.61; 95% CI: 0.44, 0.85; P = 0.003). Children and adults without diabetes who had been breastfed had marginally lower fasting insulin concentrations than did those who were formula fed (6 studies; 4800 subjects; percentage difference: -3%; 95% CI: -8%, 1%; P = 0.13); no significant difference in fasting glucose concentrations was observed. Breastfed infants had lower mean preprandial blood glucose (12 studies; 560 subjects; mean difference: -0.17 mmol/L; 95% CI: -0.28, -0.05 mmol/L; P = 0.005) and insulin (7 studies; 291 subjects; mean difference: -2.86 pmol/L; 95% CI: -5.76, 0.04 pmol/L; P = 0.054) concentrations than did those who were formula fed. CONCLUSION: Breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations in later life, and with lower blood glucose and serum insulin concentrations in infancy.     

江苏省成人脂质蓄积指数与高血压和糖尿病患病风险关系的研究

目的 探讨成人脂质蓄积指数（lipid accumulation product,LAP）与高血压、糖尿病患病风险的关系。方法 利用江苏省2013年成人慢性病及其危险因素监测数据进行分析,采用方差分析和多因素Logistic回归模型研究LAP与血压、血糖、高血压和糖尿病患病风险的关系,利用受试者工作特征（receiver operating characteristics,ROC）曲线评估LAP、体重指数（body mass index,BMI）和腰围（waist circumference,WC）对高血压、糖尿病罹患风险的预测作用。结果 不同LAP组间血压、血糖水平差异均有统计学意义（均有P<0.05）。男性和女性的高血压、糖尿病患病风险均随着LAP水平升高而增加（均有P<0.05）,与低LAP水平组相比,男性和女性高LAP水平组的高血压患病风险分别增加3.65倍（95%CI:3.74~5.78）和3.52倍（95%CI:3.70~5.53）,糖尿病患病风险分别增加2.71倍（95%CI:2.83~4.87）和3.37倍（95%CI:3.32~5.77）。在女性中,ROC曲线分析显示,LAP预测高血压和糖尿病风险的曲线下面积（area under curve,AUC）值为0.70和0.69,均高于BMI和WC（均有P<0.05）。结论 LAP与血压、血糖密切相关,高血压、糖尿病患病风险随着LAP的增加而升高。     

Prevalencia y factores de riesgo asociados a la retinopatía diabética en Santander. Norte de España

ObjetiveTo assess the prevalence and risk factors associated with diabetic retinopathy (DR) in Cantabria.Designross-sectional population based study.LocationHealth center of Cantabria.ParticiantsA random sample of 442 patients with type 2 diabetes.Main measurementsNon-mydiatric retinography, classifying them according to the International Clinical Diabetic Retinopathy Disease Severity Scale. The analyzed risk factors were: age, gender, age at diabetes onset, duration of diabetes, glycated haemoglobin levels (A1C), treatment of diabetes, blood pressure (systolic and diastolic), serum lipids concentration, body mass index, smoking status, hematocrit, pregnancy, serum vitamin D (25 OH D) levels, nephropathy and cardiovascular events.ResultsThe prevalence of DR was 8.56% (CI: 5.81-11.32): Mild non-proliferative DR: 5.07% (CI: 2.89-7.25); Moderate non-proliferative DR: 1.38% (CI: 0.17-2.60); Severe non-proliferative DR: 0.27% (CI: 0.006-1.28); proliferative DR: 1.84% (CI: 0.46-3.22). Diabetic macular oedema: 2.30% (CI: 0.77-3.83). Mean age: 70 years, mean diagnostic age: 58.97 years, mean body mass index 29.86, 78.40% patients with hypertension, 67.30% dyslipidemia and median A1C: 6.7%. A deficit of 25 (OH) D was identified in 77% of patients. In the multivariate analysis, treatment of type 2 diabetes, body mass index, duration of diabetes and metabolic control of glycaemia were identified as independent risk factors.ConclusionsThe prevalence of DR, compared with former studies, has decreased to 8.56%; this decrease is associated with the improvement in the control of modifiable risk factors. The associated independent risk factors were: treatment, body mass index, duration and control of diabetes. The variables antihypertensive treatment, cardiovascular events and nephropathy showed predictive value for DR.     

Association of obesity and chronic diseases in Taiwan

Two systems were used to classify weight status based on body mass index (BMI) of 3,178 Taiwanese adults who participated in the 1993-1996 Nutrition and Health Survey and to explore associations of BMI categories and disease. In the system proposed by the International Association for the Study of Obesity and the International Obesity Taskforce for Asian adults, overweight was associated with one disease (hypertension) and obesity was associated with four diseases: diabetes (OR = 2.66; 95% CI = 1.39-5.09; p < 0.01); gout (OR = 4.33; 95% CI = 1.92-9.75; p < 0.01); hypertension (OR = 4.92; 95% CI = 2.87-8.42; p < 0.01); thyroid disease (OR = 2.29; 95% CI = 1.12-4.67; p < 0.05). In the system devised by Taiwan Health Department for Taiwanese adults, overweight was associated with four diseases (arthritis, diabetes, gout, hypertension), and obesity was associated with three diseases: diabetes (OR = 2.11; 95% CI = 1.07-4.19; p < 0.05); gout (OR = 4.06; 95% CI = 1.77-9.28; p < 0.01); hypertension (OR = 5.28; 95% CI = 3.23-8.63; p < 0.01). The Obesity Taskforce may underestimate the association of excess weight and disease in Taiwan.     

Life-style factors and risk for abdominal aortic aneurysm in a cohort of Finnish male smokers

Prospective studies evaluating risk factors for abdominal aortic aneurysm are few. We studied the association of life-style factors with risk for abdominal aortic aneurysm among 29,133 male smokers 50-69 years of age, participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. During a mean follow-up of 5.8 years, 181 were diagnosed with ruptured abdominal aortic aneurysm or nonruptured abdominal aortic aneurysm plus aneurysmectomy. Risk for abdominal aortic aneurysm was positively associated with age [relative risk (RR) = 4.56, 95% confidence interval (CI) = 2.42-8.61 for > 65 vs < or = 55 years], smoking years (RR = 2.25, 95% CI = 1.33-3.81 for > 40 vs < or = 32 years), systolic blood pressure (RR = 1.92, 95% CI = 1.13-3.25 for > 160 vs < or = 130 mmHg), diastolic blood pressure (RR = 1.80, 95% CI = 1.05-3.08 for > 100 vs < or = 85 mmHg), and serum total cholesterol (RR = 1.85, 95% CI = 1.09-3.12 for > 6.5 vs < or = 5.0 mmol/liter). High-density lipoprotein cholesterol showed a strong inverse association with risk for aortic aneurysm (RR = 0.16, 95% CI = 0.08-0.32 for > 1.5 vs < or = 0.9 mmol/liter). High energy intake was associated with lower risk for aortic aneurysm (RR = 0.59, 95% CI = 0.38-0.94 for the highest quartile vs the lowest), whereas no associations with nutrients were evident. We conclude that classical risk factors for atherosclerotic diseases seem to be important in pathogenesis of large abdominal aortic aneurysms.     

Increases in hypertension and blood pressure during pregnancy with increased bone lead levels

Prior studies have revealed associations of current lead exposure (blood lead) and past lead exposure (bone lead) with risks of hypertension and elevated blood pressure. The authors examined the effects of blood and bone lead on hypertension and elevated blood pressure in the third trimester and postpartum among 1,006 women enrolled in Los Angeles prenatal care clinics between 1995 and 2001. The authors measured bone lead concentration by K-shell x-ray fluorescence in the tibia (mean = 8.0 micro g/g (standard deviation (SD) 11.4)) and calcaneus (heel) (mean = 10.7 micro g/g (SD 11.9)). Geometric mean prenatal and postnatal blood lead levels were 1.9 micro g/dl (geometric SD +3.6/-1.0) and 2.3 micro g/dl (geometric SD +4.3/-1.2), respectively. For each 10- micro g/g increase in calcaneus bone lead level, the odds ratio for third-trimester hypertension (systolic blood pressure > or =140 mmHg or diastolic blood pressure > or =90 mmHg) was 1.86 (95% confidence interval (CI): 1.04, 3.32). In normotensive subjects, each 10- micro g/g increase in calcaneus bone lead level was associated with a 0.70-mmHg (95% CI: 0.04, 1.36) increase in third-trimester systolic blood pressure and a 0.54-mmHg (95% CI: 0.01, 1.08) increase in diastolic blood pressure. Tibia bone lead concentration was not related to hypertension or elevated blood pressure either in the third trimester or postpartum, nor was calcaneus bone lead related to postpartum hypertension or elevated blood pressure. Past lead exposure influences hypertension and elevated blood pressure during pregnancy. Controlling blood pressure may require reduction of lead exposure long before pregnancy.