Lipoprotein abnormalities are associated with insulin resistance in South Asian Indian women

South Asian Indians are at increased risk of coronary heart disease (CHD), possibly related to dyslipidemia characterized by high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations. The importance of differences in insulin resistance as compared to abdominal obesity in the development of this atherogenic lipoprotein profile is not clear, and the current cross-sectional study was initiated to examine this issue. Consequently, we defined the relationship between differences in insulin-mediated glucose uptake (IMGU), abdominal obesity, and various measures of lipoprotein metabolism known to increase CHD risk in 52 apparently healthy women of South Asian Indian ancestry. IMGU was quantified by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test and abdominal obesity was assessed by measurement of waist circumference (WC), and the population was divided into tertiles on the basis of their SSPG results. Results indicated that although there were significant differences in SSPG, TG, and HDL-C values, there were no differences in age, blood pressure, total cholesterol, low-density lipoprotein cholesterol, body mass index, or WC between the highest and lowest tertiles. SSPG concentrations were significantly correlated with both log TG (r = 0.44, P = .001) and HDL-C (r = -0.44, P < .001) concentration, whereas TG and HDL-C concentrations were not significantly related to WC. Furthermore, the relationships between SSPG concentration and TG and HDL-C remained significant when adjusted for age and WC. Finally, a more extensive lipoprotein analysis indicated that the most insulin resistant tertile had higher TG concentrations, lower concentrations of HDL-C and HDL-C subclasses, and smaller and denser low-density lipoprotein particles than the most insulin sensitive tertile, despite the 2 groups not being different in age, BMI, or WC. These results indicate that a highly atherogenic lipoprotein profile seen in South Asian Indian women is significantly associated with insulin resistance independent of differences in WC.     

Long-term intake of dietary fiber and decreased risk of cholecystectomy in women

BACKGROUND: Epidemiologic studies on the relationship between dietary fiber and gallstone disease are inconclusive, and the effects of different types of dietary fiber are not clear. METHODS: We examined the association between long-term intake of dietary fiber as well as fiber from different sources and risk of cholecystectomy in a cohort of 69,778 women who were aged from 35 to 61 years in 1984 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every two years both their fiber intake and whether they had undergone cholecystectomy. RESULTS: During 16 yr of follow-up, we documented 5,771 cases of cholecystectomy. After adjusting for age and other known or suspected risk factors in a multivariate model, compared with women in the lowest quintile of total dietary fiber intake, the relative risk of choleystectomy for those in the highest quintile was 0.87 (95% CI, 0.78-0.96, p for trend = 0.005). For a 5-g increase in total fiber intake, the multivariate relative risk was 0.94 (95% CI, 0.90-0.98). Insoluble fiber, taking soluble fiber into account in the multivariate model, was significantly associated with a reduced risk. The multivariate relative risk was 0.83 (95% CI, 0.73-0.94, p for trend = 0.009) for insoluble fiber, and was 1.01 (95% CI, 0.89-1.15, p for trend = 0.9) for soluble fiber, when extreme quintiles were compared. For a 5-g increase in intake, the relative risk was 0.90 (95% CI, 0.84-0.97) for insoluble fiber, and was 1.01 (95% CI, 0.83-1.23) for soluble fiber. CONCLUSIONS: Our results suggest that increased long-term consumption of dietary fiber, particularly insoluble fiber, can reduce risk of cholecystectomy in women.     

Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals

A high scalp sensitivity to androgens is part of the pathophysiology of male-pattern baldness (MPB). Androgens affect established risk factors for coronary heart disease (CHD), and a supposedly heightened impact on these risk factors is hypothesized to explain the epidemiological association between MPB and CHD. In this retrospective, observational study we studied 81 female-to-male transsexual (F-->M) subjects, mean age 36.7 years (range 21-61), treated with testosterone esters (n=61; 250 mg i.m./2 weeks) or testosterone undecanoate (n=20; 160-240 mg/day orally). The degree of MPB was self-assessed using a 5-point scale (i.e. type I (no hair loss) to type V (complete hair loss)). Body mass index, blood pressure and levels of lipid and insulin were retrospectively assessed at the start of testosterone administration (0.5-24 years before) and between 3 and 4 months of follow-up. We found that 31 of 81 (38.3%) F-->M transsexuals had MPB type II-V. Thinning of hair was related to the duration of androgen administration and present in about 50% of F-->M transsexuals after 13 years. None of the CHD risk factors at follow-up, nor proportional changes, was associated with the degree MPB, except that there was an unexpected tendency of lower fasting glucose levels in balding subjects. Therefore, our findings do not support the idea that MPB serves as an indicator of increased CHD risk through androgenic effects on classic CHD risk factors.     

A prospective study of dietary fiber intake and risk of cardiovascular disease among women.

OBJECTIVES: This study was designed to examine the hypothesis that higher intake of dietary fiber is inversely related to the risk of cardiovascular disease (CVD) and myocardial infarction (MI) in a large prospective cohort of women. BACKGROUND: Although dietary fiber has been suggested to reduce the risk of coronary disease, few prospective studies have examined the association between the types and amounts of dietary fiber and CVD risk, particularly among women. METHODS: In 1993, we used a semi-quantitative food frequency questionnaire to assess dietary fiber intake among 39,876 female health professionals with no previous history of CVD or cancer. Women were subsequently followed for an average of six years for incidence of nonfatal MI, stroke, percutaneous transluminal coronary angioplasty, coronary artery bypass graft or death due to CVD confirmed by medical records or death certificates. RESULTS: During 230,006 person-years of follow-up, 570 incident cases of CVD were documented, including 177 MIs. After adjustment for age and randomized treatment status, a significant inverse association was observed between dietary fiber intake and CVD risk. Comparing the highest quintile of fiber intake (median: 26.3 g/day) with the lowest quintile (median: 12.5 g/day), the relative risks (RR) were 0.65 (95% confidence interval [CI]: 0.51, 0.84) for total CVD and 0.46 (95% CI: 0.30, 0.72) for MI. Additional adjustment for CVD risk factors reduced the RRs to 0.79 (95% CI: 0.58, 1.09) for total CVD and 0.68 (95% CI: 0.36, 1.22) for MI. The inverse trends across categories generally remained, although they were no longer statistically significant. Inverse relations were observed between both soluble and insoluble fiber and risk of CVD and MI, and among those who had never smoked and those with body mass index <25. CONCLUSIONS: A higher intake of dietary fiber was associated with a lower risk of CVD and MI, although the association was not statistically significant after further adjusting for multiple confounding factors. Nevertheless, these prospective data generally support current dietary recommendations to increase the consumption of fiber-rich whole grains and fruits and vegetables as a primary preventive measure against CVD.     

Coronary artery disease in premenopausal Indian women: risk factors and angiographic profile.

Coronary angiographic and clinical profile of 47 premenopausal women presenting with myocardial infarction (MI) or angina is presented. Seventeen patients (36%) had significant obstructive coronary artery disease (CAD) (Group I), while 30 (64%) had normal coronaries (Group II). The latter group included 4 who had MI and 26 who presented with angina. Risk factors in Group I included hypertension (53%), diabetes mellitus (24%), hypercholesterolemia (29%), oral contraceptives and a positive family history (11.8%). Frequency of one, two and three vessel disease was 47%, 18% and 35% respectively. The left anterior descending artery was most commonly affected (82%). In Group II the risk factors included hypertension (17%) and diabetes (7%). No patient in either group was a smoker. This analysis shows that significant obstructive CAD in premenopausal Indian females is more commonly associated with hypertension, diabetes and hypercholesterolemia. Smoking was not encountered and ingestion of contraceptive pills is uncommon.     

Smoking and sugar intake are separate but interactive risk factors in Crohn's disease.

Previous studies have consistently found strong positive associations between refined sugar intake and Crohn's disease (CD) and recently between smoking and CD. As refined sugar intake and smoking are themselves associated we have enquired about smoking and added sugar intake (AS) and smoking in CD using a postal questionnaire sent to 104 CD patients and 153 community controls. Smoking and AS were associated with one another. After adjusting for AS, smoking showed a significant association with CD with a relative risk of 1.8. After adjusting for smoking habit, AS was also strongly associated with CD in never and exsmokers and in a dose response pattern, with the relative risks for no AS, less than 50 g/day and greater than 50 g/day being respectively 1.0, 1.8, and 4.6 (chi 2 = 12.1; p less than 0.005). No association between CD and AS was evident in smokers. The AS relationship was supported by a separate association between frequency of confectionery consumption and CD. These findings indicate that while smoking and AS are individually associated with CD combined exposure results in no further increase in risk, suggesting that they may operate through a common mechanism.     

Relation of omega-3 Fatty Acid intake to other dietary factors known to reduce coronary heart disease risk

Data supporting the inverse correlation of fish or long-chain omega-3 fatty acid (FA) (eicosapentaenoic acid plus docosahexaenoic acid) supplement consumption and coronary heart disease are inconclusive and may be confounded by other dietary and lifestyle factors. Using the Diabetic Control and Complications Trial (DCCT) database (n = 1,441), correlations between consumption of omega-3 FAs and saturated FAs to dietary variables (kilocalories, macronutrients, sodium, and cholesterol) and to age, gender, exercise level, and tobacco use were tested using Pearson correlation coefficients. Long-chain omega-3 FA intake inversely correlated with consumption of calories (r = -0.16, p <0.0001), percent calories from total fat (r = -0.14, p <0.0001), and percent calories from saturated FAs (r = -0.21, p <0.0001) and directly with dietary fiber intake (grams per 1,000 kcal, r = 0.20, p <0.0001). In the DCCT database, long-chain omega-3 FAs (i.e., fish consumption) inversely correlated with an overall low risk nutritional profile for coronary heart disease. In conclusion, these findings provide evidence that associations observed in studies suggesting a benefit of fish or long-chain omega-3 FAs may be due to a convergence of greater fish intakes with an overall healthier dietary pattern rather than with a specific effect of long-chain omega-3 FAs.     

Relationship of psychosocial factors to HIV risk among Haitian women.

This study describes the prevalence of HIV risk behaviors among low-income, Haitian women, identifies theoretically relevant mediating psychosocial HIV risk predictors, and provides formative data for developing culturally and gender sensitive interventions for this distinctive, high risk, and understudied population. Confidential interview surveys were administered to 101 women of Haitian descent while they awaited their medical appointments at a local low-income, community medical clinic. Moderately high levels of sexual risk behavior (i.e., unprotected sex with nonmonogamous partners; multiple lifetime partners) were reported. On average, these women reported a belief in their HIV susceptibility, relatively little HIV-related anxiety, somewhat inadequate levels of communication regarding safer sex practices, and lack of adequate confidence in their ability to negotiate safer behaviors in sexual encounters. Both personal and partner condom attitudes were unfavorable and these attitudes predicted condom use levels. It was concluded that interventions need to be developed for Haitian women to improve their attitudes toward condom use and their confidence in negotiating safer sexual practices. However, these interventions cannot be developed in a vacuum. Although it is crucial to consider the woman's individual attitudes and behaviors, it is also important to consider the male partner's attitudes toward sex and the woman's relationship with her male partner within the context of Haitian culture. Only by determining and targeting important potential motivations for safe sex within the cultural context can we most effectively reduce HIV sex risk behavior in Haitian women.     

Multiple micronutrient supplementation and dietary energy intake in pregnant women

OBJECTIVE: To compare dietary intake of women supplemented with multiple micronutrients (MM) or iron only during pregnancy. MATERIALS AND METHODS: Design: Randomized, double-blind, controlled community-based trial. Setting: One semi-urban community in Central Mexico. Subjects: Pregnant women identified before week 13 of pregnancy, willing to provide informed consent. Interventions: Women were randomly assigned to receive daily supplementation with MM or iron only from recruitment until delivery. Supplements were delivered to the participants' home and compliance observed daily. Dietary intake was assessed by repeat 24-hr recall. Data were analyzed using non-parametric tests and multiple regression analysis to determine the impact of MM supplementation on dietary intake of energy and select micronutrients. RESULTS: During the third trimester, women in the MM group consumed more energy and iron from dietary sources than women in the iron only group. After adjustment for differences between the groups at baseline, women in the MM group consumed 111.3 kcal/day more (p<0.05) energy. The difference in iron intake was not significant after adjusting for the increase in energy intake. CONCLUSIONS: Women consuming MM supplements during pregnancy increased energy intake from dietary sources without a concurrent increase in micronutrient density. Future studies should include measures of appetite and physical activity during pregnancy to determine the implications of additional energy intake for weight gain and retention.     

Dietary protein intake and risk of stroke in women

BackgroundA high protein intake may reduce the risk of stroke but epidemiologic data on protein intake in relation to stroke risk are limited and inconsistent. Our objective was to test the hypothesis that protein intake would be inversely associated with risk of stroke.Methods and resultsWe conducted a population-based prospective cohort study consisting of 34,670 Swedish women who were free of cardiovascular disease and cancer in 1997. Diet was assessed with a food-frequency questionnaire. Incident cases of stroke were ascertained from the Swedish Hospital Discharge Registry. We estimated relative risks (RR) with 95% confidence intervals (CI) using Cox proportional hazard regression model. During 10.4 years of follow-up, 1680 stroke events were identified, including 1310 cerebral infarctions, 154 intracerebral hemorrhages, 79 subarachnoid hemorrhages, and 137 unspecified strokes. Intake of total and animal protein, but not vegetable protein, was statistically significantly inversely associated with risk of total stroke and cerebral infarction after adjustment for other risk factors for stroke. The multivariable RRs of total stroke for the highest versus lowest quintile of intake were 0.74 (95% CI: 0.61, 0.91; P for trend = 0.006) for total protein and 0.71 (95% CI: 0.57, 0.88; P for trend = 0.01) for animal protein. The associations were stronger in women with a history of hypertension (RR of total stroke = 0.56; 95% CI: 0.40, 0.78 for highest versus lowest quintile of total protein).ConclusionThese findings suggest that dietary protein intake is inversely associated with risk of stroke in women with hypertension.     

A preliminary study of dietary aluminium intake and risk of Alzheimer's disease.

BACKGROUND: epidemiological studies of Alzheimer's disease and aluminium intake have focused on aluminium in drinking water. There have been no studies investigating the relation between the disease and the consumption of foods containing large amounts of aluminium additives. OBJECTIVES: to conduct a pilot study to determine whether dietary intake of aluminium additives differs in individuals with and without Alzheimer's disease. DESIGN: matched case-control study. Controls were matched to cases on age, gender and date of admission to the centre. SETTING: Syracuse, New York, USA. SUBJECTS: 46 participants comprising 23 matched sets. METHODS: residents of the Loretto Geriatric Center with and without newly-diagnosed Alzheimer's disease were selected. Next-of-kin were asked to complete information on the resident's medical history, lifestyle behaviour and dietary intake before admission to the centre. An expanded form of the Health Habits and History Questionnaire was used to determine dietary intake. Consumption of foods containing elevated levels of aluminium additives was compared between cases and controls. RESULTS: the crude odds ratio for daily intake of foods containing high levels of aluminium was 2.0 and, when adjusted for covariates, was 8.6 (P=0.19). Intake of pancakes, waffles, biscuits, muffins, cornbread and/or corn tortillas differed significantly (P=0.025) between cases and controls. Adjusted odds ratios were also elevated for grain product desserts, American cheese, chocolate pudding or beverages, salt and chewing gum. However, the odds ratio was not elevated for tea consumption. CONCLUSION: past consumption of foods containing large amounts of aluminium additives differed between people with Alzheimer's disease and controls, suggesting that dietary intake of aluminium may affect the risk of developing this disease. Larger studies are warranted to corroborate or refute these preliminary findings.     

Lipoprotein lipase gene HindIII polymorphism and risk of myocardial infarction in South Indian population

IntroductionStudies have reported an association between lipoprotein lipase (LPL) gene and myocardial infarction in some populations. Therefore, the present study aimed to investigate the association of the HindIII polymorphism of the (LPL) gene with myocardial infarction and to explore its potential role in susceptibility in a South Indian population.Subjects and methodsWe included a total of 412 subjects (202 myocardial infarction patients and 210 age- and sex-matched controls). Demographic and clinical characteristics were collected. Lipid profiles were estimated. DNA was isolated and the LPL gene HindIII polymorphism was determined by polymerase chain reaction.ResultsComparison of the lipid profiles between patients and controls showed that patients had statistically high significant values (p = 0.0001). The H⁺ H⁺ genotype of the LPL gene is associated with myocardial infarction. H⁺ H⁺ vs. H^? H^? was χ2 = 19.4, OR 3.1, CI 95% 1.8–5.2, p < 0.0001.ConclusionOur study strongly suggests that the LPL gene HindIII Hþ Hþ genotype is an independent risk factor for first MI.