Publications by authors named "Carrie A Karvonen-Gutierrez"

52 Publications

Markers of Low Iron Status Are Associated with Female Athlete Triad Risk Factors.

Med Sci Sports Exerc 2021 Mar 12. Epub 2021 Mar 12.

University of Michigan Medical School, Ann Arbor, MI Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.

Purpose: The Female Athlete Triad (Triad) is common in female athletes. The Triad is caused by low energy availability (EA), which is often difficult to measure and has been postulated to be associated with low iron status. Here, we explore whether markers of low iron status may be associated with indicators of low EA including Triad risk factors.

Methods: 239 female NCAA Division I athletes completed pre-participation examinations that included Triad risk factors, medication/supplement use, diagnosis of anemia, and elected to complete dual-energy x-ray absorptiometry scan to measure bone mineral density (BMD). Association of markers of low iron (defined as self-report of iron supplementation and/or history of anemia) with each component of the Triad risk assessment score were assessed by stratifying low iron status across different levels of Triad risk category. Differences across iron status groups were assessed using Fisher exact testing.

Results: Every component of the Triad risk assessment score excluding delayed menarche was associated with low iron status. 11.5% of women reported low iron in the low-risk EA group, compared to 50% in the moderate-risk and 66.7% in the high-risk EA groups (P=0.02); respectively, these numbers were 11.6%, 25.0%, and 66.7% (P=0.02) for body mass index, 9.7%, 16.7%, and 25.0% (P<0.05) for oligomenorrhea, 10.3%, 45.5%, and 50.0% (P<0.01) for BMD, and 10.4%, 20.8%, and 30.8% (P=0.03) for history of stress reaction or fracture. Lean/endurance athletes were more likely to have low iron status than other athletes (15.5% vs. 3.4%, P=0.02).

Conclusion: Markers for low iron status were associated with Triad risk factors. Our study suggests that female athletes with history of anemia or iron supplementation may require further screening for low EA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1249/MSS.0000000000002660DOI Listing
March 2021

Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women's Health Across the Nation.

Sleep 2021 Mar 11. Epub 2021 Mar 11.

Division of Research, Kaiser Permanente Northern California.

Study Objectives: Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function.

Methods: We utilized data from 1627 Study of Women's Health Across the Nation (SWAN) participants, aged 61.9±2.7 y at the end of the 13-y follow-up. Latent class growth models identified trajectories of insomnia symptoms (trouble falling asleep, frequent night-time awakenings, and/or early-morning awakening) and sleep duration over 13 y. Physical function tests were performed at the end of the 13-y period: 40-ft walk, 4-m walk, repeated chair stand, grip strength, and balance. Multivariable regression analyses examined each physical function measure according to the insomnia symptom or sleep duration trajectory group.

Results: Five insomnia symptom trajectories and two sleep duration trajectories were identified. Women with a consistently high likelihood of insomnia symptoms and women with a decreased likelihood of insomnia symptoms (i.e., improving) had slower gait speed (3.5% slower 40-ft walk [consistently high], 3.7% slower 4-m walk [improving]; each P≤.05) than those with a consistently low likelihood of insomnia symptoms. In contrast, women with a steep increase in the likelihood of insomnia symptoms over time and women with persistent insufficient sleep duration had lower odds of having a balance problem (odds ratio [OR]=0.36 and OR=0.61, respectively; each P<.02) compared to those with a consistently low likelihood of insomnia symptoms and those with persistent sufficient sleep duration, respectively.

Conclusion: These results suggest that women's sleep during midlife has important implications for maintaining physical function during the transition into older adulthood.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsab059DOI Listing
March 2021

Symptom clusters predict risk of metabolic-syndrome and diabetes in midlife: the Study of Women's Health Across the Nation.

Ann Epidemiol 2021 Feb 22;58:48-55. Epub 2021 Feb 22.

Epidemiologic Science, School of Public Health, University of Michigan, Ann Arbor, MI; Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.

Purpose: Women's cardio-metabolic risk increases in midlife. Previous work relating menopause symptoms to diabetes/Metabolic Syndrome (MetS) does not consider the adverse impact of multiple concurrent physical and psychological symptoms in midlife.

Methods: Data are from 3097 participants in the Study of Women's Health Across the Nation, a cohort of midlife women followed for over 20 years. Baseline latent symptom classes (LSC) were derived from 58 questions assessing physical, psychological and menopausal symptoms. Six identified LSCs ranged from 1 (most symptoms present at high severity) to 6 (few symptoms present at low severity). Accelerated failure time models estimated time to onset of type 2 diabetes and MetS for each LSC.

Results: Women with multiple high/moderate severity symptoms had an earlier onset of diabetes (13.2%, 14.1% and 20.8% earlier onset in LSCs 1, 2, 3, respectively) and MetS (15.5%, 13.0% and 19.7% earlier onset in LSCs 1, 2, 3, respectively) than women with few/low severity symptoms.

Conclusions: Having multiple concurrent moderate to high intensity physical and psychological symptoms in midlife are associated with early onset of diabetes and MetS. Monitoring and subsequent intervention on a broad range of symptoms in midlife may significantly mitigate cardio-metabolic risk during this critical life stage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2021.02.011DOI Listing
February 2021

Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women.

J Aging Health 2021 Jan 31:898264320988405. Epub 2021 Jan 31.

9968University of Alabama at Birmingham, Birmingham, AL, USA.

Physical activity (PA) may slow aging-related declines in physical functioning (PF), but the relationship of PA and falls is not well understood. This study examined the association of PA and PF with falls. The Study of Women's Health Across the Nation participants ( = 1597; age: 65.1 years ± 2.7) reported PF and PA in 2012-2013 and falls in 2016-2017. Four phenotypes were identified: high PA-high PF, high PA-low PF, low PA-high PF, and low PA-low PF. One-third (29.3%) reported ≥1 fall. Women with low PA-low PF (RR = 1.32; 95% CI: 1.06, 1.66) and with high PA-low PF (RR = 1.37; 95% CI: 1.07, 1.74) were more likely to fall than high PA-high PF. Over time, women with worsening PF had increased fall risk (RR = 1.43; 95% CI: 1.17, 1.74), but women who increased PA did not. Poor PF increases the risk of falls, regardless of PA. However, increasing PA does not necessarily increase fall risk, reinforcing the importance of PA engagement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0898264320988405DOI Listing
January 2021

The Appropriateness of Digital Diabetic Retinopathy Screening Images for a Computer-Aided Glaucoma Screening System.

Clin Ophthalmol 2020 16;14:3881-3890. Epub 2020 Nov 16.

Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA.

Purpose: The purpose of this study was to evaluate the ability to screen for glaucoma using a Food Drug Administration (FDA) Class II diagnostic digital fundus photography system used for diabetic retinopathy screening (DRS).

Methods: All research participants underwent a comprehensive eye examination as well as non-mydriatic 45°single photograph retinal imaging centered on the macula. Optic nerve images within the 45° non-mydriatic and non-stereo DRS image were evaluated by two methods: 1) grading by three glaucoma specialists, and 2) a computer-aided automated segmentation system to determine the vertical cup-to-disc ratio (VCDR). Using VCDR from clinical assessment as gold standard, VCDR results from two methods were compared to that from clinical assessment. Inter-grader agreement was assessed by computing intraclass correlation coefficient (ICC). In addition, sensitivity and specificity were calculated.

Results: Among 245 fundus photos, 166 images met quality specifications for analysis. Fifty images were not processed by the automated system due to the poor quality of the optic disc, and 29 images did not include the optic nerve head due to the patient movement during the photo acquisition. The ICC value for the VCDR between the gold standard clinical exam and the automated system was 0.41, indicating fair agreement. The ICC value between the three ophthalmologists and the gold standard was 0.51, 0.56, and 0.69, respectively, indicating fair to moderate agreement.

Discussion: Assessing the VCDR on non-mydriatic and non-stereo DRS fundus photographs by either the computer-aided automated segmentation system or by glaucoma specialists showed similar fair to moderate agreement. In summary, optic nerve assessment for glaucoma from these 45° non-mydriatic and non-stereo DRS images is not yet suitable for tele-glaucoma screening.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S273659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678698PMC
November 2020

Urinary metals and adipokines in midlife women: The Study of Women's Health Across the nation (SWAN).

Environ Res 2020 Nov 4:110426. Epub 2020 Nov 4.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA. Electronic address:

Background: Information on the associations between metal exposures and adipokines in human populations is limited and results are inconsistent. We evaluated the associations between metals and adipokines.

Methods: Urinary concentrations of 15 metals (arsenic, barium, cadmium, cobalt, cesium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, tin, thallium, and zinc) were measured in 1999-2000 among 1228 women of the Study of Women's Health Across the Nation Multi-Pollutant Study. Serum adipokines including high molecular weight (HMW)-adiponectin, leptin, and soluble leptin receptor (sOB-R) were measured at the follow-up visit (2002-2003). Linear regression models with adaptive elastic-net (AENET) were fit to identify metals associated with adipokines and to compute estimated percent changes in adipokines for one standard deviation increase in log-transformed urinary metal concentrations.

Results: After adjustment for confounders, urinary molybdenum was associated with a 5.54% higher level (95% CI: 1.36%, 9.90%), whereas cadmium was associated with a 4.53% lower level (95% CI: -8.17%, -0.76%) of HMW-adiponectin. Urinary molybdenum was also associated with a 5.95% lower leptin level (95% CI: -10.15%, -1.56%) and a 2.98% (95% CI: 0.69%, 5.32%) higher sOB-R level. Urinary cesium and lead were associated with a 3.58% (95% CI: -6.06%, -1.03%) and a 2.53% (95% CI: -4.80%, -0.21%) lower level of sOB-R, respectively.

Conclusions: Our findings suggest that molybdenum was associated with favorable profiles of HMW-adiponectin, leptin, and sOB-R. Exposures to cadmium, cesium, and lead were associated with adverse adipokine profiles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envres.2020.110426DOI Listing
November 2020

Urinary metal mixtures and longitudinal changes in glucose homeostasis: The Study of Women's Health Across the Nation (SWAN).

Environ Int 2020 12 12;145:106109. Epub 2020 Sep 12.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States. Electronic address:

Background: Epidemiologic studies on associations between metals and insulin resistance and β-cell dysfunction have been cross-sectional and focused on individual metals.

Objective: We assessed the association of exposure to metal mixtures, based on assessment of 15 urinary metals, with both baseline levels and longitudinal changes in homeostatic model assessments for insulin resistance (HOMA-IR) and β-cell function (HOMA-β).

Methods: We examined 1262 women, aged 45-56 years at baseline (1999-2000), who were followed through 2015-2016, from the Study of Women's Health Across the Nation. Urinary concentrations of 15 metals (arsenic, barium, cadmium, cobalt, cesium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, tin, thallium, and zinc) were determined at baseline. HOMA-IR and HOMA-β were repeatedly measured over 16 years of follow-up. A two-stage modeling was used to account for correlations in dependent and independent variables: In stage-1, linear mixed effects models were used to estimate the participant-specific baseline HOMA levels from random intercepts and participant-specific rates of changes from random slopes. In stage-2, adaptive elastic-net (AENET) models were fit to identify components of metal mixtures associated with participant-specific baseline levels and rates of changes in HOMA-IR and HOMA-β, respectively. An environmental risk score (ERS) was used to integrate metal mixture effects from AENET results.

Results: In multivariable adjusted AENET models, urinary zinc was associated with higher HOMA-IR at baseline, whereas molybdenum was associated with lower HOMA-IR at baseline. The estimated changes in baseline HOMA-IR for one standard deviation increase in log-transformed urinary metal concentrations were 5.76% (3.05%, 8.55%) for zinc and -3.25% (-5.45%, -1.00%) for molybdenum, respectively. Urinary zinc was also associated with lower HOMA- β at baseline. Arsenic was associated with a slightly faster rate of decline in HOMA-β in the AENET model evaluating associations between metals and rate of changes. Significant associations of ERS with both HOMA-IR and HOMA-β at baseline were observed. ERS for the rate of changes was not calculated and examined in relation to rates of changes in HOMA-IR and HOMA-β because only a single metal was selected by AENET.

Conclusion: Exposure to metal mixtures may be exerting effects on insulin resistance and β-cell dysfunction, which might be mechanisms by which metal exposures lead to elevated diabetes risks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.106109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577932PMC
December 2020

The urgent need for disability studies among midlife adults.

Womens Midlife Health 2020 28;6. Epub 2020 Aug 28.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N Bellefield Avenue, Suite 300, Pittsburgh, PA 15213 USA.

Issues of poor physical functioning and disability are burdensome for midlife adults and evidence suggests that the prevalence of these conditions is increasing temporally. Physical functioning during the midlife period, however, may be highly amendable to intervention given the highly dynamic nature of functioning during this life stage. Thus, efforts to improve or forestall poor physical functioning and/or disability during midlife may not only improve the health status and quality of life for midlife adults but may have important ramifications on the health of these individuals who will become older adults in the future. This thematic series on women and disability includes contributions addressing issues of person, place and time with respect to disability in midlife and into late adulthood. The purpose of this commentary is to provide a summary overview of the major themes of the series and to offer insight into areas of most promise for intervention among midlife populations to improve physical functioning and prevent disability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40695-020-00057-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453534PMC
August 2020

Midlife falls are associated with increased risk of mortality in women: Findings from the National Health and Nutrition Examination Survey III.

Arch Gerontol Geriatr 2020 Jul 25;91:104206. Epub 2020 Jul 25.

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States.

Objectives: Falls are a public health concern for older adults but are also common among midlife adults. However, the consequences of falls occurring during midlife are not well understood.

Methods: This investigation assessed the relationship between falls and mortality among midlife adults using survey data from the Third National Health and Nutrition Examination Survey (n = 1,295), linked to the National Death Index. The relationship between recurrent falls (≥2 falls) in the past year and 10-year death rate was assessed using survey-weighted Cox regression.

Results: Nearly 20 % of adults who died within 10 years of their interview date were recurrent fallers at the time of interview. For women only, recurrent fallers had more than 4-fold increased hazard of death within 10 years compared to non-recurrent fallers (HR = 4.41; 95 % CI:2.24,8.68).

Conclusions: Findings suggest that midlife women are particularly vulnerable to adverse outcomes following recurrent falls. Fall prevention efforts should include efforts targeted at midlife women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.archger.2020.104206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854835PMC
July 2020

Urinary metals and incident diabetes in midlife women: Study of Women's Health Across the Nation (SWAN).

BMJ Open Diabetes Res Care 2020 07;8(1)

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA

Introduction: Environmental exposure to metals may play a role in the pathogenesis of diabetes; however, evidence from human studies is limited. We prospectively evaluated the associations of 20 urinary metal concentrations and their mixtures with incident diabetes in the Study of Women's Health Across the Nation, a multisite, multiethnic cohort study of midlife women.

Research Design And Methods: The sample included 1237 white, black, Chinese and Japanese-American women, aged 45-56 years, free of diabetes at baseline (1999-2000) who were followed through 2016. Concentrations of 20 metals (arsenic, barium, beryllium, cadmium, cobalt, chromium, cesium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, tin, thallium, uranium, vanadium, tungsten and zinc) were measured in urine specimens at baseline. Incident diabetes was identified annually by fasting glucose ≥126 mg/dL, self-reported doctor-diagnosed diabetes, or self-reported use of antidiabetic medications. A non-parametric clustering method, k-means clustering, was used to identify subgroups with different exposure patterns to metal mixtures.

Results: After multivariable adjustment, the HR (95% CI) for diabetes associated with each doubling increase in urinary metal concentrations was 1.19 (1.10 to 1.30) for arsenic and 1.20 (1.05 to 1.37) for lead, in Cox proportional hazards models after controlling for multiple comparisons. A doubling in urinary excretion of zinc was associated with higher risk of diabetes (adjusted HR 1.31, 95% CI 1.11 to 1.53). Two distinct exposure patterns to metal mixtures-'high' versus 'low'-were identified. Participants assigned to the 'high' pattern had higher overall concentrations of all metals compared with those classified into the 'low' pattern. Adjusted HR for diabetes associated with 'high' pattern compared with 'low' was 1.42 (1.08 to 1.87).

Conclusions: Higher urinary concentrations of arsenic and lead, increased urinary excretion of zinc, as well as higher overall exposure to metal mixtures were associated with elevated risk of diabetes. Future studies should further investigate the underlying mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjdrc-2020-001233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398092PMC
July 2020

Contribution of common chronic conditions to midlife physical function decline: The Study of Women's Health Across the Nation.

Womens Midlife Health 2020 28;6. Epub 2020 Jul 28.

Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.

Background: Chronic conditions are associated with worse physical function and commonly develop during midlife. We tested whether the presence of 8 chronic conditions, or the development of these conditions, is associated with declines in physical function among midlife women as they transition into early late life.

Methods: Participants ( = 2283) were from the Study of Women's Health Across the Nation. Physical function was assessed at 8 visits starting at the study's fourth clinic visit in 2000/2001 through follow-up visit 15 (2015/2017) using the Short Form-36 Physical Function subscale. Chronic conditions included diabetes, hypertension, osteoarthritis, osteoporosis, stroke, heart disease, cancer, and depressive symptoms. Repeated-measures Poisson regression modeled associations between 1) prevalent chronic conditions at analytic baseline (visit 4) and longitudinal physical function, and 2) change in physical function associated with developing a new condition. Models were adjusted with the total number of other chronic conditions at visit 4.

Results: In separate fully-adjusted longitudinal models, prevalent heart disease and osteoporosis were associated with 18% (IRR = 0.815, 95% confidence interval [CI]: 0.755-0.876) and 12% (IRR = 0.876, 95% CI: 0.825-0.927) worse initial physical function, respectively. Prevalent osteoarthritis was associated with approximately 6% (IRR = 0.936, 95% CI: 0.913-0.958) worse initial physical function, and a slight additional worsening over time (IRR = 0.995, 95% CI: 0.994-0.996). A 12% (IRR = 0.878, 95% CI: 0.813-0.950) decrease in physical function concurrent with stroke development was evident, as was accelerated decline in physical function concurrent with heart disease development (IRR = 0.991, 95% CI: 0.988-0.995).

Conclusions: Initial prevalent conditions related to the musculoskeletal system were associated with worse initial physical function, with some evidence of accelerated decline in physical function with osteoarthritis. Stroke and heart disease are less common than osteoarthritis in this age group, but the severe effects of these conditions on physical function shows the need for a greater focus on cardiovascular health during midlife. Women who develop chronic conditions during midlife may be at particular risk for poor physical function as they age, warranting disability prevention efforts focused on this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40695-020-00053-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385881PMC
July 2020

The impact of breast cancer on physical activity from midlife to early older adulthood and predictors of change post-diagnosis.

J Cancer Surviv 2020 08 30;14(4):545-555. Epub 2020 Mar 30.

Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.

Purpose: To examine physical activity (PA) patterns from pre- to post-diagnosis, and compare these changes to women without breast cancer. To determine pre-diagnosis predictors of PA change, post-diagnosis, in breast cancer survivors (BCS).

Methods: Data were from 2314 Study of Women's Health Across the Nation (SWAN) participants, average age of 46.4 ± 2.7 years at baseline (1996-1997). In Pink SWAN, 151 women who reported an incident breast cancer diagnosis over 20 years were classified as BCS; the remaining 2163 women were controls. LOESS plots and linear mixed models were used to illustrate and compare PA changes (sports/exercise [primary measure] and total PA) from pre- to post-diagnosis (or corresponding period) in BCS versus controls. Adjusted linear regression models were used to determine pre-diagnosis predictors of at-risk post-diagnosis PA change patterns (consistently low and decreased PA).

Results: No differences in pre- to post-diagnosis PA (or corresponding period) were observed in BCS versus controls. Among BCS, the odds of at-risk post-diagnosis PA change patterns was 2.50 (95% CI 0.96-6.48) times higher for those who reported sleep problems at ≥ 50% (compared to 0%) of pre-diagnosis visits and 3.49 (95% CI 1.26-9.65) times higher for those who were overweight or obese at all (compared to no) pre-diagnosis visits. No other statistically significant predictors were noted.

Conclusions: Age-related declines in PA were not amplified by a breast cancer diagnosis. Given the beneficial role of PA across the cancer control continuum, efforts to increase or maintain adequate PA, post-diagnosis, should be continued.

Implications For Cancer Survivors: While age-related physical activity declines were not amplified breast cancer diagnosis, efforts to identify breast cancer survivors at increased risk for post-diagnosis physical activity declines (or maintenance of low activity) may be a high-yield strategy to improve prognosis and quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11764-020-00879-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365759PMC
August 2020

Impact of Chronic Medical Condition Development on Longitudinal Physical Function from Mid- to Early Late-Life: The Study of Women's Health Across the Nation.

J Gerontol A Biol Sci Med Sci 2020 06;75(7):1411-1417

Department of Preventive Medicine, Chicago, Illinois.

Background: Chronic medical conditions (CMCs) often emerge and accumulate during the transition from mid- to late-life, and the resulting multimorbidity can greatly impact physical function. We assessed the association of CMC presence and incidence on trajectories of physical function from mid- to early late-life in the Study of Women's Health Across the Nation.

Methods: Physical function was assessed at eight clinic visits (average 14 years follow-up) using the physical function subscale of the Short Form-36. CMCs included osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depressive symptomatology, and were considered cumulatively. Repeated-measures Poisson models estimated longitudinal change (expressed as percent difference) in physical function by chronic CMCs. Change-points assessed physical function change coincident with the development of a new condition.

Results: Women (N = 2,283) followed from age 50.0 ± 2.7 to 64.0 ± 3.7 years; 7.3% had zero CMCs through follow-up, 22.5% (N = 513) had no baseline CMCs but developed ≥1, 22.7% women had ≥1 baseline CMC but never developed another, and 47.6% had ≥1 baseline CMC and developed ≥1 more. Each additional baseline CMC was associated with 4.0% worse baseline physical function and annual decline of 0.20%/year. Women with more baseline CMCs had greater decline in physical function with a new CMC (-1.90% per condition); and annual decline when developing a new condition accelerated by -0.33%/year per condition.

Conclusions: Self-reported physical function changes are evident from mid- to early late-life with the development of CMCs. Preventing or delaying CMCs may delay declines in physical function, and these potential pathways to disability warrant further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/glz243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302170PMC
June 2020

Western Dietary Pattern Derived by Multiple Statistical Methods Is Prospectively Associated with Subclinical Carotid Atherosclerosis in Midlife Women.

J Nutr 2020 03;150(3):579-591

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.

Background: The menopause has adverse effects on cardiometabolic profiles that are linked to an increased risk of atherosclerosis in women. A healthy diet during the menopausal transition may counteract the menopause-induced atherosclerotic risk.

Objective: This prospective cohort study aimed to examine the associations between empirically derived dietary patterns and subclinical carotid atherosclerosis in midlife women.

Methods: A total of 1246 midlife women (average age at baseline: 46.3 y) from the Study of Women's Health Across the Nation who completed dietary assessments and had a carotid ultrasound scan were included. Dietary data were collected at 3 time points, during 1996-1997, 2001-2003, and 2005-2007. Measures of carotid atherosclerosis included common carotid artery intima-media thickness (CCA-IMT), adventitial diameter (AD), and carotid plaque index collected during 2009-2013. Three statistical methods, including principal component analysis (PCA), reduced rank regression (RRR), and partial least squares regression (PLS), were used to identify dietary patterns.

Results: A Western dietary pattern was identified from each method and a Prudent dietary pattern from PCA. High adherence to the Western pattern was associated with higher CCA-IMT. Women in the fourth quartile of the Western pattern identified by PCA, RRR, and PLS had 0.042 mm (95% CI: 0.011, 0.073), 0.033 mm (95% CI: 0.0086, 0.057), and 0.049 mm (95% CI: 0.025, 0.074), respectively, larger CCA-IMT than women in the first quartile; these differences correspond to 30%, 24%, and 35% of the sample SD, respectively. The Prudent pattern was not significantly associated with CCA-IMT. No significant associations were found between the identified dietary patterns and AD or carotid plaque.

Conclusions: The positive association between the Western diet and CCA-IMT was robust under different dietary pattern derivation methods. The adoption of a diet low in red meat, processed meat, deep-fried products, and sugar-sweetened beverages among midlife women is associated with a lower future risk of atherosclerosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jn/nxz270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443736PMC
March 2020

Peripheral Nerve Impairment and Recurrent Falls Among Women: Results From the Study of Women's Health Across the Nation.

J Gerontol A Biol Sci Med Sci 2020 09;75(10):2020-2027

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor.

Background: Falls and related injuries are important public health concerns yet underappreciated in early aging. This study examined the association of peripheral nerve impairment (PNI) with fall outcomes in early old aged women (60-72 years).

Methods: Women (n = 1,725; mean age 65.1 ± 2.7 years) from the longitudinal cohort Study of Women's Health Across the Nation completed a PNI questionnaire on presence, frequency, and severity of symptoms, and 10- and 1.4-g monofilament testing in 2016-2017. PNI was defined as four or more self-reported symptoms or monofilament insensitivity. Recurrent falls (two or more) and recurrent fall injuries (two or more falls with one or more injuries) in the previous 12 months were assessed via questionnaire. Poisson regression was used to generate risk ratios (RRs) and corresponding 95% confidence intervals (CIs) for the fall outcomes, adjusting for covariates.

Results: Approximately 12.3% of participants reported two ore more falls, 7.6% reported recurrent falls with injury, and 15.8% reported four or more PNI symptoms. Women with recurrent falls were more likely to report four or more PNI symptoms compared to women without recurrent falls (32.1% vs 13.5%; p < .001). One quarter (25.6%) of participants had four or more PNI symptoms or monofilament insensitivity; after adjusting for covariates, women with either symptoms or insensitivity were more likely to report recurrent falls compared to women with neither (RR = 1.64; 95% CI: 1.24, 2.17).

Conclusions: These findings suggest that PNI may identify those at high risk for falls, particularly among women during early late life. Neuropathy screening instruments such as symptom questionnaires or monofilament testing are easy to implement and may have utility for fall risk assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/glz211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518556PMC
September 2020

The association between perceived discrimination in midlife and peripheral neuropathy in a population-based cohort of women: the Study of Women's Health Across the Nation.

Ann Epidemiol 2019 09 27;37:10-16. Epub 2019 Jul 27.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor. Electronic address:

Purpose: Peripheral neuropathy (PN) is a highly prevalent condition with serious sequelae. Many studies of the condition have been restricted to populations with diabetes, limiting evidence of potential contributing risk factors including salient psychosocial risk factors such as discrimination.

Methods: The longitudinal Study of Women's Health Across the Nation was used to assess the relationship between perceived discrimination and prevalent PN in 1718 ethnically diverse midlife women. We used multivariable logistic regression to determine the association between perceived discrimination (Detroit Area Study Everyday Discrimination Scale) and PN (symptom questionnaire and monofilament testing) and conducted an assessment of the mediating effects of body mass index (BMI).

Results: The prevalence of PN was 26.1% in the total sample and 40.9% among women with diabetes. Women who reported perceived discrimination had 29% higher odds of PN compared with women who did not report perceived discrimination (95% confidence interval, 1.01-1.66). Approximately 30% of the total effect of discrimination on PN was mediated indirectly by BMI.

Conclusions: More research is needed to determine the contributing factors to nondiabetic PN. Our findings reaffirm the impact of financial strain, BMI, and diabetes as significant correlates of PN and highlight discrimination as an important risk factor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2019.07.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755046PMC
September 2019

Prospective associations between beverage intake during the midlife and subclinical carotid atherosclerosis: The Study of Women's Health Across the Nation.

PLoS One 2019 10;14(7):e0219301. Epub 2019 Jul 10.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.

Background: The potential impacts of beverage intake during the midlife on future subclinical atherosclerosis among women are unclear. The aim of this study was to evaluate the prospective associations between the intakes of eight beverage groups and subclinical carotid atherosclerosis in midlife women.

Methods: Data came from the Study of Women's Health Across the Nation, a multicenter, multiethnic, and prospective cohort study. A total of 1,235 midlife women had measures of subclinical carotid atherosclerosis and repeatedly beverage intake data collected using a validated food frequency questionnaire. Beverages were aggregated into eight groups, including coffee, tea, sugar-sweetened beverages, artificially sweetened beverages, fruit juices, whole milk, milk with lower fat content, and alcoholic beverages. The associations of beverage intake with common carotid artery intima-media thickness (CCA-IMT) and adventitial diameter (CCA-AD) were estimated using linear models; the associations with carotid plaque were estimated using log-binomial models.

Results: Coffee intake was associated with CCA-IMT in an inverted J-shaped pattern. After adjusting for covariates, women with >0 to <1 cup/day and 1 to <2 cups/day of coffee intake had a 0.031 mm (95% CI: 0.012, 0.051) and a 0.027 mm (95% CI: 0.005, 0.049) larger CCA-IMT, respectively, than coffee non-drinkers. Women who consumed ≥2 cups/day of coffee did not have significantly different CCA-IMT than non-drinkers. There was an inverse linear association between moderate alcoholic beverages intake and CCA-IMT (P-trend = 0.014). Whole milk intake had inverted U-shaped associations with CCA-IMT and carotid plaque. No significant associations were found between other beverage groups and subclinical atherosclerosis.

Conclusions: In midlife women, occasional coffee intake may be associated with more subclinical atherosclerosis while moderate alcoholic beverages intake may be associated with less subclinical atherosclerosis. Future work should focus on the determination of the optimal beverage intake profile for maximum cardiovascular benefits in midlife women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219301PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620009PMC
February 2020

Serum Sex Hormones and the Risk of Fracture Across the Menopausal Transition: Study of Women's Health Across the Nation.

J Clin Endocrinol Metab 2019 06;104(6):2412-2418

University of California, Los Angeles, Los Angeles, California.

Context: Sex steroid hormones have been linked to fractures in older women.

Objective: To test the hypothesis that hormones measured over the menopausal transition predict fractures.

Setting: Seven US clinical centers.

Subjects And Measurements: Two thousand nine hundred sixty women (average age, 46.4 ± 2.7 years) who had at least two repeat hormone measures and prospective information on fractures. Fasting serum was collected annually for hormone assays. Estradiol (E2) was measured with a modified direct immunoassay. FSH and SHBG were measured with two-site chemiluminescence immunoassays. Hormones were lagged (visit year -1) and transformed using log base 2. Incident fractures were ascertained at each annual visit. All medications including hormone therapy were time varying covariates. Discrete survival methods were used.

Results: Five hundred eight (17.2%) women experienced an incident fracture over an average follow up of 8.8 ± 4.4 years. Women who experienced an incident fracture were more likely to be white, report high alcohol intake and diabetes, and less likely to report premenopausal status at baseline. A woman whose log E2 was twice that of another had a 10% lower risk of fracture independent of covariates, relative risk (95% CI) = 0.90 (0.82, 0.98). Neither FSH nor SHBG were associated with fractures.

Conclusions: Serum E2 levels may help to identify women at higher risk of fractures over the menopausal transition. However, hormone assays must be standardized across laboratories for clinical implementation and further work is needed to define E2 thresholds.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1210/jc.2018-02047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505454PMC
June 2019

Age at Onset of Metabolic Syndrome Among Women With and Without Polycystic Ovary Syndrome-Like Status.

J Clin Endocrinol Metab 2019 05;104(5):1429-1439

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.

Context: Women with polycystic ovary syndrome (PCOS) have a higher prevalence of metabolic syndrome (MetS), but whether they develop MetS earlier than women without PCOS is unknown. Understanding the impact of PCOS on the timing of MetS onset is important for screening and clinical care in this population.

Design: Women with PCOS-like status (PCOSp) were identified from participants of the Michigan Bone Health and Metabolism Study based upon history of irregular menstrual cycles, high free-androgen index, and high levels of antimüllerian hormone. MetS was defined according to the Adult Treatment Panel III criteria. Age at MetS onset was compared between women with and without PCOSp using an accelerated failure time model adjusted for baseline education, lifestyle factors, and midlife body weight.

Results: Among the 496 women in the analysis, 11.7% (n = 58) were determined to have PCOSp. Over a mean follow-up of 11 years, 20 women with PCOSp and 136 women without PCOSp developed MetS. After adjusting for smoking, education, and physical activity, women with PCOSp developed MetS at an age 14.4% (95% CI -22.7, -5.2) younger than women without PCOSp. The magnitude of the association was attenuated to 5.4% in models additionally adjusted for body mass index (95% CI -12.4, 2.1). Because a typical study participant without PCOSp developed MetS at 51.5 years old, 5.4% translates to almost 3 years earlier onset of MetS for a comparable woman with PCOSp.

Conclusions: Women with PCOSp develop MetS at a younger age. Earlier screening for MetS in women with PCOS may be warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1210/jc.2018-01428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435100PMC
May 2019

Healthy Lifestyle During the Midlife Is Prospectively Associated With Less Subclinical Carotid Atherosclerosis: The Study of Women's Health Across the Nation.

J Am Heart Assoc 2018 12;7(23):e010405

1 Department of Epidemiology University of Michigan Ann Arbor MI.

Background Measures of subclinical atherosclerosis are predictors of future cardiovascular outcomes as well as of physical and cognitive functioning. The menopausal transition is associated with accelerated progression of atherosclerosis in women. The prospective association between a healthy lifestyle during the midlife and subclinical atherosclerosis is unclear. Methods and Results Self-reported data on smoking, diet, and physical activity from 1143 women in the Study of Women's Health Across the Nation were used to construct a 10-year average Healthy Lifestyle Score ( HLS ) during the midlife. Markers of subclinical atherosclerosis were measured 14 years after baseline and included common carotid artery intima-media thickness ( CCA - IMT ), adventitial diameter ( CCA - AD ), and carotid plaque. The associations of average HLS with CCA - IMT and CCA - AD were estimated using linear models; the association of average HLS with carotid plaque was estimated using cumulative logit models. Average HLS was associated with smaller CCA - IMT and CCA - AD in the fully adjusted models ( P=0.0031 and <0.001, respectively). Compared with participants in the lowest HLS level, those in the highest level had 0.024 mm smaller CCA - IMT (95% confidence interval: -0.048, 0.000), which equals 17% of the SD of CCA - IMT , and 0.16 mm smaller CCA - AD (95% confidence interval: -0.27, -0.04), which equals 24% of the SD of CCA - AD . Among the 3 components of the HLS , abstinence from smoking had the strongest association with subclinical atherosclerosis. Conclusions Healthy lifestyle during the menopausal transition is associated with less subclinical atherosclerosis, highlighting the growing recognition that the midlife is a critical window for cardiovascular prevention in women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.118.010405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405552PMC
December 2018

Menopause versus chronologic aging: their roles in women's health.

Menopause 2018 08;25(8):849-854

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA Department of Psychology, University of Pittsburgh School of Arts and Sciences, Pittsburgh, PA Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI Department of Neurology, Albert Einstein College of Medicine, Bronx, NY Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA Departments of Psychiatry and Preventive Medicine, Rush Medical College, Rush University Medical Center, Chicago, IL Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/GME.0000000000001143DOI Listing
August 2018

Perceived stress across the midlife: longitudinal changes among a diverse sample of women, the Study of Women's health Across the Nation (SWAN).

Womens Midlife Health 2018 16;4. Epub 2018 Mar 16.

Department of Epidemiology, School of Public Health, University of Michigan, 6610B SPH I, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.

Background: In women, midlife is a period of social and physiological change. Ostensibly stressful, cross-sectional studies suggest women experience decreasing stress perceptions and increasing positive outlook during this life stage. The aim of this paper was to describe the longitudinal changes in perceived stress as women transitioned through the midlife.

Methods: Premenopausal women ( = 3044) ages 42-52 years at baseline, were recruited from seven sites in the Study of Women's Health Across the Nation, and followed approximately annually over 13 visits with assessment of perceived stress and change in menopausal status. Longitudinal regression models were used to assess the effects of age, menopausal status and baseline sociodemographic variables on the trajectory of perceived stress over time.

Results: At baseline, mean age was 46.4 ± 2.7 years; participants were white (47%), black (29%), Hispanic (7%), Japanese (9%), or Chinese (8%). Hispanic women, women with lesser educational attainment, and women reporting financial hardship were each more likely to report high perceived stress levels at baseline (all < 0.0001). After adjustment for baseline sociodemographic factors, perceived stress decreased over time for most women ( < 0.0001), but increased for both Hispanic and white participants at the New Jersey site ( < 0.0001). Changing menopausal status was not a significant predictor of perceived stress.

Conclusions: Self-reported stress decreased for most women as they transitioned across the midlife; changing menopausal status did not play a significant role after adjustment for age and sociodemographic factors. Future studies should explore the stress experience for women by racial/ethnic identity and demographics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6027744PMC
http://dx.doi.org/10.1186/s40695-018-0032-3DOI Listing
March 2018

Low grip strength predicts incident diabetes among mid-life women: the Michigan Study of Women's Health Across the Nation.

Age Ageing 2018 09;47(5):685-691

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Background: skeletal muscle is the primary site of glucose uptake, yet the impact of age-related changes in muscle strength on diabetes risk is unknown.

Methods: four hundred and twenty-four participants (60% Black, 40% White) from the Michigan site of the Study of Women's Health Across the Nation contributed annual grip strength measures and were followed from 1996 to 2012 to identify incident cases of diabetes. Diabetes was defined as self-reported physician-diagnosed diabetes, use of anti-diabetic medications or measured fasting glucose ≥126 mg/dl or haemoglobin A1c > 6.5%.

Results: the 16-year diabetes incidence was 37%. The average baseline weight-normalised grip strength (NGS, kg per kg body weight) was 0.41 ± 0.12 and a mean of 0.29 ± 0.14 kg of absolute grip strength was lost per year. Each 0.1 higher NGS was associated with a 19% lower hazard of incident diabetes (P = 0.006) after adjustment for age, race/ethnicity, economic strain, smoking, menopause status, hormone use, physical activity and waist-hip ratio. In race/ethnic-stratified models, each 0.10 increase in NGS was associated with a 54% lower hazard of incident diabetes (P < 0.0001) among White women but the association among Black women was not statistically significant. In models without adjustment for waist-hip ratio or restricted to women <48 years of age at baseline, there was a statistically significant association between baseline NGS and incident diabetes among Black women. The rate of change in grip strength was not associated with diabetes incidence.

Conclusion: the mid-life is an important risk period for diabetes onset. Improving muscle strength. during mid-life may contribute to preventing diabetes among women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ageing/afy067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108393PMC
September 2018

Moving toward a prevention strategy for osteoporosis by giving a voice to a silent disease.

Womens Midlife Health 2016;2. Epub 2016 Mar 7.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.

A major unmet challenge in developing preventative treatment programs for osteoporosis is that the optimal timing of treatment remains unknown. In this commentary we make the argument that the menopausal transition (MT) is a critical period in a woman's life for bone health, and that efforts aimed at reducing fracture risk later in life may benefit greatly from strategies that treat women earlier with the intent of keeping bones strong as long as possible. Bone strength is an important parameter to monitor during the MT because engineering principles can be applied to differentiate those women that maintain bone strength from those women that lose bone strength and are in need of early treatment. It is critical to understand the underlying mechanistic causes for reduced strength to inform treatment strategies. Combining measures of strength with data on how bone structure changes during the MT may help differentiate whether a woman is losing strength because of excessive bone resorption, insufficient compensatory bone formation, trabeculae loss, or some combination of these factors. Each of these biomechanical mechanisms may require a different treatment strategy to keep bones strong. The technologies that enable physicians to differentially diagnose and treat women in a preventive manner, however, have lagged behind the development of prophylactic treatments for osteoporosis. To take advantage of these treatment options, advances in preventive treatment strategies for osteoporosis may require developing new technologies with imaging resolutions that match the pace by which bone changes during the MT and supplementing a woman's bone mineral density (BMD)-status with information from engineering-based analyses that reveal the structural and material changes responsible for the decline in bone strength during the menopausal transition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40695-016-0016-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035036PMC
March 2016

Effectiveness of the Tobacco Tactics Program in the Trinity Health System.

Am J Prev Med 2016 10;51(4):551-65

Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, Hines, Illinois.

Introduction: This study determined the effectiveness of the Tobacco Tactics intervention.

Design/setting/participants: This was a pragmatic, quasi-experimental study conducted from 2010 to 2013 and analyzed from 2014 to 2015 in five Michigan community hospitals; three received the Tobacco Tactics intervention, and two received usual care. Smokers (N=1,528) were identified during hospitalization, and sent surveys and cotinine tests after 6 months. Changes in pre- to post-intervention quit rates in the intervention sites were compared with usual care control sites.

Intervention: The toolkit for nurses included: (1) 1 continuing education unit contact hour for training; (2) a PowerPoint presentation on behavioral and pharmaceutical interventions; (3) a pocket card entitled "Helping Smokers Quit: A Guide for Clinicians"; (4) behavioral and pharmaceutical protocols; and (5) a computerized template for documentation. The toolkit for patients included: (1) a brochure; (2) a cessation DVD; (3) the Tobacco Tactics manual; (4) a 1-800-QUIT-NOW card; (5) nurse behavioral counseling and pharmaceuticals; (6) physician reminders to offer brief advice to quit coupled with medication sign-off; and (7) follow-up phone calls by trained hospital volunteers.

Main Outcome Measures: The effectiveness of the intervention was measured by 6-month 30-day point prevalence; self-reported quit rates with NicAlert(®) urinary biochemical verification (48-hour detection period); and the use of electronic medical record data among non-responders.

Results: There were significant improvements in pre- to post-intervention self-reported quit rates (5.7% vs 16.5%, p<0.001) and cotinine-verified quit rates (4.3% vs 8.0%, p<0.05) in the intervention sites compared with no change in the control sites. Propensity-adjusted multivariable analyses showed a significant improvement in self-reported 6-month quit rates from the pre- to post-intervention time periods in the intervention sites compared to the control sites (p=0.044) and a non-statistically significant improvement in the cotinine-verified 6-month quit rate.

Conclusions: The Tobacco Tactics intervention, which meets the Joint Commission standards for inpatient smoking, has the potential to significantly decrease smoking among inpatient smokers.

Trial Registration: This study is registered at www.clinicaltrial.gov NCT01309217.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2016.03.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031413PMC
October 2016

Body mass index, falls, and injurious falls among U.S. adults: Findings from the 2014 Behavioral Risk Factor Surveillance System.

Prev Med 2016 10 26;91:217-223. Epub 2016 Aug 26.

School of Public Health, University of Michigan, Ann Arbor, MI, United States.

Falls are an important health concern because they are associated with loss of independence and disability, particularly among women. We determined the age- and sex-specific prevalence of injurious falls among adults in the United States and examined the impact of obesity on fall risk. Self-reported falls, injurious falls, and health histories were obtained from 280,035 adults aged 45-79years in the 2014 Behavioral Risk Factor Surveillance System. Body mass index was categorized as underweight (<18.5kg/m), normal weight (18.5-24.9kg/m), overweight 25-29.9kg/m), class I obesity (30.0-34.9kg/m), or class II/III obesity (≥35.0kg/m) based on self-reported height and weight. Data were analyzed using weighted age- and sex-specific prevalence rates and Poisson regression. Overall, 11.0% reported ≥1 injurious fall in the previous 12months. Mid-life women 55-59years reported the highest prevalence of injurious falls (15.4%). Among mid-life women, overweight was associated with injurious falls (RR=1.17; 95% CI: 1.08, 1.28), but overweight was not associated with falling among other age-sex groups. Class II/III obesity was associated with injurious falls among all age-sex groups. After considering the mediators like health conditions (depression, cardiovascular disease, diabetes, arthritis) and behaviors (physical activity, sleep), the association of class II/III obesity and injurious fall risk persisted only among mid-life women (RR=1.23; 95% CI: 1.12, 1.36). Not only are mid-life women at high risk for falls, but the class II/III obesity is a risk factor for injurious falls. Targeting mid-life women for fall and injury prevention is an important aim for practitioners, particularly given unique correlates of falling for this group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2016.08.044DOI Listing
October 2016

Diabetes and Menopause.

Curr Diab Rep 2016 Apr;16(4):20

Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109, USA.

During menopause, women's body composition, sex hormone profile, and metabolic profile may change dramatically. In this review, we summarize studies examining whether the menopausal transition and physiologic factors characterizing the transition are associated with increased risk of diabetes. We review the evidence for estrogen therapy and diabetes risk and studies examining the relationship between diabetes and menarche, which represents an extension of the reproductive life span at the opposite end of the age spectrum. Although studied less extensively, the presence of type 1 or type 2 diabetes may increase the risk of ovarian failure, and we review this literature. In conclusion, we note that the evidence linking menopausal sex hormone changes with increased diabetes risk is weak, although rapid changes as observed with oophorectomy may increase risk. Further studies should investigate the contradictory effects of estrogen therapy upon hepatic and glucose metabolism in mid-life women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11892-016-0714-xDOI Listing
April 2016

Childhood Socioeconomic Circumstances, Inflammation, and Hemostasis Among Midlife Women: Study of Women's Health Across the Nation.

Psychosom Med 2016 04;78(3):311-8

From the Departments of Psychiatry and Department of Psychology (Matthews, Thurston), Epidemiology (Matthews, Bromberger, Thurston), and Neurological Surgery (Chang), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Epidemiology (Karvonen-Gutierrez), University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Psychiatry and Department of Preventive Medicine (Kravitz), Rush University Medical Center, Chicago, Illinois; and Department of Sociology (Montez), Syracuse University, Syracuse, New York.

Background: Childhood socioeconomic status (SES) is related to risk for cardiovascular disease in adulthood, perhaps, in part, due to associations with inflammatory and hemostasis processes. We tested the hypotheses that childhood SES is related to C-reactive protein (CRP), fibrinogen, factor VIIc, and plasminogen activator inhibitor-1 (PAI-1) in midlife women and that the associations are mediated by adult SES and/or adult body mass index (BMI).

Methods: Using data from the prospective Study of Women's Health Across the Nation, we classified 1067 black and white women into 3 multidimensional childhood SES groups based on latent class analysis. Biological measures were assessed across 7 years along with covariates and mediators and analyzed by mixed regression models, followed by tests for mediation.

Results: Compared with women raised in high SES families, those from the lowest SES families had higher levels of CRP (b [standard error] = 0.37 [0.11]), PAI-1 (b = 0.23 [0.07]) factor VIIc (b = 0.05 [0.02]), and fibrinogen (b = 11.06 [4.89]), after adjustment for ethnicity, site, age, ratings of health between ages 11 and 18 years, visit, smoking status, menopausal status, stroke or heart attack, medications, and hormone use. Introduction of adult SES and BMI into the models reduced the childhood SES associations to nonsignificance for all four measures. Indirect mediation was apparent for adult education and BMI for CRP, and BMI for PAI-1.

Conclusions: Women raised in lower SES families had elevated markers of inflammation and hemostasis, in part, due to elevated BMI and education in adulthood.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PSY.0000000000000283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844772PMC
April 2016

The importance of disability as a health issue for mid-life women.

Womens Midlife Health 2015 14;1:10. Epub 2015 Oct 14.

Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Room 6618, Ann Arbor, MI 48109 USA.

Data suggest that disability prevalence among mid-aged populations is increasing in recent years; current prevalence estimates for mid-aged adults range from 20 to 40 %. The World Health Organization's International Classification of Functioning (ICF) has provided a multi-dimensional biopsychosocial model to understand disability that is highly relevant to mid-aged populations. Under the ICF framework, mid-aged women experience high levels of work, non-work, and mobility-associated disability but very little difficulty with self care. Despite the high prevalence, evidence suggests that there is a large proportion of non-chronic disability and that mid-aged women can both worsen and improve their functioning. Thus, the mid-life period may represent a critical window during which interventions to improve disability may be most efficacious for the improvement of current and future functioning. Interventions that are initiated during the mid-life are highly relevant as a strategy to reduce disability during this life stage and prevent or forestall the onset of late life disability. Targets for intervention include improvement of depressive symptoms and increasing physical activity levels, both of which have shown to be efficacious in older populations and are correlates of mid-life functioning and disability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40695-015-0011-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297968PMC
October 2015

Higher Leptin and Adiponectin Concentrations Predict Poorer Performance-based Physical Functioning in Midlife Women: the Michigan Study of Women's Health Across the Nation.

J Gerontol A Biol Sci Med Sci 2016 Apr 24;71(4):508-14. Epub 2015 Aug 24.

Department of Epidemiology and.

Background: Excess fat mass is a greater contributor to functional limitations than is reduced lean mass or the presence of obesity-related conditions. The impact of fat mass on physical functioning may be due to adipokines, adipose-derived proteins that have pro- or anti-inflammatory properties.

Methods: Serum samples from 1996 to 2003 that were assayed for leptin, adiponectin, and resistin were provided by 511 participants from the Michigan site of the Study of Women's Health Across the Nation. Physical functioning performance was assessed annually during study visits from 1996 to 2003.

Results: Among this population of Black and White women (mean baseline age = 45.6 years, SD = 2.7 years), all of whom were premenopausal at baseline, higher baseline leptin concentrations predicted longer stair climb, sit-to-rise, and 2-pound lift times and shorter forward reach distance (all p < .01). This relationship persisted after adjustment for age, BMI, percent skeletal muscle mass, race/ethnicity, economic strain, bodily pain, diabetes, knee osteoarthritis, and C-reactive protein. Baseline total adiponectin concentrations did not predict any mobility measures but did predict quadriceps strength; a 1 µg/mL higher adiponectin concentration was associated with 0.64 Nm lower quadriceps strength (p = .02). Resistin was not associated with any of the physical functioning performance measures. Change in the adipokines was not associated with physical functioning.

Conclusion: In this population of middle-aged women, higher baseline leptin concentrations predicted poorer mobility-based functioning, whereas higher adiponectin concentrations predicted reduced quadriceps strength. These findings suggest that the relationship between the adipokines and physical functioning performance is independent of other known correlates of poor functioning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/glv123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014187PMC
April 2016