Context-Physical functioning represents an integrated marker of aging. Whether menopause is assoc... more Context-Physical functioning represents an integrated marker of aging. Whether menopause is associated with an accelerated decline in physical functioning is not known.
Quantifying the effects of specific neighborhood features on self-reported health is important in... more Quantifying the effects of specific neighborhood features on self-reported health is important in understanding the global health impact of neighborhood context. We investigated associations of neighborhood poverty, sociability and walkability with self-rated physical and mental health in the Multi-Ethnic Study of Atherosclerosis (MESA). In separate models, each neighborhood variable was associated with physical health but associations with sociability and walkability were stronger than those for poverty. Only walkability remained significant after adjusting for the other neighborhood variables. There was no evidence that selfrated mental health as assessed by the SF12 was associated with neighborhood poverty, walkability or sociability. This study provides information on how neighborhood context is associated with global health in diverse midlife and older persons.
Background—Several cohort studies report associations between chronic exposure to ambient fine pa... more Background—Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods—We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1,923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results—We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m 3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions—In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
Studies have reported associations between long-term air pollution exposures and cardiovascular m... more Studies have reported associations between long-term air pollution exposures and cardiovascular mortality. The biological mechanisms connecting them remain uncertain. We examined associations of fine particles (PM2.5) and ozone with serum markers of cardiovascular disease risk in a cohort of midlife women. We obtained information from women enrolled at six sites in the multi-ethnic, longitudinal Study of Women's Health Across the Nation, including repeated measurements of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, tissue-type plasminogen activator antigen (tPA-ag), plasminogen activator inhibitor Type 1 (PAI-1), and Factor VIIc (Factor VII coagulant activity). We obtained residence-proximate PM2.5 and ozone monitoring data for a maximum five annual visits, calculating prior year, six-month, one-month, and one-day exposures and their relations to serum markers using longitudinal mixed models. For the 2,086 women studied from 1999 through 2004,PM2.5 exposures were a...
Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic... more Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capi...
Objectives: We investigated whether higher neighborhood poverty was associated with poorer physic... more Objectives: We investigated whether higher neighborhood poverty was associated with poorer physical functioning-related health outcomes, including body mass index (BMI), waist size and percent body fat; self-rated physical activity; and performance-based physical functioning, including timed walk, timed stair climb, and timed 2-lb lift in a sample of mid-life women.Methods: The study sample (n=1156) combines two study cohorts, including Michigan Bone Health and Metabolism Study (n=614) and Michigan site of Study of Women's Health Across the Nation (n=542). Year 1996 participant addresses were geocoded using batchgeocode.com and measures of neighborhood poverty (the proportion of residents living below the poverty line in a participant's census tract) were obtained from 1990 census data. Multilevel models with random intercepts were justified for two outcomes only (timed walk and 2-lb lift). All other continuous outcomes were modeled using OLS regression. Ordinal logistic reg...
Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuat... more Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuating oxidative stress. We evaluated associations between lifestyle factors and urine F(2a)-isoprostanes, a marker of oxidative stress in 1610 participants of the Study of Women's Health Across the Nation (SWAN). Dietary intake and physical activity were assessed at baseline and the 5th year 05 (Y05). These data were related to Y05 urinary F(2a)-isoprostane concentration with regression analyses. Median urine F(2a)-isoprostane concentration was 433 ng/L overall, 917 ng/L in smokers [inter-quartile range (IQR): 467, 1832 ng/L], and 403 ng/L in nonsmokers (IQR: 228, 709 ng/L; P < 0.0001 for difference). Higher trans fat intake was associated with higher urine F(2a)-isoprostane concentration; partial Spearman correlations (rho(x|y)) between Y05 urine F(2a)-isoprostane concentration and trans fatty acids was 0.19 (P = 0.03) in smokers and 0.13 (P < 0.0001) in nonsmokers. Increased lo...
Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic... more Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capi...
Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuat... more Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuating oxidative stress. We evaluated associations between lifestyle factors and urine F(2a)-isoprostanes, a marker of oxidative stress in 1610 participants of the Study of Women's Health Across the Nation (SWAN). Dietary intake and physical activity were assessed at baseline and the 5th year 05 (Y05). These data were related to Y05 urinary F(2a)-isoprostane concentration with regression analyses. Median urine F(2a)-isoprostane concentration was 433 ng/L overall, 917 ng/L in smokers [inter-quartile range (IQR): 467, 1832 ng/L], and 403 ng/L in nonsmokers (IQR: 228, 709 ng/L; P < 0.0001 for difference). Higher trans fat intake was associated with higher urine F(2a)-isoprostane concentration; partial Spearman correlations (rho(x|y)) between Y05 urine F(2a)-isoprostane concentration and trans fatty acids was 0.19 (P = 0.03) in smokers and 0.13 (P < 0.0001) in nonsmokers. Increased lo...
Background: Several cohort studies report associations between chronic exposure to ambient fine p... more Background: Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods: We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results: We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 mg/m 3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions: In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
Pain has been associated with cognitive problems in pain patients. This study evaluated the exten... more Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) -0.074 (0.021); p value<0.01] and this association was partially explained by depressive symptoms [β (SE) -0.061 (0.022); p value<0.01 after adjusting for depressive...
During midlife, physical functioning limitations emerge and depressive symptoms are highly preval... more During midlife, physical functioning limitations emerge and depressive symptoms are highly prevalent. We examined the relationship between physical functioning and depressive symptoms in the Michigan Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven performance-based physical functioning measures quantifying strength, balance, coordination, flexibility and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D scores were associated with performance-based functions including slower timed walk sit-to-stand, and stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age increased, those with higher CES-D scores were more likely to have perceived limitations in physical functioning, though the association was weak. History of depressive symptoms was not significant in any model. These findings suggest that higher concurrent depressive symptoms are modestly associated with slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms played little or no role in current physical functioning of mid-life women. When evaluating physical function, women’s current mental health status should be considered. 2010 Elsevier
Context—Physical functioning represents an integrated marker of aging. Whether menopause is assoc... more Context—Physical functioning represents an integrated marker of aging. Whether menopause is associated with an accelerated decline in physical functioning is not known. Objective—To characterize whether losses in physical functioning are related to the natural or surgical menopause or time, following adjustment for body size and smoking behavior.
The Journal of Clinical Endocrinology & Metabolism, 2007
Understanding the menopause association with body weight is important because excess weight incre... more Understanding the menopause association with body weight is important because excess weight increases risk for stroke, incident cardiovascular disease, cardiovascular mortality, and all-cause mortality among the middle-aged. The objective of this study was to examine chronological age and ovarian age and consider how these could influence body size and composition in midlife women. The Study of Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Across the Nation is a longitudinal, community-based study. This report uses data from the Michigan Study of Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Across the Nation site. Participants were 543 premenopausal or early perimenopausal African-American and Caucasian women aged 42-52 yr at baseline examination. Waist circumference, fat mass and skeletal muscle mass, from bioelectrical impedance, were assessed in seven annual serial measures. Annual FSH values were assayed by ELISA. The final menstrual period was defined retrospectively after 12 months of amenorrhea. There was an absolute cumulative 6-yr increase in fat mass of 3.4 kg and a 6-yr decrease in skeletal muscle mass of approximately 0.23 kg. There was an absolute cumulative 6-yr increase of approximately 5.7 cm in waist circumference. The (log)FSH change was positively correlated with (log)(fat mass) change. Waist circumference increased over the time period, but 1 yr after final menstrual period, the rate of increase slowed. Fat mass continued to increase with no change in rate. Both time (chronological aging) and ovarian aging contributed to substantial changes in body composition (fat and skeletal muscle mass) and waist circumference. These changes have important ramifications for establishing a metabolic environment that can be healthy or unhealthy.
Background—Due to the public health burden of age-related declines in physical functioning, it is... more Background—Due to the public health burden of age-related declines in physical functioning, it is important to identify targets for intervention for the prevention of functional decline. We prospectively examined whether higher levels of inflammatory and hemostatic markers (high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA-ag), fibrinogen, and Factor VIIc (FVIIc)) were prospectively associated with reporting greater limitations in perceived physical functioning, and explored potential racial differences in the associations, in a multi-ethnic sample of mid-life women.
We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP... more We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP) and fibrinogen are related to measures of physical functioning in midlife women. Our sample included 543 participants in the Michigan site of Study of Women's Health Across the Nation (SWAN). Predictors included CRP from serum and fibrinogen from plasma. Performance-based outcomes included measures of gait, hand grip strength, flexibility, stair climb, 40-foot walk, and chair rise. Perception of physical functioning was assessed with the Medical Outcomes Study Short-Form 36 questionnaire. Regression analyses adjusted for relevant covariates. Cross-sectional associations were identified between higher CRP and more time spent in double support (with both feet on the floor while walking), shorter forward reach, slower 2-lb lift, and slower stair climb. Higher CRP and fibrinogen were associated with worse perceived functioning in cross-sectional analyses. Predictive associations across time were found between higher CRP and increased time spent in double support, diminishing forward reach distance and grip strength and worse perceived physical functioning. Predictive associations across time were also found between higher fibrinogen and greater time spent in double support, slower stair climb and worse perceived physical functioning. Our results suggest that inflammatory processes are associated with poor physical functioning in midlife women.
Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborho... more Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Arch Phys Med Rehabil 2008;89:1468-73. Objectives: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). Design: A cross-sectional study. Setting: Urban university. Participants: Men with SCI (N131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. Results: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR].19; 95% confidence interval [CI], .04 –.80), metabolic syndrome (OR.15; 95% CI, .03–.66) and high CRP (OR.17; 95% CI, .04 –.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR.14; 95% CI, .04 –.49) than their counterparts. Conclusions: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome , and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.
Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban commu... more Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005;86:664-71. Objectives: To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data. Design: Cross-sectional. Setting: Urban university. Participants: Ninety-five community-dwelling men with paraplegia (age range, 20 –59y). Interventions: Not applicable. Main Outcome Measures: Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression. Results: Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets. Conclusions: Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases.
Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community... more Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community-dwelling adults with Down syndrome in the Chicago area. Dietary intake was measured using a food frequency questionnaire completed by the participant's primary caregiver; anthropometric measures included height and weight and waist circumference. Plasma glucose and lipid concentrations were assessed following a 10-hour fast. Overall, 89% of participants were overweight or obese, 54% had large waist circumferences, and none met the current guidelines for fruit and vegetable intake. Mean concentrations for lipids and glucose, however, were within normal limits; and prevalence for hypertension, elevated lipids, and glucose were less than those for the general population of the United States.
Context-Physical functioning represents an integrated marker of aging. Whether menopause is assoc... more Context-Physical functioning represents an integrated marker of aging. Whether menopause is associated with an accelerated decline in physical functioning is not known.
Quantifying the effects of specific neighborhood features on self-reported health is important in... more Quantifying the effects of specific neighborhood features on self-reported health is important in understanding the global health impact of neighborhood context. We investigated associations of neighborhood poverty, sociability and walkability with self-rated physical and mental health in the Multi-Ethnic Study of Atherosclerosis (MESA). In separate models, each neighborhood variable was associated with physical health but associations with sociability and walkability were stronger than those for poverty. Only walkability remained significant after adjusting for the other neighborhood variables. There was no evidence that selfrated mental health as assessed by the SF12 was associated with neighborhood poverty, walkability or sociability. This study provides information on how neighborhood context is associated with global health in diverse midlife and older persons.
Background—Several cohort studies report associations between chronic exposure to ambient fine pa... more Background—Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods—We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1,923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results—We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m 3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions—In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
Studies have reported associations between long-term air pollution exposures and cardiovascular m... more Studies have reported associations between long-term air pollution exposures and cardiovascular mortality. The biological mechanisms connecting them remain uncertain. We examined associations of fine particles (PM2.5) and ozone with serum markers of cardiovascular disease risk in a cohort of midlife women. We obtained information from women enrolled at six sites in the multi-ethnic, longitudinal Study of Women's Health Across the Nation, including repeated measurements of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, tissue-type plasminogen activator antigen (tPA-ag), plasminogen activator inhibitor Type 1 (PAI-1), and Factor VIIc (Factor VII coagulant activity). We obtained residence-proximate PM2.5 and ozone monitoring data for a maximum five annual visits, calculating prior year, six-month, one-month, and one-day exposures and their relations to serum markers using longitudinal mixed models. For the 2,086 women studied from 1999 through 2004,PM2.5 exposures were a...
Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic... more Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capi...
Objectives: We investigated whether higher neighborhood poverty was associated with poorer physic... more Objectives: We investigated whether higher neighborhood poverty was associated with poorer physical functioning-related health outcomes, including body mass index (BMI), waist size and percent body fat; self-rated physical activity; and performance-based physical functioning, including timed walk, timed stair climb, and timed 2-lb lift in a sample of mid-life women.Methods: The study sample (n=1156) combines two study cohorts, including Michigan Bone Health and Metabolism Study (n=614) and Michigan site of Study of Women's Health Across the Nation (n=542). Year 1996 participant addresses were geocoded using batchgeocode.com and measures of neighborhood poverty (the proportion of residents living below the poverty line in a participant's census tract) were obtained from 1990 census data. Multilevel models with random intercepts were justified for two outcomes only (timed walk and 2-lb lift). All other continuous outcomes were modeled using OLS regression. Ordinal logistic reg...
Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuat... more Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuating oxidative stress. We evaluated associations between lifestyle factors and urine F(2a)-isoprostanes, a marker of oxidative stress in 1610 participants of the Study of Women's Health Across the Nation (SWAN). Dietary intake and physical activity were assessed at baseline and the 5th year 05 (Y05). These data were related to Y05 urinary F(2a)-isoprostane concentration with regression analyses. Median urine F(2a)-isoprostane concentration was 433 ng/L overall, 917 ng/L in smokers [inter-quartile range (IQR): 467, 1832 ng/L], and 403 ng/L in nonsmokers (IQR: 228, 709 ng/L; P < 0.0001 for difference). Higher trans fat intake was associated with higher urine F(2a)-isoprostane concentration; partial Spearman correlations (rho(x|y)) between Y05 urine F(2a)-isoprostane concentration and trans fatty acids was 0.19 (P = 0.03) in smokers and 0.13 (P < 0.0001) in nonsmokers. Increased lo...
Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic... more Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capi...
Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuat... more Smoking, diet, and physical activity may impact chronic diseases in part by promoting or attenuating oxidative stress. We evaluated associations between lifestyle factors and urine F(2a)-isoprostanes, a marker of oxidative stress in 1610 participants of the Study of Women's Health Across the Nation (SWAN). Dietary intake and physical activity were assessed at baseline and the 5th year 05 (Y05). These data were related to Y05 urinary F(2a)-isoprostane concentration with regression analyses. Median urine F(2a)-isoprostane concentration was 433 ng/L overall, 917 ng/L in smokers [inter-quartile range (IQR): 467, 1832 ng/L], and 403 ng/L in nonsmokers (IQR: 228, 709 ng/L; P < 0.0001 for difference). Higher trans fat intake was associated with higher urine F(2a)-isoprostane concentration; partial Spearman correlations (rho(x|y)) between Y05 urine F(2a)-isoprostane concentration and trans fatty acids was 0.19 (P = 0.03) in smokers and 0.13 (P < 0.0001) in nonsmokers. Increased lo...
Background: Several cohort studies report associations between chronic exposure to ambient fine p... more Background: Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods: We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results: We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 mg/m 3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions: In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
Pain has been associated with cognitive problems in pain patients. This study evaluated the exten... more Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) -0.074 (0.021); p value<0.01] and this association was partially explained by depressive symptoms [β (SE) -0.061 (0.022); p value<0.01 after adjusting for depressive...
During midlife, physical functioning limitations emerge and depressive symptoms are highly preval... more During midlife, physical functioning limitations emerge and depressive symptoms are highly prevalent. We examined the relationship between physical functioning and depressive symptoms in the Michigan Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven performance-based physical functioning measures quantifying strength, balance, coordination, flexibility and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D scores were associated with performance-based functions including slower timed walk sit-to-stand, and stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age increased, those with higher CES-D scores were more likely to have perceived limitations in physical functioning, though the association was weak. History of depressive symptoms was not significant in any model. These findings suggest that higher concurrent depressive symptoms are modestly associated with slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms played little or no role in current physical functioning of mid-life women. When evaluating physical function, women’s current mental health status should be considered. 2010 Elsevier
Context—Physical functioning represents an integrated marker of aging. Whether menopause is assoc... more Context—Physical functioning represents an integrated marker of aging. Whether menopause is associated with an accelerated decline in physical functioning is not known. Objective—To characterize whether losses in physical functioning are related to the natural or surgical menopause or time, following adjustment for body size and smoking behavior.
The Journal of Clinical Endocrinology & Metabolism, 2007
Understanding the menopause association with body weight is important because excess weight incre... more Understanding the menopause association with body weight is important because excess weight increases risk for stroke, incident cardiovascular disease, cardiovascular mortality, and all-cause mortality among the middle-aged. The objective of this study was to examine chronological age and ovarian age and consider how these could influence body size and composition in midlife women. The Study of Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Across the Nation is a longitudinal, community-based study. This report uses data from the Michigan Study of Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Across the Nation site. Participants were 543 premenopausal or early perimenopausal African-American and Caucasian women aged 42-52 yr at baseline examination. Waist circumference, fat mass and skeletal muscle mass, from bioelectrical impedance, were assessed in seven annual serial measures. Annual FSH values were assayed by ELISA. The final menstrual period was defined retrospectively after 12 months of amenorrhea. There was an absolute cumulative 6-yr increase in fat mass of 3.4 kg and a 6-yr decrease in skeletal muscle mass of approximately 0.23 kg. There was an absolute cumulative 6-yr increase of approximately 5.7 cm in waist circumference. The (log)FSH change was positively correlated with (log)(fat mass) change. Waist circumference increased over the time period, but 1 yr after final menstrual period, the rate of increase slowed. Fat mass continued to increase with no change in rate. Both time (chronological aging) and ovarian aging contributed to substantial changes in body composition (fat and skeletal muscle mass) and waist circumference. These changes have important ramifications for establishing a metabolic environment that can be healthy or unhealthy.
Background—Due to the public health burden of age-related declines in physical functioning, it is... more Background—Due to the public health burden of age-related declines in physical functioning, it is important to identify targets for intervention for the prevention of functional decline. We prospectively examined whether higher levels of inflammatory and hemostatic markers (high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA-ag), fibrinogen, and Factor VIIc (FVIIc)) were prospectively associated with reporting greater limitations in perceived physical functioning, and explored potential racial differences in the associations, in a multi-ethnic sample of mid-life women.
We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP... more We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP) and fibrinogen are related to measures of physical functioning in midlife women. Our sample included 543 participants in the Michigan site of Study of Women's Health Across the Nation (SWAN). Predictors included CRP from serum and fibrinogen from plasma. Performance-based outcomes included measures of gait, hand grip strength, flexibility, stair climb, 40-foot walk, and chair rise. Perception of physical functioning was assessed with the Medical Outcomes Study Short-Form 36 questionnaire. Regression analyses adjusted for relevant covariates. Cross-sectional associations were identified between higher CRP and more time spent in double support (with both feet on the floor while walking), shorter forward reach, slower 2-lb lift, and slower stair climb. Higher CRP and fibrinogen were associated with worse perceived functioning in cross-sectional analyses. Predictive associations across time were found between higher CRP and increased time spent in double support, diminishing forward reach distance and grip strength and worse perceived physical functioning. Predictive associations across time were also found between higher fibrinogen and greater time spent in double support, slower stair climb and worse perceived physical functioning. Our results suggest that inflammatory processes are associated with poor physical functioning in midlife women.
Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborho... more Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Arch Phys Med Rehabil 2008;89:1468-73. Objectives: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). Design: A cross-sectional study. Setting: Urban university. Participants: Men with SCI (N131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. Results: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR].19; 95% confidence interval [CI], .04 –.80), metabolic syndrome (OR.15; 95% CI, .03–.66) and high CRP (OR.17; 95% CI, .04 –.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR.14; 95% CI, .04 –.49) than their counterparts. Conclusions: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome , and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.
Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban commu... more Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005;86:664-71. Objectives: To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data. Design: Cross-sectional. Setting: Urban university. Participants: Ninety-five community-dwelling men with paraplegia (age range, 20 –59y). Interventions: Not applicable. Main Outcome Measures: Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression. Results: Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets. Conclusions: Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases.
Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community... more Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community-dwelling adults with Down syndrome in the Chicago area. Dietary intake was measured using a food frequency questionnaire completed by the participant's primary caregiver; anthropometric measures included height and weight and waist circumference. Plasma glucose and lipid concentrations were assessed following a 10-hour fast. Overall, 89% of participants were overweight or obese, 54% had large waist circumferences, and none met the current guidelines for fruit and vegetable intake. Mean concentrations for lipids and glucose, however, were within normal limits; and prevalence for hypertension, elevated lipids, and glucose were less than those for the general population of the United States.
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Papers by Kristin Tomey
We examined the relationship between physical functioning and depressive symptoms in the Michigan
Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven
performance-based physical functioning measures quantifying strength, balance, coordination, flexibility
and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning
sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified
concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive
symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was
used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D
scores were associated with performance-based functions including slower timed walk sit-to-stand, and
stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age
increased, those with higher CES-D scores were more likely to have perceived limitations in physical
functioning, though the association was weak. History of depressive symptoms was not significant in any
model. These findings suggest that higher concurrent depressive symptoms are modestly associated with
slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms
played little or no role in current physical functioning of mid-life women. When evaluating physical
function, women’s current mental health status should be considered.
2010 Elsevier
We examined the relationship between physical functioning and depressive symptoms in the Michigan
Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven
performance-based physical functioning measures quantifying strength, balance, coordination, flexibility
and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning
sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified
concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive
symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was
used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D
scores were associated with performance-based functions including slower timed walk sit-to-stand, and
stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age
increased, those with higher CES-D scores were more likely to have perceived limitations in physical
functioning, though the association was weak. History of depressive symptoms was not significant in any
model. These findings suggest that higher concurrent depressive symptoms are modestly associated with
slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms
played little or no role in current physical functioning of mid-life women. When evaluating physical
function, women’s current mental health status should be considered.
2010 Elsevier