Sex dimorphism in the association of cardiometabolic characteristics and osteophytes-defined radiographic knee osteoarthritis among obese and non-obese adults: NHANES III

SummaryObjectiveTo examine the relationship of knee osteoarthritis (OA) with cardiovascular and metabolic risk factors by obesity status and gender.MethodsData from 1,066 National Health and Nutrition Examination Survey III participants (≥60years of age) was used to examine relationships of osteophytes-defined radiographic knee OA and cardiovascular and metabolic measures. Analyses were considered among obese [body mass index (BMI)≥30kg/m2] and non-obese (BMI<30kg/m2) men and women.ResultsThe prevalence of osteophytes-defined radiographic knee OA was 34%. Leptin levels and homeostatic model assessment-insulin resistance (HOMA-IR), a proxy measure of insulin resistance, were significantly associated with knee OA; those with knee OA had 35% higher HOMA-IR values and 52% higher leptin levels compared to those without knee OA. The magnitude of the association between HOMA-IR and knee OA was strongest among men, regardless of obesity status; odds ratios (ORs) for HOMA-IR were 34% greater among non-obese men (OR=1.18) vs obese women (OR=0.88). Among obese women, a 5-μg/L higher leptin was associated with nearly 30% higher odds of having knee OA (OR=1.28). Among men, ORs for the association of leptin and knee OA were in the opposite direction.ConclusionsCardiometabolic dysfunction is related to osteophytes-defined radiographic knee OA prevalence and persists within subgroups defined by obesity status and gender. A sex dimorphism in the direction and magnitude of cardiometabolic risk factors with respect to knee OA was described including HOMA-IR being associated with OA prevalence among men while leptin levels were most important among women

Lack of food access and food consumption patterns of late midlife women in southeast Michigan

Background: Food access is a key social determinant of health for older adults at high risk of chronic disease and physical disability. Methods: This cross-sectional analysis examined correlates of food access and the relationship between food access and food consumption characteristics in a sample of 316 late midlife women from Southeast Michigan in 2015-2016. Results: Lack of food access, defined as access to self-perceived adequate grocery shopping resources in one’s neighborhood, was reported by 20.9% of women. Women who reported lack of food access were less likely to report making meals at home (p=0.02) and had less frequent consumption of fresh fruits (p=0.04), fresh vegetables (p=0.001), and lean meats (p=0.048) as compared to those that did not report a lack of food access (p=0.04, p=0.001, p=0.048). Being African American (OR: 2.49; 95% CI: 1.20-5.17) and experiencing economic stress (OR: 2.86; 95% CI: 2.53-5.33) were major correlates of reporting lack of food access. Conclusion: Interventions to improve food access for midlife women may help address differences in chronic disease risk associated with diet quality among racial/ethnic groups and across socioeconomic status

Reproductive History and Chronic Hepatic Steatosis in the Michigan Study of Women's Health Across the Nation

Background: Reproductive history, particularly maternal age at most recent birth, may reflect lower risk for chronic disease and mortality due to socioeconomic factors, lifestyle behaviors, or genetics. Reproductive history has not been examined with respect to hepatic steatosis, the most common liver disease in the United States. Our objective was to examine the association between reproductive history and hepatic steatosis. Methods: We examined the association between reproductive history characteristics?specifically age at most recent birth?and the odds of moderate to severe hepatic steatosis using a population-based retrospective cohort study of women who underwent hepatic ultrasound at the Michigan site of the Study of Women's Health Across the Nation (n=331). Results: Women who gave birth at ≥35 years of age comprised 19% of the study population and were similar to other women regarding sociodemographic history and health behaviors. In multivariable analyses adjusting for age, race/ethnicity, chronic disease, and medications associated with hepatic steatosis, age at birth ≥35 years was associated with significantly decreased odds of hepatic steatosis (adjusted odds ratio [OR] 0.41, 95% confidence interval [CI] 0.20?0.87), which was attenuated after adjustment for waist circumference (OR 0.51, 95% CI 0.24?1.10). Other reproductive factors including gravidity, parity, miscarriages and abortions, recall of gestational weight gain, breastfeeding, age at first birth, and age at final menstrual period were not associated with hepatic steatosis. Conclusions: Women who were older at their most recent birth had a reduced odds of hepatic steatosis, possibly associated with their lower waist circumference.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140129/1/jwh.2014.4839.pd

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

Abstract 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 (n = 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 p < 0.0001). After adjustment for baseline sociodemographic factors, perceived stress decreased over time for most women (p < 0.0001), but increased for both Hispanic and white participants at the New Jersey site (p < 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.https://deepblue.lib.umich.edu/bitstream/2027.42/142790/1/40695_2018_Article_32.pd

Ethnicity predicts perceptions of smoking and smoking cessation among veterans

The objective of this study was to determine if race/ethnicity predicts motivation to quit smoking and preferences for cessation services among smokers serviced by a primarily psychiatric Veterans Affairs hospital. A self‐administered survey was given to a convenience sample of smokers ( n = 146) at the Battle Creek Veterans Affairs Medical Center. Univariate, bivariate and multivariate regression analyses were calculated to determine the association between race/ethnicity and motivation to quit smoking. Forty‐two per cent of the sample was non‐White. Non‐White patients smoked significantly less cigarettes per day as compared with White patients ( P = 0.002). In the multivariate analyses, compared with Whites, non‐Whites had 3.5 times greater odds of thinking that quitting smoking was extremely/very important to health ( P = 0.01), 4.0 times greater odds of thinking of quitting using tobacco products in the next 30 days ( P = 0.004) and 3.4 times greater odds of being interested in receiving smoking cessation services ( P = 0.007). Yet, non‐White patients were less likely to be interested in intensive nurse counselling and cessation medications. As the number of non‐Whites continues to increase in the military, novel strategies may be needed to capitalize on the high motivation to quit smoking and preference for non‐traditional interventions among non‐White smokers treated in Veterans Affairs hospitals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90416/1/j.1365-2850.2011.01757.x.pd

Urinary Nâ Telopeptide as Predictor of Onset of Menopauseâ Related Bone Loss in Preâ and Perimenopausal Women

The menopause transition (MT) is a period of rapid bone loss and has been proposed to be a timeâ limited window for early intervention to prevent permanent microarchitectural damage and reduce the risk of subsequent fracture. To intervene early, however, we first need to be able to determine whether menopauseâ related bone loss is about to begin, in advance of substantial bone loss. The objective of this study was, therefore, to assess whether urinary Nâ telopeptide (Uâ NTX) in preâ or early perimenopause can predict the onset of menopauseâ related bone loss. Repeated Uâ NTX measurements were obtained during preâ and early perimenopause in 1243 participants from the Study of Women’s Health Across the Nation (SWAN). We examined the ability of Uâ NTX to predict the onset of significant menopauseâ related bone loss (categorical outcome, yes versus no) at the lumbar spine (LS) and femoral neck (FN), defined as annualized bone mineral density (BMD) decline at a rate faster than the smallest detectable change in BMD over the 3 to 4 years from the time of Uâ NTX measurement. Adjusting for age, race/ethnicity, body mass index, urine collection time, starting BMD, and study site in multivariable, modified Poisson regression, every standard deviation increment in Uâ NTX, measured at baseline in early perimenopausal women, was associated with an 18% and 22% greater risk of significant bone loss at the LS (pâ =â 0.003) and FN (pâ =â 0.003), respectively. The area under the receiverâ operator curve for predicting LS and FN bone loss was 0.72 and 0.72, respectively. In mixedâ effects analysis of all repeated measures of early perimenopausal Uâ NTX over followâ up, Uâ NTX predicted onset of bone loss at the LS (pâ =â 0.002) but not at the FN. We conclude that Uâ NTX can be used early in the MT to determine if a woman is about to experience significant LS bone loss before there has been substantial skeletal deterioration. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149249/1/jbm410116_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149249/2/jbm410116.pd

Post‐discharge tobacco cessation rates among hospitalized US veterans with and without diabetes

Aims  Smoking is a major risk factor for cardiovascular complications among patients with diabetes. Hospitalization has been shown to enhance cessation rates. The purpose of this study was to compare 6‐month post‐hospitalization tobacco cessation rates among US veterans with and without diabetes. Methods  This was a longitudinal study among inpatient veterans who used tobacco in the past month ( n  = 496). Patients were recruited and surveyed from three Midwestern Department of Veterans Affairs hospitals during an acute‐care hospitalization. They were also asked to complete a follow‐up survey 6 months post‐discharge. Bivariate‐ and multivariable‐adjusted analyses were conducted to determine differences in tobacco cessation rates between patients with and without a diagnosis of diabetes. Results  The mean age of patients was 55.2 years and 62% were white. Twenty‐nine per cent had co‐morbid diabetes. A total of 18.8% of patients with diabetes reported tobacco cessation at 6 months compared with 10.9% of those without diabetes ( P  = 0.02). Cotinine‐verified cessation rates were 12.5 vs. 7.4% in the groups with and without diabetes, respectively ( P  = 0.07). Controlling for psychiatric co‐morbidities, depressive symptoms, age, self‐rated health and nicotine dependence, the multivariable‐adjusted logistic regression showed that patients with diabetes had three times higher odds of 6‐month cotinine‐verified tobacco cessation as compared with those without diabetes (odds ratio 3.17, P  = 0.005). Conclusions  Post‐hospitalization rates of smoking cessation are high among those with diabetes. Intensive tobacco cessation programmes may increase these cessation rates further.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92145/1/j.1464-5491.2012.03635.x.pd

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

Abstract 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.http://deepblue.lib.umich.edu/bitstream/2027.42/134529/1/40695_2016_Article_16.pd

Estradiol and Follicleâ Stimulating Hormone as Predictors of Onset of Menopause Transitionâ Related Bone Loss in Preâ and Perimenopausal Women

The menopause transition (MT) may be an opportunity for early intervention to prevent rapid bone loss. To intervene early, we need to be able to prospectively identify preâ and perimenopausal women who are beginning to lose bone. This study examined whether estradiol (E2), or follicleâ stimulating hormone (FSH), measured in preâ and perimenopausal women, can predict significant bone loss by the next year. Bone loss was considered significant if bone mineral density (BMD) decline at the lumbar spine (LS) or femoral neck (FN) from a preâ or early perimenopausal baseline to 1â year after the E2 or FSH measurement was greater than the least detectable change. We used data from 1559 participants in the Study of Women’s Health Across the Nation and tested E2 and FSH as separate predictors using repeated measures modified Poisson regression. Adjusted for MT stage, age, race/ethnicity, and body mass index, women with lower E2 (and higher FSH) were more likely to lose BMD: At the LS, each halving of E2 and each doubling of FSH were associated with 10% and 39% greater risk of significant bone loss, respectively (pâ <â 0.0001 for each). At the FN, each halving of E2 and each doubling of FSH were associated with 12% (p = 0.01) and 27% (pâ <â 0.001) greater risk of significant bone loss. FSH was more informative than E2 (assessed by the area under the receiverâ operator curve) at identifying women who were more versus less likely to begin losing bone, especially at the LS. Prediction was better when hormones were measured in preâ or early perimenopause than in late perimenopause. Tracking withinâ individual change in either hormone did not predict onset of bone loss better than a single measure. We conclude that measuring FSH in the MT can help prospectively identify women with imminent or ongoing bone loss at the LS. © 2019 American Society for Bone and Mineral Research.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153118/1/jbmr3856_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153118/2/jbmr3856.pd

Variance as a predictor of health outcomes: Subject-level trajectories and variability of sex hormones to predict body fat changes in peri- and post-menopausal women

Longitudinal biomarker data and cross-sectional outcomes are routinely collected in modern epidemiology studies, often with the goal of informing tailored early intervention decisions. For example, hormones such as estradiol and follicle-stimulating hormone may predict changes in womens' health during the midlife. Most existing methods focus on constructing predictors from mean marker trajectories. However, subject-level biomarker variability may also provide critical information about disease risks and health outcomes. In this paper, we develop a joint model that estimates subject-level means and variances of longitudinal biomarkers to predict a cross-sectional health outcome. Simulations demonstrate excellent recovery of true model parameters. The proposed method provides less biased and more efficient estimates, relative to alternative approaches that either ignore subject-level differences in variances or perform two-stage estimation where estimated marker variances are treated as observed. Analyses of women's health data reveal larger variability of E2 or larger variability of FSH were associated with higher levels of fat mass change and higher levels of lean mass change across the menopausal transition