Comparison of multiple and novel measures of dietary glycemic carbohydrate with insulin resistant status in older women

Background: Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). We explored multiple and novel measures of dietary glycemic intake to determine which was most predictive of an association with insulin resistance. Methods: Usual dietary intakes were assessed by diet history interview in women aged 42-81 years participating in the Longitudinal Assessment of Ageing in Women. Daily measures of dietary glycemic intake (n = 329) were carbohydrate, GI, GL, and GL per megacalorie (GL/Mcal), while meal based measures (n = 200) were breakfast, lunch and dinner GL; and a new measure, GL peak score, to represent meal peaks. Insulin resistant status was defined as a homeostasis model assessment (HOMA) value of \u3e3.99; HOMA as a continuous variable was also investigated. Results: GL, GL/Mcal, carbohydrate (all P \u3c 0.01), GL peak score (P = 0.04) and lunch GL (P = 0.04) were positively and independently associated with insulin resistant status. Daily measures were more predictive than meal-based measures, with minimal difference between GL/Mcal, GL and carbohydrate. No significant associations were observed with HOMA as a continuous variable. Conclusion: A dietary pattern with high peaks of GL above the individual’s average intake was a significant independent predictor of insulin resistance in this population, however the contribution was less than daily GL and carbohydrate variables. Accounting for energy intake slightly increased the predictive ability of GL, which is potentially important when examining disease risk in more diverse populations with wider variations in energy requirements

Guidelines for the management of postmenopausal osteoporosis for GPs

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Background: Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established osteoporosis. Objective: This article provides updated guidelines for the management of postmenopausal osteoporosis to assist general practitioners identify those women at risk, and reviews current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone therapy has mixed risks and benefits that requires individual patient counselling.O'Neill S; MacLennan A; Bass S; Diamond T; Ebeling P; Findlay D; Flicker L; Markwell A; Nowson C; Pocock N; Sambrook P; Singh M

Guidelines for the management of postmenopausal osteoporosis for GPs

BACKGROUND : Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established osteoporosis.OBJECTIVE : This article provides updated guidelines for the management of postmenopausal osteoporosis to assist general practitioners identify those women at risk, and reviews current treatment strategies.DISCUSSION : Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonatesr raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone therapy has mixed risks and benefits that requires individual patient counselling.<br /

The management of perimenopausal menstrual symptoms

Abnormal bleeding around the time of the menopause is common and may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. As such all will need uterine assessment which may include transvaginal scan combined with endometrial biopsy, hysteroscopy or a sonohysterogram. Having excluded (pre) cancer, treatment can then be offered. Medical treatment options include tranexamic acid to reduce blood loss, low-dose contraceptive Pills, the levonorgestrel intra-uterine device and cyclic progestins. Surgical options include resecting sub-mucus fibroids hysteroscopically, endometrial ablation and hysterectomy

The pathophysiology of menopausal symptoms

Increasing life expectancy means that most Western women will experience the menopausal transition. This phase of reproductive life involves a biopsychosocial process where the majority of women experience physiological changes, influenced by a wide range of ethnic, psychological, social and cultural factors. With relatively similar endocrine changes, symptom reporting should be generalized, yet more women in Western cultures report vasomotor symptoms (hot flushes and night sweats) compared to women in Asian cultures. Different approaches to menopause based on biological/medical, psychological or psychosocial premises result in different treatments for women who have troublesome symptoms. Hormone replacement therapy (HRT) is widely used in the management of symptoms associated with oestrogen withdrawal (hot flushes, night sweats, sleep disturbance, vaginal dryness and dyspareunia), but has no known role in the treatment of midlife depression or arthritis. HRT prevents menopausal bone loss and osteoporotic fracture, though long-term use remains controversial because of the increased risk of breast cancer, myocardial infarction and stroke, as reported by the Women\u27s Health Initiative

The management of perimenopausal menstrual symptoms

Abnormal bleeding around the time of the menopause is common and may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. As such all will need uterine assessment which may include transvaginal scan combined with endometrial biopsy, hysteroscopy or a sonohysterogram. Having excluded (pre) cancer, treatment can then be offered. Medical treatment options include tranexamic acid to reduce blood loss, low-dose contraceptive Pills, the levonorgestrel intra-uterine device and cyclic progestins. Surgical options include resecting sub-mucus fibroids hysteroscopically, endometrial ablation and hysterectomy

The pathophysiology of menopausal symptoms

Increasing life expectancy means that most Western women will experience the menopausal transition. This phase of reproductive life involves a biopsychosocial process where the majority of women experience physiological changes, influenced by a wide range of ethnic, psychological, social and cultural factors. With relatively similar endocrine changes, symptom reporting should be generalised, yet more women in Western cultures report vasomotor symptoms (hot flushes and night sweats) compared to women in Asian cultures. Different approaches to menopause based on biological, medical, psychological or psychosocial premises result in different treatments for women who have troublesome symptoms. Hormone Replacement Therapy (HRT) is widely used in the management of symptoms associated with oestrogen withdrawal such as hot flushes, night sweats, sleep disturbance, vaginal dryness and dyspareunia, but has no known role in the treatment of midlife depression or arthritis. HRT prevents menopausal bone loss and osteoporotic fracture, though long-term use remains controversial because of the increased risk of breast cancer, myocardial infarction and stroke, as reported by the Women\u27s Health Initiative. An understanding of the pathophysiology of menopausal symptoms and the risks and benefits of both hormonal and non-hormonal treatments assists in the individual management of patients

Glycemic index and glycemic load intake patterns in older Australian women

Aims: Dietary glycaemic index and glycaemic load have been associated with risk of chronic diseases, yet limited research exists on patterns of consumption in Australia. Our aims were to investigate glycaemic carbohydrate in a population of older women, identify major contributing food sources and determine low, moderate and high ranges.Methods: Subjects were 459 Brisbane women aged 42ÿ81 years participating in the Longitudinal Assessment of Ageing in Women. Diet history interviews were used to assess usual diet and results were analysed into energy and macronutrients using the FoodWorks dietary analysis program combined with a customised glycaemic index database.Results: Mean SD dietary glycaemic index was 55.6 4.4% and mean dietary glycaemic load was 115 25. A low glycaemic index in this population was 52.0, corresponding to the lowest quintile of dietary glycaemic index, and a low glycaemic load was 95. Glycaemic index showed a quadratic relationship with age (P = 0.01), with a slight decrease observed in women aged in their 60s relative to younger or older women. Glycaemic load decreased linearly with age (P \u3c 0.001). Bread was the main contributor to carbohydrate and dietary glycaemic load (17.1% and 20.8%, respectively), followed by fruit (15.5% and 14.2%), and dairy for carbohydrate (9.0%), or breakfast cereals for glycaemic load (8.9%).Conclusions: In this population, dietary glycaemic load decreased with increasing age; however, this was likely to be a result of higher energy intakes in younger women. Focus on careful selection of lower-glycaemic-index items within bread and breakfast cereal food groups would be an effective strategy for decreasing dietary glycaemic load in this population of older women

Carotid ultrasound pulsatility indices and cardiovascular risk in Australian women

Introduction Ultrasound-acquired internal carotid arterial (ICA) pulsatility indices (PI) have been demonstrated to be useful measures of cerebrovascular disease. The purpose of this cross-sectional study was to investigate the association between carotid artery PI, cardiovascular risk and ischaemic heart disease in aging women. Methods One hundred and fifty-eight female participants of the Longitudinal Assessment of Ageing in Women study, aged 48-85 years, were evaluated. The relationships between common carotid artery (CCA) and ICA Doppler PI to cardiovascular risk factors (age, body mass index, systolic and mean arterial blood pressure, smoking and diabetes), carotid-femoral (femPWV) and carotid-radial (radPWV) pulse wave velocities, and ischaemic heart disease (IHD) were assessed using Spearman\u27s rank correlation (ρ), multiple regression and logistic regression. Dependent variables were Box-Cox transformed to meet linear regression assumptions. Results CCA and ICA PI were significantly correlated to femPWV (ρ = 0.414 and ρ = 0.544, respectively). Cardiovascular risk factors were significantly predictive of CCA PI (Adj R2 = 0.176, P \u3c 0.01); however, their relationship to ICA PI (Adj R2 = 0.508, P \u3c 0.01) was stronger. This result was comparable with the relationship between cardiovascular risk factors and femPWV (Adj R2 = 0.561, P \u3c 0.01). Age and systolic blood pressure were the dominant risk factors for IHD in this group. Conclusion ICA PI is comparable with femPWV in its association with cardiovascular disease. PI does not improve the prediction of IHD over age and systolic blood pressure