G. Rhys Williams

Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults

Background—Mortality resulting from coronary heart disease (CHD), cardiovascular disease (CVD), and all causes in persons with diabetes and pre-existing CVD is high; however, these risks compared with those with metabolic syndrome (MetS) are unclear. We examined the impact of MetS on CHD, CVD, and overall mortality among US adults. Methods and Results—In a prospective cohort study, 6255 subjects 30 to 75 years of age (54% female) (representative of 64 million adults in the United States) from the Second National Health and Nutrition Examination Survey were followed for a mean±sd of 13.3±3.8 years. MetS was defined by modified National Cholesterol Education Program criteria. From sample-weighted multivariable Cox proportional-hazards regression, compared with those with neither MetS nor prior CVD, age-, gender-, and risk factor–adjusted hazard ratios (HRs) for CHD mortality were 2.02 (95% CI, 1.42 to 2.89) for those with MetS and 4.19 (95% CI, 3.04 to 5.79) for those with pre-existing CVD. For CVD mortality, HRs were 1.82 (95% CI, 1.40 to 2.37) and 3.14 (95% CI, 2.49 to 3.96), respectively; for overall mortality, HRs were 1.40 (95% CI, 1.19 to 1.66) and 1.87 (95% CI, 1.60 to 2.17), respectively. In persons with MetS but without diabetes, risks of CHD and CVD mortality remained elevated. Diabetes predicted all mortality end points. Those with even 1 to 2 MetS risk factors were at increased risk for mortality from CHD and CVD. Moreover, MetS more strongly predicts CHD, CVD, and total mortality than its individual components. Conclusions—CHD, CVD, and total mortality are significantly higher in US adults with than in those without MetS.

Defining clinically meaningful change in health-related quality of life

This article reviews current approaches to defining clinically meaningful change in health-related quality of life (HRQOL) and provides guidelines for their use. Definitions of clinically meaningful change are discussed. Two broad methods for identifying clinically meaningful change are contrasted: anchor-based methods and distribution-based methods. Anchor-based methods include cross-sectional approaches and longitudinal approaches. Distribution-based methods include those based on statistical significance, sample variability, and measurement precision. Anchor-based and distribution-based methods have advantages and limitations, and neither seems to be superior to the other. An integrated system for defining clinically meaningful change is recommended that combines anchor-based and distribution-based methods. We propose a new terminology for describing meaningful change derived from anchor-based and distribution-based methods.

Walking speed predicts health status and hospital costs for frail elderly male veterans

This study evaluated the use of walking speed as an indicator of function and health status in acutely ill, hospitalized, older male veterans. Hospital inpatients in a Department of Veterans Affairs (VA) study of Geriatric Evaluation and Management (GEM) (n = 1,388, age 74.2 +/- 5.7, 98% male) were followed for 1 year. The results indicate that each 0.10 m/s reduction in baseline walking speed was associated with poorer health status (36-item short form [SF-36] beta = 4.5 [95% confidence interval (CI) 2.8 to 6.1]), poorer physical functioning (beta = 2.1 [6.9 to 14.8]), more disabilities (beta = 0.63 [0.53 to 0.73]), additional rehabilitation visits (2.0 [1.4 to 2.5]), increased medical-surgical visits (2.8 [1.9 to 3.7]), longer hospital stays (2.2 [1.4 to 2.9]), and higher costs (

Assessing weight-related quality of life in obese persons with type 2 diabetes

1,334 [

Evaluation of continuous summary physical performance scores (CSPPS) in an elderly cohort

869 to

Treatment of Rheumatoid Arthritis by Selective Inhibition of T-Cell Activation with Fusion Protein CTLA4Ig

1,798]). In addition, each 0.10 m/ s/yr increase in walking speed resulted in improved health status (SF-36 beta = 8.4 [6.0 to 10.7]), improved physical function (beta = 2.9 [2.5 to 3.3]), fewer basic disabilities (0.30 [0.2 to 0.4]), fewer instrumental disabilities (0.7 [0.6 to 0.8]), fewer hospitalization days (2.3 [1.3 to 3.3]), and 1-year cost reductions of

Inflammatory Markers and Physical Performance in Older Persons: The InCHIANTI Study

1,188 [-

Development of a Brief Measure to Assess Quality of Life in Obesity

65 to

Health-Related Quality of Life Varies among Obese Subgroups

2,442]. Walking speed is useful for the functional assessment of acutely ill, hospitalized older adults. Measurement of walking speed over time may help predict those who will need and use more health-related services.

The relationship between health-related quality of life and weight loss.

Because approximately 80% of individuals with type 2 diabetes are obese, we examined weight-related QOL in obese persons with diabetes using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. Study participants were enrolled in a clinical trial for an obesity medication or a clinical study of gastric bypass surgery. Psychometric properties of the IWQOL-Lite were evaluated separately for obese persons with (n = 225) and without (n = 972) type 2 diabetes. Internal consistency reliabilities were similar for persons with and without diabetes (0.981 versus 0.980). Correlations between IWQOL-Lite scores and body mass index were significant and comparable for persons with and without diabetes. The IWQOL-Lite factor structure was similar for both the diabetic and non-diabetic subjects and consistent with earlier studies. There was no difference between diabetic and non-diabetic subjects on weight-related QOL as measured by the IWQOL-Lite; however, subjects in this study had more impaired weight-related QOL relative to a reference sample of overweight/obese community persons. We recommend the use of weight-related QOL measures in addition to generic and diabetes-specific measures when assessing quality of life in type 2 diabetes, particularly when patients are overweight or obese.