K Jameson

Birthweight and mortality in adulthood: a systematic review and meta-analysis

BACKGROUNDnSmall birth size may be associated with increased risk of cardiovascular diseases (CVD), whereas large birth size may predict increased risk of obesity and some cancers. The net effect of birth size on long-term mortality has only been assessed in individual studies, with conflicting results.nnnMETHODSnThe Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines for conducting and reporting meta-analysis of observational studies were followed. We retrieved 22 studies that assessed the association between birthweight and adult mortality from all causes, CVD or cancer. The studies were systematically reviewed and those reporting hazard ratios (HRs) and 95% confidence intervals (95% CIs) per kilogram (kg) increase in birthweight were included in generic inverse variance meta-analyses.nnnRESULTSnFor all-cause mortality, 36,834 deaths were included and the results showed a 6% lower risk (adjusted HRu2009=u20090.94, 95% CI: 0.92-0.97) per kg higher birthweight for men and women combined. For cardiovascular mortality, the corresponding inverse association was stronger (HRu2009=u20090.88, 95% CI: 0.85-0.91). For cancer mortality, HR per kg higher birthweight was 1.13 (95% CI: 1.07-1.19) for men and 1.04 (95% CI: 0.98-1.10) for women (P(interaction)u2009=u20090.03). Residual confounding could not be eliminated, but is unlikely to account for the main findings.nnnCONCLUSIONnThese results show an inverse but moderate association of birthweight with adult mortality from all-causes and a stronger inverse association with cardiovascular mortality. For men, higher birthweight was strongly associated with increased risk of cancer deaths. The findings suggest that birthweight can be a useful indicator of processes that influence long-term health.

The relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study.

Aimsu2002 To assess the relationship between depression scores and diabetes, glucose and insulin in a cross‐sectional population‐based study.

The relationship of dietary patterns with adult lung function and COPD

Previous studies of diet and lung function have focused on associations with individual nutrients and foods, and not dietary patterns. The relationships between dietary patterns and lung function and spirometrically defined chronic obstructive pulmonary disease (COPD) were investigated in 1,551 males and 1,391 females in Hertfordshire, UK. Dietary information was obtained by food frequency questionnaire and dietary patterns were identified using principal components analysis. Using regression analysis, after controlling for confounders, a “prudent” pattern (high consumption of fruit, vegetables, oily fish and wholemeal cereals) was positively associated with forced expiratory volume in 1 s (FEV1) (trend p-value <0.001 in males, 0.008 in females) (difference in FEV1 between top and bottom quintiles of pattern score, 0.18 L (95% CI 0.08–0.28 L) in males, 0.08 L (95% CI 0.00–0.16 L) in females). This pattern was also positively associated with forced vital capacity (FVC) in both sexes. Males with a higher “prudent” pattern score had a higher FEV1/FVC (trend p-value 0.002) and a lower prevalence of COPD (odds ratio comparing top versus bottom quintile 0.46, 95% CI 0.26–0.81; trend p-value 0.012). Associations in males were stronger in smokers than nonsmokers (interaction p-value for FEV1/FVC 0.002). A “prudent” dietary pattern may protect against impaired lung function and COPD, especially in male smokers.

Volumetric bone mineral density of the tibia is not increased in subjects with radiographic knee osteoarthritis

OBJECTIVESnRadiographic osteoarthritis (ROA) has previously been shown to be associated with an increase in areal bone mineral density (BMD) as assessed by dual energy X-ray absorptiometry (DXA). Here we have assessed volumetric bone density, size and strength by peripheral quantitative computed tomography (pQCT) in a large population-based cohort study in which knee radiographs were available.nnnMETHODSnTwo hundred and ninety-five men and 288 women from the MRC Hertfordshire Cohort Study underwent weight bearing extended knee X-rays and bone density measurement of the ipsi-lateral knee using pQCT.nnnRESULTSnIncreasing radiographic grade in men but not women was associated with an increase in tibial total area at 38% site and cortical area at 14% site, but not with volumetric BMD. The tibial fracture loads as well as tibial polar strength strain index at 38% site were also increased. There were no significant associations of tibia bone area, BMD or strength with radiographic grade in women.nnnCONCLUSIONnROA is not associated with an increase in volumetric BMD as assessed by pQCT. It is, however, associated with a significant increase in bone area and strength, indicating that the association between ROA and areal BMD is mediated through bone size rather than volumetric BMD.

Measuring appetite with the simplified nutritional appetite questionnaire identifies hospitalised older people at risk of worse health outcomes

OBJECTIVESnPoor appetite is commonly reported by older people but is rarely measured. The Simplified Nutritional Appetite Questionnaire (SNAQ) was validated to predict weight loss in community dwelling older adults but has been little used in hospitals. We evaluated it in older women on admission to hospital and examined associations with healthcare outcomes.nnnDESIGNnLongitudinal observational with follow-up at six months.nnnSETTINGnFemale acute Medicine for Older People wards at a University hospital in England.nnnPARTICIPANTSn179 female inpatients.nnnMEASUREMENTSnAge, weight, Body Mass Index (BMI), grip strength, SNAQ, Barthel Index Score, Mini Mental State Examination (MMSE), Geriatric Depression Scale: Short Form (GDS-SF), Malnutrition Universal Screening Tool (MUST), category of domicile and receipt of care were measured soon after admission and repeated at six month follow-up. The length of hospital stay (LOS), hospital acquired infection, readmissions and deaths by follow-up were recorded.nnnRESULTSn179 female participants mean age 87 (SD 4.7) years were recruited. 42% of participants had a low SNAQ score (<14, indicating poor appetite). A low SNAQ score was associated with an increased risk of hospital acquired infection (OR 3.53; 95% CI: 1.48, 8.41; p=0.004) and with risk of death (HR 2.29; 95% CI: 1.12, 4.68; p = 0.023) by follow-up.nnnCONCLUSIONnPoor appetite was common among the older hospitalised women studied, and was associated with higher risk of poor healthcare outcomes.

Incidence of hip fracture in Rohtak district, North India

SummaryHip fracture incidence is not known in India. This retrospective study was conducted to evaluate hip fracture incidence rates in Rohtak, a single district of North India. A total of 304 patients from this district with hip fracture were hospitalized during the calendar year 2009. The crude hip fracture rates were found to be 159 and 105 per 100,000, respectively, in women and men above the age of 50xa0years. Hip fracture is a significant health problem in North India.PurposeThis aims to study hip fracture incidence in Rohtak district of North India.MethodsThe study was conducted in Rohtak district, Haryana state, India located 80xa0km north of New Delhi. All patients having hip fracture admitted in Pandit B.D. Sharma Postgraduate Institute or one of the four orthopaedic centres located in Rohtak in year 2009 were included. Total population of Rohtak for the year 2009 was used to calculate age-specific hip fracture incidence.ResultsA total of 541 patients with hip fracture were hospitalized in Rohtak district in year 2009. Out of these, 304 were from Rohtak district. Hip fracture crude incidence above the age of 50xa0years was 129 per 100,000. The corresponding figures were 105 and 159 per 100,000 among men and women, respectively. Hip fracture incidence was similar in both sexes till age of 55xa0years. From age of 55 onwards, the rates were significantly higher in women.ConclusionsThis is the first hip fracture incidence study from India. Hip fracture incidence rates in Rohtak district of India are intermediate between those in the industrialised world and Africa and similar to some of Asian countries such as China, Iran and South Korea. This study will help in formulating strategies for prevention of hip fracture in India.

Evaluation of common genetic variants identified by GWAS for early onset and morbid obesity in population-based samples

Background:Meta-analysis of case–control genome-wide association studies (GWAS) for early onset and morbid obesity identified four variants in/near the PRL, PTER, MAF and NPC1 genes.Objective:We aimed to validate association of these variants with obesity-related traits in population-based samples.Design:Genotypes and anthropometric traits were available in up to 31u2009083 adults from the Fenland, EPIC-Norfolk, Whitehall II, Ely and Hertfordshire studies and in 2042 children and adolescents from the European Youth Heart Study. In each study, we tested associations of rs4712652 (near-PRL), rs10508503 (near-PTER), rs1424233 (near-MAF) and rs1805081 (NPC1), or proxy variants (r 2>0.8), with the odds of being overweight and obese, as well as with body mass index (BMI), percentage body fat (%BF) and waist circumference (WC). Associations were adjusted for sex, age and age2 in adults and for sex, age, age group, country and maturity in children and adolescents. Summary statistics were combined using fixed effects meta-analysis methods.Results:We had 80% power to detect odds ratios of 1.046 to 1.092 for overweight and 1.067 to 1.136 for obesity. Variants near PRL, PTER and MAF were not associated with the odds of being overweight or obese, or with BMI, %BF or WC after meta-analysis (P>0.15). The NPC1 variant rs1805081 showed some evidence of association with %BF (β=0.013u2009s.d./allele, P=0.040), but not with any of the remaining obesity-related traits (P>0.3).Conclusion:Overall, these variants, which were identified in a GWAS for early onset and morbid obesity, do not seem to influence obesity-related traits in the general population.

Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius.

SummaryIn this study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to investigate geometric, volumetric and microstructural parameters at the distal radius and at the distal tibia in participants with ischaemic heart disease. We found that, compared with participants without ischaemic heart disease, they had substantially lower cortical volumetric bone mineral density (BMD) at the distal radius.IntroductionHR-pQCT captures novel aspects of bone geometry and volumetric bone mineral density (vBMD) and offers the ability to measure bone microarchitecture, but data relating measures obtained from this technique in patients with ischemic heart disease (IHD) are lacking.MethodsHere, we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between measures obtained from HR-pQCT of distal radius and distal tibia in 350 participants (184 men and 166 women) aged 71.5–80.5xa0years with or without IHD (e.g. heart attack, angina or heart failure; nu2009=u200975 and nu2009=u2009275, respectively).ResultsAnalyses for all participants (men and women together) revealed that cortical vBMD (Ct.vBMD) was lower (pu2009<u20090.001) and cortical thickness (Ct.th) was not different (pu2009=u20090.519), whereas cortical porosity (Ct.Po) was higher (pu2009=u20090.016) in participants with IHD at the distal radius. Moreover, trabecular microarchitectural parameters were not significantly different in patients with IHD (pu2009>u20090.05 for all). Adjustment for a priori confounders (age, gender, body mass index, smoking status, alcohol consumption, high blood pressure and diabetes mellitus) did not materially affect the relationship described for Ct.vBMD (pu2009=u20090.002), but differences in Ct.Po were attenuated. Analyses in men alone revealed that only Ct.vBMD was lower at the distal radius in participants with IHD with and without adjustment for a priori confounders (pu2009=u20090.0002 and pu2009=u20090.004, respectively), whereas no statistical differences were found in women, although patterns of differences were similar in both sexes. Moreover, no association was found between IHD and bone parameters at the distal tibia either in men or women.ConclusionsWe have demonstrated that IHD is associated with lower Ct.vBMD of the distal radius.

Cigarette smoking, birthweight and osteoporosis in adulthood: results from the hertfordshire cohort study.

We looked for interaction between early environment and adult lifestyle in determination of bone mineral content (BMC) and bone mineral density (BMD) among 498 men and 468 women for whom birth records were available. Participants completed a health questionnaire, and bone densitometry (DXA) of the lumbar spine and femoral neck performed. We found no relationships between cigarette and alcohol consumption, physical activity and either BMC or BMD after adjustment for age, body mass index, dietary calcium, social class, HRT use and years since menopause. However, male current smokers in the lowest third of birth weight had lower femoral neck BMD than ex- or never smokers from the lowest birth weight third (p value for interaction term = 0.04). Similar trends were seen with femoral neck BMC and lumber spine BMC.Individuals of lower birth weight may be particularly vulnerable to the effects of bone noxious stimuli such as cigarette smoking.

A Study of Relationships Between Single Nucleotide Polymorphisms from the Growth Hormone-Insulin-like Growth Factor Axis and Bone Mass: the Hertfordshire Cohort Study

Objective. We sought evidence of association of candidate single nucleotide polymorphisms (SNP) within the growth hormone-insulin-like growth factor 1 (IGF1) axis, largely selected on the basis of functional data available at the time of our study, with adult bone mass. Methods. Four hundred ninety-eight men and 468 women aged 59–71 years were recruited. A lifestyle questionnaire was administered, and bone mineral content (BMC) and bone mineral density (BMD) were measured at the lumbar spine and femoral neck. Two hundred fifty-four men and 271 women had repeat bone densitometry 4 years later. DNA was obtained from whole blood samples using standard extraction techniques. Single nucleotide variants in the growth hormone releasing hormone gene (GHRH, G/A 223 Phe75Leu, rs4988492), growth hormone releasing hormone receptor gene (GHRHR, G/A 217, Ala57Thr, rs4988496), the growth hormone secretagogue receptor gene (GHSR, T/C, Gly57Gly, rs495225), and the growth hormone receptor gene (GHR, T/G, noncoding, rs2940944) were analyzed. Results. In both sexes, allelic variation in the gene encoding GHRH was associated with BMC and BMD at the proximal femur and lumbar spine, with results generally stronger in women. In women, the mean BMC lumbar spine within the GHRH 11 genotype was 56.9 g, while that of the GHRH 12 genotype was 68.4 g [p < 0.001, fully adjusted for age, body mass index, cigarette and alcohol consumption, dietary calcium intake, physical activity, years since menopause, and hormone replacement therapy (HRT) use]; corresponding figures for BMD lumbar spine (GHRH 11 genotype) were 0.96 g/cm2 versus 1.10 g/cm2 (p < 0.001 fully adjusted). Conclusion. We have demonstrated a relationship between allelic variation in the gene encoding GHRH and bone density; we welcome attempts at replication in other populations.