Wilma Wooten

A New Tool for Encouraging Activity. Project PACE.

In brief Promoting physical activity among patients is an essential role for physicians. Project PACE (Physician-based Assessment and Counseling for Exercise) is a practical system of matching physician counseling with patient readiness for physical activity. The PACE counseling approach will help physicians attain national goals for health promotion for the year 2000.

Ethnic-specific associations of sleep duration and daytime napping with prevalent type 2 diabetes in postmenopausal women

OBJECTIVE The objective of this study was to evaluate ethnic differences in the associations of nighttime sleep and daytime napping durations with prevalent type 2 diabetes. METHODS Samples of White (n = 908), Filipina (n = 330), and Black (n = 371) community-dwelling, postmenopausal women aged 50-86 years were evaluated with cross-sectional data obtained during 1992-1999 including self-reported duration of nighttime sleep and daytime napping, behaviors, medical history, and medication use. The prevalence of type 2 diabetes was evaluated with a 2-h 75-g oral glucose tolerance test. RESULTS Overall, 10.9% of White, 37.8% of Filipina, and 17.8% of Black women had type 2 diabetes. Average sleep durations were 7.3, 6.3, and 6.6 h and napping durations were 16.8, 31.7, and 25.9 min for White, Filipina, and Black women, respectively. Sleep duration showed a significant (p < 0.01) nonlinear association with type 2 diabetes in Filipina women, with increased odds of diabetes at both low and high sleep durations independent of age, body mass index (BMI), triglyceride to high-density lipoprotein (HDL) ratio, hypertension, and daytime napping duration. Daytime napping duration was associated with type 2 diabetes only among White women; those napping ≥ 30 min/day had 74% (95% confidence interval (CI) = 10%, 175%) higher odds of diabetes compared to non-nappers independent of covariates including nighttime sleep duration. CONCLUSIONS Results suggest ethnic-specific associations of nighttime sleep and daytime napping durations with type 2 diabetes.

Estrogen Therapy and Bone Mineral Density in African-American and Caucasian Women

Controlling for body size and composition, the authors examined the association between estrogen therapy and bone mineral density in older African-American and Caucasian women. In 1992-1998, 443 African-American and 989 Caucasian women aged 45-87 years were assessed for medication use, laboratory variables, behavioral characteristics, and bone mineral density. The mean age was 61.3 (95% confidence interval: 60.3, 62.3) years in African Americans and 71.0 (95% confidence interval: 70.4, 71.7) years in Caucasians (P < 0.001). All measures of body size and composition were significantly greater in the African-American women compared with Caucasian women (P < 0.001). As expected, African Americans had significantly higher bone mineral density at all 4 sites independent of age, weight, body composition, estrogen use, and lifestyle factors. Although Caucasians were significantly more likely to currently use estrogen (48.9% vs. 33.9%; P < 0.001), African Americans not using estrogen had significantly higher bone mineral density at all sites except the spine than Caucasians who were using estrogen. Regression models including age and lean mass explained the most variation in bone mineral density (R(2) range = 0.13-0.37). Results suggest that higher levels of bone mineral density in African-American women were not due to estrogen use.

The Association Between Abdominal Muscle and Type II Diabetes Across Weight Categories in Diverse Post-Menopausal Women

CONTEXT Despite the key role of muscle in glucose regulation, little is known about the association between muscle area and prevalence of metabolic disorders, or the role low muscle may play in normal weight metabolic obesity. OBJECTIVE The objective was to assess the independent associations between both abdominal muscle and fat depositions (measured by computed tomography) and the prevalence of type II diabetes, and to explore the modifying role of weight category. DESIGN We conducted a cross-sectional analysis of the 2001-2002 visit for the Rancho Bernardo Study, Filipino Womens Health Study, and Health Assessment Study of African American Women. SETTING AND PARTICIPANTS Participants were 392 community-dwelling older women (mean age = 64) free of clinical cardiovascular disease. MAIN OUTCOME MEASURE The main outcome was prevalence of type II diabetes, defined as use of anti-diabetes medication, fasting plasma glucose ≥ 126 mg/dL, and/or OGTT ≥ 200 mg/dL. RESULTS Adjusting for demographics, hypertension, estrogen use, lipids, smoking, physical activity, visceral fat area, and height, a greater muscle-to-total abdominal area ratio (MAR) was associated with lower odds of diabetes [OR = 0.63 per standard deviation, 95% CI (0.43-0.92), p = .02]. Higher visceral fat was associated with greater odds of diabetes in fully adjusted models including total muscle area [OR = 1.48, 95% CI (1.09, 2.01), p = .01]. Associations between MAR and diabetes were stronger for normal weight (BMI 18.5-24.9; OR = 0.32) than overweight/obese women (BMI ≥ 25, OR = 0.71, p-for-interaction = 0.046). Associations with visceral fat did not differ by BMI (p-for-interaction = 0.71). CONCLUSIONS In older women, abdominal muscle area is inversely associated with type II diabetes independent of visceral adiposity, particularly for normal weight women.

Body adiposity index as a risk factor for the metabolic syndrome in postmenopausal Caucasian, African American, and Filipina women

AIMS To investigate the utility of the body adiposity index (BAI) and its association with the metabolic syndrome (MetS) in older Caucasian (n=369), African American (n=336) and Filipina (n=275) women. METHODS Dual energy X-ray absorptiometry, anthropometric measures, plasma glucose and medical history were assessed in 1993-1999. RESULTS Despite smaller body size, 32.7% of Filipina women had higher MetS compared to African American and Caucasian women based on the National Cholesterol Education Program (NCEP) (32.7% vs 19.6% and 13.3%, respectively) or the International Diabetes Federation (IDF) (42.6% vs 33.0% and 18.7%, respectively ps<0.05). BAI had higher positive correlations with BMI, %body fat (%BF), and %truncal fat in Caucasian than African American and Filipina women. Adjusted for age, smoking, estrogen use, exercise, and alcohol intake, odds of the MetS (NCEP) were 2.08 (95%CI: 1.52-2.85) by BAI, 3.04 (95%CI: 2.11-4.38) by BMI, and 2.13 (95%CI: 1.52-3.00) by %BF for Caucasian women; 0.92 (95%CI: 0.69-1.23) by BAI, 1.44 (95%CI: 1.09-1.90) by BMI, and 1.12 (95%CI: 0.84-1.50) by %BF for African American women; and 1.14 (95%CI: 0.88-1.47) by BAI, 1.51 (95%CI: 1.15-1.97) by BMI, and 0.96 (95%CI: 0.74-1.25) by %BF for Filipinas. CONCLUSION BAI was better able to assess adiposity in postmenopausal Caucasian women compared to African American and Filipina women. This index can distinguish ethnic differences in MetS confirmed by %BF.

Associations of Abdominal Muscle Area with 4-Year Change in Coronary Artery Calcium Differ by Ethnicity among Post-Menopausal Women

OBJECTIVE To examine the association of abdominal muscle area with coronary artery calcium (CAC) presence, extent, and progression in a multi-ethnic cohort of older, community-dwelling post-menopausal women. DESIGN AND SETTING Cross-sectional and longitudinal population-based cohort. PARTICIPANTS The sample comprised 179 non-Hispanic White women, 116 Filipina women and 144 African American women, all without known CVD, who underwent chest and abdominal computed tomography (CT) scans twice about four years apart for abdominal muscle and fat, as well as CAC. MAIN OUTCOME MEASURES CAC presence, extent and progression. RESULTS There was a significant interaction of ethnicity with baseline oblique muscle area (p-for-interaction .01), and marginally significant interactions with baseline total and paraspinal muscle for change in CAC (p-for-interactions both .09). Among Filipina women, each standard deviation (SD) greater total muscle area was associated with a 26% (95% CI (-43%, -4%), P=.02) reduced rate of change in CAC; higher paraspinal and oblique muscle area were associated with a 24% (-38%, -6%, P=.01) and a 37% (-53%, -16%, P=.0002) reduced rate of change in CAC, respectively. These associations were not significant in African American or non-Hispanic White women. There were no significant associations of abdominal muscle with CAC presence or extent, nor were there significant ethnicity by muscle interactions in these models. CONCLUSIONS Among Filipina women, greater abdominal muscle mass is associated with a decreased rate of CAC progression. Higher muscle mass may be important for this group in reducing CVD outcomes.

Integrated Health and Human Services Information Systems to Enhance Population-Based and Person-Centered Service

& 2013 Publ In this issue of the American Journal of Preventive Medicine, Vaithianathan and colleagues have made a valuable contribution in demonstrating how administrative data from human services systems can be used to develop a predictive risk model that identifies children at high risk of maltreatment and could support targeting of prevention and early intervention services. They integrated data from the New Zealand public benefit and child protective services systems to develop their risk algorithm. It is particularly relevant to the U.S. now as many state and local governments are using the impetus of national healthcare reform to redesign health and human services information and service delivery systems. As the authors note, predictive risk modeling (PRM) is most advanced in healthcare utilization, and it is an increasingly important tool in a wide range of innovations to improve quality and “bend the cost curve” in the U.S. healthcare system. The integration of data from multiple sources, including all-payer claims databases and electronic health records, is providing the foundation for identifying individuals at high risk, targeting interventions for chronic disease management, reducing hospital admissions and readmissions, improving end-of-life care, and recognizing many other opportunities for improvement. A whole new industry is emerging to capitalize on the analytic promise of “Big Data.” In recent years, heightened attention is also being directed to modernizing the information systems that support human services. The National Human Services Interoperability Architecture (NHSIA) initiative sponsored by the Administration for Children and Families (ACF) within the U.S. DHHS and the National

Association of breastfeeding with postmenopausal visceral adiposity among three racial/ethnic groups

We examined the association between breastfeeding and postmenopausal visceral adiposity.

Association of Breastfeeding with Maternal Visceral Adiposity Postmenopause Among Three Racial/ Ethnic Groups

We examined the association between breastfeeding and postmenopausal visceral adiposity.

Association of breastfeeding with postmenopausal visceral adiposity among three racial/ethnic groups: Breastfeeding and Visceral Adiposity

We examined the association between breastfeeding and postmenopausal visceral adiposity.