RESUMO
AIMS: To examine the association between islet autoantibody positivity and clinical characteristics, residual ß-cell function (C-peptide) and prevalence of complications in a childhood-onset (age <17 years), long-duration (≥32 years) type 1 diabetes cohort. METHODS: Islet autoantibodies (glutamic acid decarboxylase, insulinoma-associated protein 2 and zinc transporter-8 antibodies) were measured in the serum of participants who attended the 2011-2013 Pittsburgh Epidemiology of Diabetes Complications study follow-up examination (n=177, mean age 51 years, diabetes duration 43 years). RESULTS: Prevalences of islet autoantibodies were: glutamic acid decarboxylase, 32%; insulinoma-associated protein 2, 22%; and zinc transporter-8, 4%. Positivity for each islet autoantibody was associated with older age at diabetes onset (glutamic acid decarboxylase antibodies, P=0.03; insulinoma-associated protein 2 antibodies, P=0.001; zinc transporter-8 antibodies, P<0.0001). Older age at onset was also associated with an increasing number of autoantibodies (P = 0.001). Glutamic acid decarboxylase antibody positivity was also associated with lower HbA1c (P = 0.02), insulinoma-associated protein 2 antibody positivity was associated with lower prevalence of severe hypoglycaemic episodes (P=0.02) and both distal and autonomic neuropathy (P=0.04 for both), and zinc transporter-8 antibody positivity was associated with higher total and LDL cholesterol (P=0.01). No association between autoantibody positivity and C-peptide was observed. CONCLUSIONS: The strong association between islet autoantibody positivity and older age at type 1 diabetes onset supports the hypothesis of a less aggressive, and thus more persistent, immune process in those with older age at onset. This observation suggests that there may be long-term persistence of heterogeneity in the underlying autoimmune process.
Assuntos
Autoanticorpos/imunologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 1/imunologia , Transportador 8 de Zinco/imunologia , Adulto , Idade de Início , Idoso , Peptídeo C/metabolismo , Colesterol/metabolismo , LDL-Colesterol/metabolismo , Complicações do Diabetes/etiologia , Complicações do Diabetes/imunologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/metabolismo , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The objective of this study was to examine whether fasting serum insulin is a predictor of coronary heart disease in high-risk US men, and whether any such predictive role explains the enhanced cardiovascular risk seen in subjects with the apolipoprotein (Apo) E 3/2 phenotype. This was a nested case-control study of participants in the Multiple Risk Factor Intervention Trial. Ninety-four subjects who died from coronary heart disease (post-trial follow-up) and 114 case patients with myocardial infarction (during trial) were compared to control subjects (n = 414) matched (1:2) by age, center, randomization date, and intervention group. Overall, fasting serum insulin at baseline was not associated with case-control status. (Means for cases versus controls: 16.8 and 16.6 microU/mL), although serum insulin showed significant correlations with low-density-lipoprotein cholesterol, triglycerides, and uric acid. When stratified by the three Apo E phenotypes, 3/2, 3/3, 3/4, a significant association of fasting insulin with case-control status was seen for Apo E 3/2 individuals (19.9 versus 14.5 microU/mL; P = 0.02) but not for those with the other two phenotypes. Though fasting insulin is not a risk factor overall in this high-risk male population, it appears to contribute to cardiovascular risk in those with the Apo E 3/2 phenotype but does not explain the increased risk seen in these subjects. This new finding, if confirmed, may throw further light on the role of insulin in atherosclerosis.
Assuntos
Apolipoproteínas E/análise , Doença das Coronárias/sangue , Doença das Coronárias/mortalidade , Insulina/sangue , Infarto do Miocárdio/sangue , Infarto do Miocárdio/mortalidade , Adulto , Apolipoproteína E2 , Apolipoproteína E3 , Apolipoproteína E4 , Apolipoproteínas E/genética , Estudos de Casos e Controles , LDL-Colesterol/sangue , Doença das Coronárias/genética , Jejum , Humanos , Modelos Logísticos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Infarto do Miocárdio/genética , Fenótipo , Valor Preditivo dos Testes , Fatores de Risco , Triglicerídeos/sangueRESUMO
The beneficial effect of physical activity in the general population is well known, but, to the authors' knowledge, has not been reported for persons with insulin-dependent diabetes mellitus. In a cohort of 548 diabetes patients followed as part of the Pittsburgh Insulin-dependent Diabetes Mellitus Morbidity and Mortality Study, physical activity was ascertained by survey in 1981, and mortality was ascertained through January 1, 1988. Cases were also compared with non-diabetic sibling controls. Activity level among cases varied inversely with the occurrence of diabetic complications. Overall activity level was inversely related to mortality risk. Sedentary males (< 1,000 kcal/week) were three times more likely to die than active males (> 2,000 kcal/week). A similar, but statistically nonsignificant, relation was seen in females. Cox proportional hazards analysis controlling for potential confounders (age, body mass index, insulin dose, reported diabetes complications, cigarette smoking, and current alcohol drinking) similarly revealed that activity level was inversely associated with mortality risk. Comparison of cases with non-diabetic sibling controls identified similar activity levels for the two groups. The results suggest that activity is not detrimental with regard to mortality, and may in fact provide a beneficial effect in terms of longevity in diabetes patients.
Assuntos
Diabetes Mellitus Tipo 1/mortalidade , Exercício Físico , Adolescente , Adulto , Feminino , Humanos , Estilo de Vida , Masculino , Pennsylvania/epidemiologia , Estudos Prospectivos , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
The risk for insulin-dependent diabetes mellitus (IDDM) associated with genetic susceptibility markers at the human leukocyte antigen (HLA) DQA1 and DQB1 loci was evaluated among individuals with and those without islet cell antibodies. A total of 108 antibody-positive parents and siblings of IDDM patients from the Pittsburgh registry were identified among 1,592 who were screened. HLA-DQ molecular typing was performed on 79 of these individuals and on 78 antibody-negative relatives. There were similar proportions of homozygotes for both of the diabetogenic alleles DQA1 arginine-52 (R/R) and DQB1 non-aspartate-57 (nD/nD) among the antibody-positive and antibody-negative relatives (19.0 and 15.4%, respectively). However, subsequent development of IDDM was restricted to individuals who were both antibody positive and carried the potential to make at least one diabetogenic DQ heterodimer. A dose-response effect was observed among the antibody-positive relatives, in which two of 18 capable of generating one diabetogenic heterodimer and six of 29 generating two heterodimers became insulin requiring. Nine of 15 who were homozygous for both R/R and nD/nD, coding exclusively for diabetogenic variants, became diabetic over the course of the follow-up. With a multivariate model, the relative risk for IDDM among those with islet cell antibodies who were also R/R and nD/nD was estimated to be 229.3 compared with those lacking both, after age and sex were controlled for. The data suggest that while autoimmunity, indicated by the presence of cytoplasmic islet cell antibodies may be relatively common, it progresses only in those with variant HLA-DQ molecules.
Assuntos
Anticorpos/sangue , Doenças Autoimunes/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Marcadores Genéticos/genética , Antígenos HLA-DQ/imunologia , Ilhotas Pancreáticas/imunologia , Adolescente , Adulto , Doenças Autoimunes/genética , Doenças Autoimunes/imunologia , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/imunologia , Feminino , Testes Genéticos/normas , Teste de Histocompatibilidade/normas , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Genéticos , Análise Multivariada , Pennsylvania/epidemiologia , Valor Preditivo dos Testes , Sistema de Registros , Fatores de RiscoRESUMO
The role of waist-to-hip ratio (WHR) in the metabolic disturbance of IDDM has not been widely explored. Cross-sectional data from the Epidemiology of Diabetes Complications Study were used to examine the associations between WHR and risk factors for IDDM complications such as lipid or lipoprotein levels, blood pressure and fibrinogen. A total of 586 adults (greater than or equal to 18 years of age) were examined. WHR was calculated as the mean of duplicate waist circumference measurements made at mid-point between the iliac crest and the lower costal margin in mid-axillary line divided by the mean of duplicate maximum hip measures. WHR was positively correlated with total cholesterol, LDL-cholesterol, triglycerides, systolic and diastolic blood pressure and fibrinogen univariately for both sexes. WHR was negatively correlated with HDL-cholesterol. These correlations remained significant after adjustment for age among females and became less strong, although still significant, for males. The independent effects of WHR to these IDDM risk factors, assessed by multiple linear regression, indicated WHR was related to adverse lipid and lipoprotein levels, but not to fibrinogen or blood pressure. These findings underscore the importance of targeting intervention to IDDM individuals who have a high WHR to reduce known risk factors for IDDM complications especially those for cardiovascular disease, and is consistent with the hypothesis that insulin resistance may have a role to play in IDDM complications.
Assuntos
Abdome/anatomia & histologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/epidemiologia , Quadril/anatomia & histologia , Tecido Adiposo/anatomia & histologia , Adolescente , Adulto , Fatores Etários , Idoso , Pressão Sanguínea/fisiologia , Peso Corporal/fisiologia , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/patologia , Feminino , Fibrinogênio/análise , Humanos , Resistência à Insulina/fisiologia , Lipídeos/sangue , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Triglicerídeos/sangueRESUMO
The apolipoprotein (apo) E polymorphism has been related to differences in lipoprotein metabolism and lipid/lipoprotein concentrations in a number of studies. Whether these associations are seen in insulin-dependent diabetes mellitus (IDDM), which itself affects many of the same aspects of lipoprotein metabolism as does the apo E polymorphism, is unknown. The present study is an investigation into the influence of apo E phenotype on lipoprotein concentrations in a large group of IDDM patients (n = 433) participating in the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study. The frequency of the three apo E alleles 2, 3, and 4 did not differ in this population from that reported in general white populations. Although the diabetic subjects show the same trends as seen in the general population, ie, apo E-2 is associated with lower and apo E-4 with higher low-density lipoprotein cholesterol (LDLc) compared with apo E3 (P less than .03), they also show relationships with glycemic control that influence the relative levels of lipid measures with respect to apo E phenotype. Results also raise the possibility that lipoprotein composition varies according to apo E phenotype in IDDM.
Assuntos
Apolipoproteínas E/genética , Diabetes Mellitus Tipo 1/sangue , Lipoproteínas/sangue , Adulto , Alelos , Apolipoproteínas E/sangue , Diabetes Mellitus Tipo 1/genética , Feminino , Frequência do Gene , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Caracteres SexuaisRESUMO
To test the hypothesis that diabetes mellitus is associated with cognitive dysfunction, a battery of neuropsychological tests was administered to 75 diabetic adults and an equal number of demographically similar nondiabetic control subjects. Compared with control subjects, diabetic subjects performed significantly more poorly on measures of psychomotor efficiency and spatial information processing. In contrast, no between-group differences appeared on measures of verbal intelligence, learning, memory, problem solving, or simple motor speed. Results from multiple regression analyses showed that clinically significant distal symmetrical polyneuropathy was strongly associated with psychomotor slowing, whereas, glycosylated hemoglobin values were weakly associated with both psychomotor slowing and spatial processing. No other biomedical variables predicted cognitive test performance. These neurobehavioral data are consistent with the hypothesis that a "central neuropathy" may be associated, at least in part, with chronic hyperglycemia.
Assuntos
Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/psicologia , Neuropatias Diabéticas/fisiopatologia , Neuropatias Diabéticas/psicologia , Desempenho Psicomotor , Adulto , Retinopatia Diabética/fisiopatologia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Aprendizagem , Masculino , Memória , Valores de ReferênciaRESUMO
To determine the extent to which cholesterol measured in childhood is predictive of values in adulthood, the investigators conducting the second follow-up of the Beaver County Lipid Study tracked the cholesterol values of 295 adults who had initially participated as children (ages 11 to 14 years) in a countywide school screening program. The follow-up study was conducted 16 years after the initial study, when the participants had reached a mean age of 28 years. The overall correlation (r) between baseline (1972-1973) total cholesterol values and the values found at the present follow-up was 0.44 (p less than 0.0001). Women had a higher correlation (r = 0.51) than men (r = 0.38). In addition, the efficacy of childhood screening for cholesterol levels was assessed by considering currently recommended borderline values (greater than 175 mg/dl (4.6 mmol/L) for children and greater than 200 mg/dl (5.2 mmol/L) for adults) as a "positive" test result. The sensitivity of screening at age 12 years for predicting elevated adult total cholesterol concentrations was 63%, specificity was 67%, and the predictive value of a positive test result was 47%. Comparison of false-positive results (above the borderline cutoff point as a child but not as an adult) and false-negative results (below the borderline cutoff point as a child but above it as an adult) showed that male subjects with false-positive results smoked significantly less than those with false-negative results (p less than 0.05) and had a greater improvement during the preceding 7 years in cholesterol-lowering dietary practices (p less than 0.01). Female subjects with false-positive results smoked significantly less than those with false-negative results (p less than 0.05), were less overweight (p less than 0.05), and had a lower prevalence of oral contraceptive use (p less than 0.01). These results support the potential value of screening for hypercholesterolemia in childhood on a population basis. Although some subjects were misclassified as a result of childhood screening, some of this misclassification was associated with adopting changes that a screening and intervention program would be designed to promote--nonsmoking, weight control, and a prudent diet.
Assuntos
Colesterol/sangue , Adolescente , Índice de Massa Corporal , Criança , Feminino , Seguimentos , Humanos , Estilo de Vida , Masculino , Pennsylvania , Valor Preditivo dos Testes , FumarRESUMO
Cardiovascular disease is a frequent complication of insulin-dependent diabetes mellitus (IDDM), but the prevalence, interrelations, and risk factors of its principal components (coronary, cerebrovascular, and lower-extremity arterial disease) and of medial arterial wall calcification are not well understood. To address these issues, data from the Epidemiology of Diabetes Complications Study (n = 657) baseline examination were examined. The term coronary heart disease (CHD) was applied to those with myocardial infarction or angina, whereas lower-extremity arterial disease (LEAD) was applied to those who had undergone amputation of a lower limb or who had an ankle to arm blood pressure ratio less than 0.8 at rest or after exercise. Calcification of the lower-extremity arteries was considered to be present if ankle pressure was more than 100 mm Hg higher than brachial pressure. Although the prevalence of CHD was low, LEAD was significantly more common in women than in men (p less than 0.01), whereas calcification was more frequent in men than in women (p less than 0.01). Ten percent of those with LEAD also had CHD, and 8% with LEAD had calcification. Modeling of potential risk factors (e.g., diabetes duration and glycosylated hemoglobin) revealed that duration, female gender, fibrinogen, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and high density lipoprotein cholesterol to apolipoprotein A-I ratio were independent predictors of LEAD, whereas for CHD only, diabetes duration and hypertension contributed to CHD. Calcification revealed a mixed pattern, with duration, hypertension, and triglyceride to apolipoprotein A-I ratio being the statistically significant associated factors. The results suggest that although LEAD, CHD, and calcification often coexist, their risk factor profiles differ.
Assuntos
Calcinose/epidemiologia , Doença das Coronárias/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Angiopatias Diabéticas/epidemiologia , Adulto , Calcinose/sangue , Calcinose/etiologia , Doença das Coronárias/sangue , Doença das Coronárias/etiologia , Diabetes Mellitus Tipo 1/sangue , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/etiologia , Feminino , Humanos , Lipídeos/sangue , Masculino , Pennsylvania/epidemiologia , Prevalência , Análise de Regressão , Fatores de RiscoRESUMO
Recently, concern has arisen that human (as opposed to beef or pork) insulin may cause more frequent and/or severe hypoglycaemia in association with reduced warning symptoms. This question was examined from questionnaire data of 628 Type 1 diabetic patients (mean age 28 years and duration of diabetes 19 years) participating in the baseline examination of a follow-up study of diabetes complications. Those using human insulin (n = 73) reported an insignificantly higher frequency of hypoglycaemic reactions in the last year than those using animal insulin (66 vs 55% with reactions at least monthly) and only a weak trend was seen overall for the prevalence of human insulin use to increase with increasing frequency of hypoglycaemia (p = 0.06). Hypoglycaemic reactions resulting in unconsciousness were too rare to permit analysis by type of insulin used. The prevalence of reduced awareness of hypoglycaemia was similar among human insulin users to that seen in animal insulin users (25 vs 19%, NS). However, prevalence of reduced awareness showed a strong relationship to current blood glucose in the animal (r = -0.18, p less than 0.001) but not human (r = -0.06, NS) insulin users. Excluding patients with autonomic symptoms or neuropathy did not alter the results, nor did excluding the 34 individuals taking more than three insulin injections per day. It is concluded that human insulin use is not associated with either any substantial increased frequency of hypoglycaemia or reduction in awareness of hypoglycaemia. However, human insulin use does appear to be associated with reduced awareness of hypoglycaemia in those whose blood glucose control is relatively poor.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemia/diagnóstico , Insulina/efeitos adversos , Adulto , Animais , Conscientização , Bovinos , Diabetes Mellitus Tipo 1/complicações , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/complicações , Insulina/uso terapêutico , Masculino , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Inquéritos e Questionários , SuínosRESUMO
We report results from 120 (25- to 34-year-old) participants in a neuropathy substudy of subjects with insulin-dependent diabetes mellitus (IDDM) taking part in a cohort follow-up study. Diabetic neuropathy was evaluated by quantitative sensory testing, nerve conduction studies, and clinical examination. Mean quantitative sensory thresholds differed significantly by clinical category of abnormal sensation and ankle reflex activity. Mean sural and peroneal amplitudes and conduction velocities were also significantly lower for subjects classified as having abnormal ankle reflex activity. Modeling potential correlates in logistic analyses showed glycemic control, triglyceride levels, and hypertension status to be independently associated with clinically overt neuropathy. Similar lipid and hemodynamic parameters were associated with abnormality by any single assessment method used to define neuropathy. Although follow-up is needed to resolve the best assessment methods for determining neuropathy, these results suggest that good glycemic control as well as control of blood pressure and lipids is advisible.
Assuntos
Diabetes Mellitus Tipo 1/fisiopatologia , Neuropatias Diabéticas/diagnóstico , Adulto , Diabetes Mellitus Tipo 1/sangue , Neuropatias Diabéticas/sangue , Neuropatias Diabéticas/fisiopatologia , Feminino , Seguimentos , Humanos , Lipídeos/sangue , Masculino , Condução Nervosa , Exame Neurológico , Fatores de Risco , Limiar SensorialRESUMO
The prevalence of and interrelationships among all four major complications of insulin-dependent diabetes mellitus (IDDM) and their risk factors are being examined in a large epidemiologic study of IDDM subjects diagnosed in childhood. This article focuses on the baseline prevalence of complications in the 657 subjects diagnosed between 1950 and 1980 and currently aged 8-48 yr, with a mean duration of 20 yr. In addition to background retinopathy being virtually universal after 20 yr of diabetes, proliferative retinopathy affects 70% of IDDM subjects after 30 yr duration. As with overt nephropathy, prevalence of proliferative retinopathy is marginally higher in females than in males at short durations; the previously reported male excess is limited to the subjects with IDDM of longer duration (greater than or equal to 25 yr). Somewhat different patterns of microalbuminuria are also seen by sex. Males show a threefold increase in prevalence from 10 to 25 yr duration, whereas females show a more constant prevalence across these durations. A further rise in microalbuminuria is seen in males but not females at greater than or equal to 30 yr duration, giving a combined prevalence of microalbuminuria and overt nephropathy at greater than or equal to 30 yr duration of 84% (males) and 59% (females). Distal symmetrical polyneuropathy shows a constant rise with duration and is only marginally higher in men. Prevalence of cardiovascular (coronary and cerebral) disease shows no sex difference, whereas peripheral vascular disease is particularly common in women after 30 yr duration (greater than 30%) compared with men (11%) when determined by ankle/arm blood pressure ratio less than 0.8 at rest or after exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Adulto , Albuminúria/epidemiologia , Pressão Sanguínea , Transtornos Cerebrovasculares/epidemiologia , Criança , Doença das Coronárias/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/fisiopatologia , Angiopatias Diabéticas/epidemiologia , Nefropatias Diabéticas/epidemiologia , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pennsylvania/epidemiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Fatores de TempoRESUMO
Diabetic autonomic neuropathy (DAN) has been shown to confer a high risk of mortality. The association between DAN and cardiovascular risk factors was examined in a well-defined cohort of 25- to 34-year-old insulin-dependent diabetes mellitus subjects (n = 168) with and without DAN as evaluated by heart rate response to deep breathing, standing, and the Valsalva maneuver. The autonomic tests were performed using both an office-based procedure and a method employed by the Diabetes Control and Complications Trial with analyses performed by the Diabetes Research and Analysis Association, Lexington, Ky. Good agreement was found between the procedures for the assessment modalities of heart rate response to deep breathing. Modeling potential correlates in logistic analyses, where heart rate response to deep breathing was the dependent variable, revealed hypertension status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and gender (female) to be independent determinants of DAN. These results suggest that traditional cardiovascular risk factors are important correlates of DAN and may relate to both its cause and poor prognosis. Since these results are from a cross-sectional study, prospective follow-up of this cohort will be needed for confirmation.
Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças Cardiovasculares/complicações , Neuropatias Diabéticas/fisiopatologia , Adulto , Doenças do Sistema Nervoso Autônomo/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Colesterol/metabolismo , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/fisiopatologia , Neuropatias Diabéticas/epidemiologia , Feminino , Frequência Cardíaca , Humanos , Hipertensão/complicações , Incidência , Masculino , Análise Multivariada , Análise de Regressão , Reprodutibilidade dos Testes , Fatores de Risco , Manobra de Valsalva/fisiologiaRESUMO
Higher levels of physical activity have been related to higher concentrations of high density lipoprotein (HDL) cholesterol and lower concentrations of triglycerides. To test the hypothesis that the association between physical activity and the lipoprotein profile is mediated at least in part through increased insulin sensitivity, the authors measured fasting serum levels of HDL cholesterol, triglycerides, insulin, and glucose in 87 men and 83 women (aged 20-24 years) from a population-based survey in Beaver County, Pennsylvania, in 1981-1982. An insulin sensitivity index was calculated as the reciprocal of the insulin and glucose product multiplied by 10,000. Univariate analysis among men indicates that HDL cholesterol was positively related to insulin sensitivity (r = 0.24, p less than 0.05) and to the physical activity score as assessed with Paffenbarger's questionnaire (r = 0.21, p less than 0.05). Insulin sensitivity and physical activity score were positively related (r = 0.14), although not significantly (p = 0.21). Triglycerides were inversely related to both physical activity (r = -0.22, p less than 0.05) and insulin sensitivity (r = -0.19, p = 0.07). No significant findings among women were noted. Multivariate results indicate that the relation between physical activity and the male lipoprotein profile is reduced after controlling for the effects of insulin sensitivity (p greater than 0.10). The authors conclude that in these young men the beneficial effect of physical activity is likely to be partially mediated by increased insulin sensitivity. The lack of findings among women suggests that sex hormones may influence the association between insulin sensitivity and lipoprotein lipids.
Assuntos
Glicemia/análise , HDL-Colesterol/sangue , Insulina/sangue , Esforço Físico , Triglicerídeos/sangue , Adulto , Estatura , Peso Corporal , Feminino , Seguimentos , Humanos , Masculino , Pennsylvania , Análise de Regressão , Fatores SexuaisRESUMO
To establish the value of screening children for hypercholesterolemia in terms of identifying future adults with hypercholesterolemia, we studied 611 individuals 9 years after they were initially screened at age 12 years. They represent 61% of a stratified sample of the original cohort, which was drawn from all seventh graders in a countywide school district. Overall, the correlation between baseline and follow-up cholesterol concentration was r = 0.52 (P less than 0.0001). Forty-nine percent of the top cholesterol quintile at baseline were similarly placed at follow-up, with 70% in the top two quintiles. Children who dropped out of the top quintile had lower body mass index at follow-up (P less than 0.05), were less frequently smokers, and tended to be more active than those who were only in the top quintile as adults.