Iron deficiency and anemia of chronic disease in elderly women: a discriminant-analysis approach for differentiation.

To differentiate iron-deficiency anemia and anemia associated with chronic inflammatory diseases in elderly women, subsets of laboratory, dietary, and functional assessment variables were obtained by using discriminant analysis. Fifty-one subjects (70-79 y of age) were classified into one of four groups on the basis of the presence of iron deficiency and chronic inflammatory disease. Iron deficiency was defined on the basis of a significant response in hemoglobin concentration after iron supplementation. The discriminating subset of laboratory tests consisted of measures for serum ferritin, plasma transferrin receptors, and erythrocyte sedimentation rate. The discriminant function classified subjects into iron-deficient, anemia of chronic disease, or a category in which the two coexist, with an error rate of 18.6%. The addition of other variables (dietary iron and functional assessment information) did not appreciably improve the classification. The results of these three key laboratory tests may help to identify functional iron deficiency in the presence of chronic inflammation.

Perinatal lactation protocol and outcome in mothers with and without insulin-dependent diabetes mellitus.

This study compared the course of lactation from days 2 to 84 postpartum in 33 women with insulin-dependent diabetes mellitus (IDDM); 33 women without diabetes selected by using gestational age of the infant, method of delivery, sex of the infant, and prior lactation experience as a means of ensuring similar patterns in factors known to influence success (control subjects); and 11 healthy reference subjects who delivered vaginally. Nutritionists visited the mothers on days 2, 3, 7, 14, 42, and 84 postpartum; obtained prenatal and perinatal medical information; and questioned the mothers on their breast-feeding experience. Women with IDDM were able to establish lactation despite postpartum separation from their infants, delays in the start of breast-feeding, reduced frequency of feeding, increased use of supplemental feedings, and the high rate of cesarean section. Clinicians must recognize the need to provide appropriate counseling so that mothers with IDDM will not be discouraged by problems with breast-feeding.

Food supplement usage in seven Western states.

Data on food supplement usage were collected from 2451 adults in seven Western states. No significant differences were determined among states. A majority (66.6%) of the sample used some form of food supplements, with 40.0% consuming one to three supplements per day. The archetype food supplement user was likely to be a young female with some college education, who believes that the nutritional quality of food has decreased in the last 10 yr and in the efficacy of supplements for disease prevention or cure, and primarily receives information concerning food and nutrition from books and health food stores. Correspondingly, one of the most frequently cited reasons for using food supplements, next to "to prevent colds and other illnesses" was "to make up for what is not in food." The three most frequently used food supplements, in rank order, were multiple vitamins, vitamin C, and multiple vitamins plus iron.

Maternal plasma phospholipid polyunsaturated fatty acids in pregnancy with and without gestational diabetes mellitus: relations with maternal factors.

BACKGROUND: The fatty acids arachidonic acid (AA; 20:4n-6) and docosahexaenoic acid (DHA; 22:6n-3) are essential for fetal growth and development, but their metabolism may be altered in insulin resistance. OBJECTIVES: The objectives were to determine maternal plasma phospholipid polyunsaturated fatty acid concentrations in pregnant women receiving dietary therapy for gestational diabetes mellitus (GDM) and to identify maternal factors associated with plasma phospholipid AA and DHA concentrations in the third trimester. DESIGN: Fasting plasma phospholipid fatty acids were determined in women with GDM (n = 15) receiving dietary therapy only and in healthy, pregnant women without GDM (control group, n = 15) at 27-30, 33-35, and 36-39 wk gestation. RESULTS: Maternal plasma phospholipid (as % by wt of total fatty acids and mg/L) linoleic acid (18:2n-6), AA, and 22:5n-6 concentrations did not differ significantly between women with GDM and control subjects. The other n-6 long-chain polyunsaturated fatty acids (% by wt) were lower in GDM subjects than in control subjects. Plasma phospholipid (expressed as % by wt and mg/L) linolenic acid (18:3n-3) and summed precursors of DHA were lower and DHA (% by wt and mg/L), adjusted for dietary DHA intake, was 13% higher in GDM subjects than in control subjects. Maternal blood hemoglobin A1C was inversely related to plasma phospholipid AA (% by wt) (r = -0.56, P = 0.03) in control subjects and positively associated with plasma phospholipid AA (% by wt) in women with GDM (r = 0.76, P = 0.001). Pregravid body mass index was negatively associated with plasma phospholipid DHA (% by wt) in control subjects (r = -0.55, P = 0.04) and in women with GDM with a body mass index (in kg/m2) <30 (r = -0.76, P = 0.007). CONCLUSIONS: This is the first report documenting alterations in maternal plasma phospholipid PUFAs in pregnant women receiving dietary therapy for GDM. In pregnant woman, both with and without GDM, maternal glycemic control and pregravid BMI appear to be significant predictors of plasma phospholipid AA and DHA, respectively, during the third trimester. Additionally, dietary DHA significantly affects phospholipid DHA concentrations.

Delayed lactogenesis in women with insulin-dependent diabetes mellitus.

Breast milk lactose, total nitrogen, conductivity, osmolality, and intake by infants of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 control women without diabetes, and 11 reference women were determined in a 3-mo study of lactation. Milk of women with IDDM had significantly lower lactose and higher total nitrogen (2-3 d postpartum), and their infants had significantly less milk intake (7-14 d postpartum) than did control or reference women. Total nitrogen was negatively correlated with milk lactose for women with IDDM at all times and for control women through day 14 postpartum. The data indicate delayed lactogenesis for women with IDDM, which was more likely to occur with poor metabolic control. Differences in milk composition of women with IDDM do not preclude them from breast-feeding their infants.

Cigarette smoking among native and foreign-born African Americans.

PURPOSE: To examine differences in current smoking status and the number of cigarettes consumed daily between foreign and native-born African Americans, and the impact of demographic and socioeconomic status (SES) factors on smoking behavior. METHODS: Data were obtained from combining the 1990-1994 National Health Interview Surveys and consisted of 16,738 U.S. born and foreign-born African Americans between 18 and 64 years of age. The statistical analysis included cross-tabulations and weighted multiple logistic regression (MLR) using the Statistical Packages for the Social Sciences (SPSS) and the Survey Data Analysis (SUDAAN) computer programs. RESULTS: Adjusted MLR analysis revealed that native-born African Americans were more likely (odds ratio (OR) = 2.7, p < 0.001) to be current smokers than foreign-born blacks. Within the native-born group, smoking prevalence decreased with increasing education and income, but these associations were not found for foreign-born blacks. Women in both groups were less likely than men to be current smokers. Statistically significant differences were not found between the two groups in the number of cigarettes smoked per day. CONCLUSIONS: This analysis of nativity and smoking behavior further demonstrates the social diversity among African Americans and suggests the differential impact of social and cultural factors on smoking behavior within racially classified social groups. In areas where there are substantial numbers of foreign-born blacks, researchers should consider differentiating smoking status by nativity. Though differences in smoking prevalence were apparent for native and foreign-born American Americans, prevention and cessation programs are needed for both groups.

Insulin and glucose studies after one year of treatment with a sequential-type oral contraceptive.

PIP: Plasma insulin and blood glucose were measured during an intravenous glucose tolerance test at the University of Minnesota hospital clinic on 28 women on oral sequential contraceptives (15 tablets of 80 mu-g mestranol, 5 tablets of 80 MCG mestranol and 2 mg chlormadinone acetate) both prior to drug initiation and after 1 year of use. No statistical difference in either glucose or insulin levels or weight change was seen after 1 year of therapy. A significant positive association was found between the elevation of glucose and insulin with the drug at cerain time periods during the glucose test, and if there was a family history of diabetes mellitus. A higher frequency of abnormal glucose and insulin levels has been found among users of combination-type drugs as compared to the sequential type.^ieng

FHR variability and other heart rate observations during second stage labor.

Seventy-four fetal heart rate (FHR) records that were continued to vaginal delivery were selected for study from more than 2000 intrapartum FHR tracings. Thirty-six of the births were associated with neonatal depression and Apgar scores of 3 or less and/or 6 or less at 1 and 5 minutes, respectively; 38 patients exhibited normal Apgar scores (7 and 10 at 1 and 5 minutes, respectively). Twenty minutes of heart rate activity immediately prior to birth was the basis of analysis. All categories of loss of short-term beat-to-beat variability (BBV), both baseline and with decelerations, were observed more frequently in the group with low Apgar scores (P less than .001). In assessing variability, duration of observed loss of BBV appears to be an extremely critical factor. If BBV was lost 50% or less of observation time, a wide range of Apgar scores was observed. When more than 50% of the record showed loss of BBV, the number of depressed neonates was relatively high. Bradycardia (heart rate of less than 120 beats per minute) was present frequently in the records of the normal group. The number of variable decelerations and the amount of uterine activity were relatively high during second stage labor; a similar frequency was noted in both groups. Decelerations were nearly uniformly associated with uterine contractions in both groups, and accelerations were also noted in both groups. Uniform decelerations (late) were also present in both groups, with a greater frequency in the group with lower Apgar scores, but there were no distinguishing characteristics noted.

Pulsed Doppler umbilical artery waveforms: significance of elevated umbilical artery systolic/diastolic ratios in the normally grown fetus.

Previous studies have demonstrated a high correlation between elevated resistance in the placental circulation, evidenced by abnormal umbilical artery systolic-to-diastolic (S/D) ratios, and the subsequent birth of a small for gestational age (SGA) infant. However, few data exist on the significance of elevated S/D ratios for pregnancies in which outcome does not involve an SGA infant. Pulsed Doppler spectral recordings and level II ultrasound examinations were performed 373 times in 256 referred high-risk patients. Doppler data were not used for patient management decisions. Thirty-two women with elevated umbilical artery S/D ratios of 4.5 or greater (defined as abnormal regardless of gestational age) gave birth to non-SGA infants. The ultrasound characteristics and outcome for this group were compared with those of 200 patients who were also non-SGA but who exhibited normal waveforms and with 24 SGA infants with predominantly abnormal waveforms. Thirty-one percent of the non-SGA infants with abnormal waveforms had structural malformations, a rate significantly higher (P less than or equal to .03) than the 18% malformation rate in the normal-waveform group. Further, the stillbirth rate and number of terminations of pregnancy for lethal anomalies were five times greater in the non-SGA group with abnormal waveforms than in the non-SGA group with normal waveforms (P less than or equal to .001). A wide variety of structural malformations was observed in the abnormal-waveform group, most frequently involving the central nervous system. Amniotic fluid volume tended to be decreased in the SGA group, whereas increased amniotic fluid volume or hydramnios was seen in 23% of the non-SGA abnormal-waveform group.

Intrauterine aspiration of a large fetal ovarian cyst.

Most large series of neonatal ovarian cysts are limited to those diagnosed in the newborn period. Eight cases of fetal ovarian cysts diagnosed prenatally by ultrasound have been reported, only one of which was aspirated in utero. Reported is the youngest fetus to undergo in utero aspiration of an ovarian cyst to reduce the risk of secondary pulmonary hypoplasia.

Prenatal diagnosis of fetal urinary tract abnormalities by ultrasound.

The prenatal detection of renal enlargement and sonolucent "cystic" lesions in 4 fetal abdomens by ultrasound is described. These were later proved to be congenital urinary tract anomalies. Only one of the other 4,628 mothers who had ultrasound gave birth to a child with a congenital urinary tract anomaly that was missed, and 1 fetus was falsely diagnosed as having a congenital urinary tract anomaly based on the ultrasound. Obstruction in the developing urinary tract is associated with renal dysplasia and insufficiency. More experience and improved ultrasonography may enable an accurate diagnosis of urinary tract obstruction; and early relief of the obstruction may be a possible method of management to minimize the renal damage.

Limbus-based vs fornix-based conjunctival flap in combined glaucoma and cataract surgery with adjunctive mitomycin C.

PURPOSE: To determine the efficacy and safety of limbus-based vs fornix-based conjunctival flaps in patients with primary open-angle glaucoma undergoing trabeculectomy combined with phacoemulsification and intraocular lens implantation with adjunctive subconjunctival mitomycin C. METHODS: In a prospective study, 69 eyes of 69 patients with primary open-angle glaucoma, visually symptomatic cataracts, and no previous incisional ocular surgery were randomly assigned to limbus-based and fornix-based conjunctival flap groups. All patients received trabeculectomy combined with phacoemulsification and posterior chamber lens implantation with 1-minute (0.5 mg/ ml) application of subconjunctival mitomycin C. RESULTS: The mean intraocular pressures were significantly (P < .05) lower on significantly (P < .05) fewer medications postoperatively at 1 week, 1 month, 3, 6, 9, 12, and 15 to 18 months, and at last follow-up in both groups than they had been preoperatively. However, there were no significant (P > .05) differences in postoperative mean intraocular pressure, mean number of medications, and visual acuity between the two groups at any time interval. Hypotony with wound leak was significantly (P = .019) higher in the limbus-based group. Other postoperative complications were not significantly (P > .05) different between the two groups. CONCLUSIONS: There was no notable difference in glaucoma control or visual outcome between limbus-based and fornix-based conjunctival flaps in primary trabeculectomy combined with phacoemulsification and lens implantation with adjunctive subconjunctival mitomycin C. The fornix-based flap was as safe as, if not safer than, the limbus-based flap in the glaucoma triple procedure with adjunctive subconjunctival mitomycin C.

Elevated lipoprotein lipids and gestational hormones in women with diet-treated gestational diabetes mellitus compared to healthy pregnant controls.

The objective of this study was to describe plasma and lipoprotein perturbations in gestational diabetes mellitus (GDM) compared to controls, and determine if alterations in lipids are related to gestational hormones and/or glucose control. Maternal HbA1c, free fatty acids (FFA), beta-estradiol, progesterone, prolactin, and plasma, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), HDL2 and HDL3 triglyceride (TG), cholesterol, and dietary intake were determined for women with diet-treated GDM and controls in a longitudinal design. Subjects (N = 25/group) were matched for age, race, and body-mass index (BMI). Women with GDM had significantly higher HbA1c than controls, although both groups were within the normal range (4%-6%). However, body weight gain was less for women with GDM. There was a trend for higher plasma FFAs at 37-38 weeks in GDM versus controls. Plasma and lipoprotein TG among the groups increased over the third trimester, and mean concentrations were greater for women with GDM. In GDM versus controls, VLDL and HDL3 TGs were higher at all times, HDL and HDL2 TGs at 33-34 and 37-38 weeks, and LDL TGs at 37-38 weeks. In VLDL, core lipids (TG + cholesterol) increased over gestation and were greater in GDM. In HDL, the TG/cholesterol ratio was greater in GDM. In GDM versus controls, plasma progesterone and prolactin were higher at all times; beta-estradiol was elevated at 37-38 weeks. HbA1c, progesterone, and prolactin correlated with all lipoprotein TG fractions. Exaggerated hypertriglyceridemia, particularly in the VLDL and HDL fractions, is a feature of GDM. The increase in VLDL TG is likely due to an increase in VLDL synthesis, whereas particle enrichment in TG is a plausible explanation for changes in HDL TG. Slight perturbations in glucose control and gestational hormones in diet-treated GDM may contribute to the observed increase in plasma and lipoprotein TG.

Attitudinal and demographic correlates of food supplementation practices.

Attitudinal and demographic correlates to food supplement use were ascertained for 689 adults residing in seven Western states. Of the 689, 372 (54%) were food supplement users and 317 (46%) were non-users. The only attitudinal variable significantly (p less than .001) related to the practice of food supplementation was the belief that vitamin C could cure and prevent a cold. More users than non-users agreed with the statement that "vitamin C can both prevent and cure a cold." Demographic variables found to be significantly (p less than .05) related to food supplement use included education, marital status, home type, employment status, and population of town/city in which the respondent resided. Food supplement users tended to be living together without marriage, never married, or divorced and living in town houses or "other" types of dwellings. More users than non-users resided in communities with populations of 2,500 or in communities with populations of 10,000 to 49,999.

Comparison of skewness coefficient, coefficient of variation, and Gini coefficient as inequality measures within populations.

The moment skewness coefficient, coefficient of variation and Gini coefficient are contrasted as statistical measures of inequality among members of plant populations. Constructed examples, real data examples, and distributional considerations are used to illustrate pertinent properties of these statistics to assess inequality. All three statistics possess some undesirable properties but these properties are shown to be often unimportant with real data. If the underlying distribution of the variable follows the often assumed two-parameter lognormal model, it is shown that all three statistics are likely to be highly and positively correlated. In contrast, for distributions which are not two-parameter lognormally distributed, and when the distribution is not concentrated near zero, the coefficient of variation and Gini coefficient, which are sensitive to small shifts in the mean, are often of little practical use in ordering the equality of populations. The coefficent of variation is more sensitive to individuals in the right-hand tail of a distribution than is the Gini coefficient. Therefore, the coefficient of variation may often be recommended over the Gini coefficient if a measure of relative precision is selected to assess inequality. The skewness coeficient is suggested when the distribution is either three-parameter lognormally distributed (or close to such), or when a measure of relative precision is not indicated.

Fetal erythrocyte phospholipid polyunsaturated fatty acids are altered in pregnancy complicated with gestational diabetes mellitus.

Insulin resistance and altered maternal metabolism in gestational diabetes mellitus (GDM) may impair fetal arachidonic acid (AA) and docosahexaenoic acid (DHA) status. The objectives were to test the hypothesis that fetal polyunsaturated fatty acids would be altered with GDM and identify factors related to fetal phospholipid (PL) AA and DHA. Maternal and cord vein erythrocyte PL fatty acids were determined in GDM (n = 13) and healthy pregnant women (controls, n = 12). Cord vein erythrocyte PL AA and DHA concentrations were significantly lower in GDM vs. controls. Maternal blood hemoglobin A1C was inversely correlated to fetal erythrocyte PL DHA and AA in controls and GDM (n = 25). Pregravid body mass index was negatively associated with fetal PL DHA. The data support the hypothesis that there is impairment in fetal accretion of DHA and AA in GDM.

Smoking in Maywood: the unhealthy southern migrant hypothesis among African Americans.

OBJECTIVES: This paper examines the "unhealthy Southern migrant" hypothesis with regard to cigarette smoking among African Americans. METHODS: Using data collected in 1992 from a sample of 1,518 African Americans in Maywood, Illinois, as part of the International Collaborative Study of Hypertension in Blacks, logistic regression analysis was conducted to examine and compare smoking behavior and sociodemographic characteristics of Southern and Midwestern-born respondents. RESULTS: African Americans born in the South were less likely (OR = .69, CI = 95%, 0.53, 0.90) to be smokers than those born in the Midwest, after controlling for other sociodemographic variables, prior smoking status, and age of arrival to Maywood. CONCLUSIONS: The results do not support the "unhealthy Southern migrant" hypothesis, with regard to cigarette smoking, and indicate the need to identify factors that protect Southern-born African-American migrants from smoking.

A statistical model estimating the number of African-American physicians in the United States.

Using mark-recaptured methodology and network sampling procedures, a statistical model was developed to estimate the number of African-American physicians in the United States. A sample (stratified by geographic region, medical specialty and an age surrogate) was selected from the National Medical Association's Masterfile of Black Physicians (NMAMBP). Respondents were asked to list the names of five black physicians who resided or practiced in their immediate geographic area. Data also were collected about citizenry as well as other demographic and professional information. The NMAMBP was used mathematically as a "marked" group that could then be "recaptured," allowing mark-recapture methodology to be used as the nucleus of the statistical estimation procedure. The results revealed that in 1991, the total number of US African-American physicians (black US citizens) was estimated to be 16,282 with a conservative standard error of 764 and an approximate 95% confidence interval, yielding a range of 14,754 to 17,810 physicians. This estimate is from 17% to about 32% lower than the 21,538 black doctors reported by the 1990 Bureau of the Census and has important implications for attempts to reform the health-care system and policies designed to produce more African-American physicians.

Maternal and cord plasma lipid and lipoprotein concentrations in women with and without gestational diabetes mellitus. Predictors of birth weight?

OBJECTIVE: To describe lipid and lipoprotein perturbations in gestational diabetes mellitus (GDM) and to examine the potential consequences--e.g, increased birth weight and increased placental lipid transfer. STUDY DESIGN: Maternal and cord free fatty acids (FFAs) and total, very low density lipoprotein (VLDL), low density lipoprotein (LDL), high density lipoprotein (HDL) (and maternal HDL2 and HDL3), triglyceride (TG), and cholesterol and dietary intake were determined for women with diet-treated GDM and for healthy pregnant women with normal glucose tolerance. RESULTS: Women with GDM had higher hemoglobin A1c than controls, while body weight gain was significantly lower for women with GDM as compared to controls. Plasma and lipoprotein TG concentrations were greater for women with GDM, and although plasma FFAs were higher in women with GDM versus controls, the difference was not significant. No differences were observed between groups with respect to maternal plasma or lipoprotein cholesterol. Cord plasma and lipoprotein lipids were similar between groups; with the exception of VLDL + LDL TG, which was lower in women with GDM. In controls, there were significant correlations between maternal plasma TG and cord FFAs; maternal HDL2 cholesterol and cord plasma cholesterol; and maternal plasma TG, maternal HDL2 cholesterol, cord FFAs, and infant birth weight. In GDM, maternal plasma cholesterol and cord VLDL + LDL cholesterol correlated. There were no significant correlations between maternal or cord lipids and infant birth weight in women with GDM. CONCLUSION: Hypertriglyceridemia, rather than hypercholesterolemia, is a feature of GDM. However, elevations in maternal plasma and lipoprotein TGs in women with GDM were not related to fetal lipid concentrations or infant birth weight.

Carcass composition of "bob" and "special-fed" veal and its prediction.

Percentage of lean, fat, and bone were determined in 18 bob veal (BV) and 28 special-fed veal (SFV) carcasses. Carcasses were subjected to a set of visual conformation scores and a variety of physical measurements. No significant differences were found regarding carcass percentage of lean, fat, and bone within the three BV weight groups (P > .05). On average, SFV were 12% fatter than BV and did not have a greater percentage of lean (P > .05), except for SFV carcasses weighing 88.2 to 97.7 kg. Bob veal had less fat (internal, external, and intermuscular) and a higher bone percentage than SFV (P < .05). The round and shoulder primals had the greatest proportion of lean in both the BV and SFV carcasses. Bob veal carcasses had an average conformation score of average Good and SFV carcasses had an average conformation score of average Choice. In addition, a parsimonious subset of variables was identified for predicting total percentage of lean (TPLEAN) for both BV and SFV separately, using "stepwise" regression model building procedures. For BV, all four identified predictor variables were subjective conformation scores (i.e., muscling, appearance, leg thickness, loin-back plumpness) (R = .73, P < .03). For SFV, four predictor variables were also identified: kidney and pelvic fat, fat thickness, carcass length, and lateral thickness (R = .61, P < .03). Although both regression equations were significant predictors of TPLEAN, confidence limits for predicting future TPLEAN value were wide relative to the variation in the actual TPLEAN values. Thus, the practical utility of the regression equations is limited.