Medical Correlates of Chronic Multisymptom Illness in Gulf War Veterans.

BACKGROUND: Chronic multisymptom illness (CMI) is more prevalent among deployed than nondeployed veterans from the first Gulf War. Objective physiologic markers of CMI are lacking. The purpose of this study is to determine whether measurable abnormalities in the autonomic nervous system or hypothalamic-pituitary adrenal axis would distinguish CMI cases (CMI+) from controls (CMI-) among deployed veterans of the 1990-1991 Gulf War. METHODS: This is a cross-sectional case-control cohort study that examined deployed veterans who participated in the Phase III study: National Health Survey of Gulf War Veterans and Their Families. Autonomic nervous system and hypothalamic-pituitary adrenal axis function-related measures included: 24-hour heart-rate variability, urinary catecholamines and cortisol, hypertension, insulin sensitivity, dyslipidemia, body fat, bone mineral density, and ultrasensitive C-reactive protein. RESULTS: Veterans of the first Gulf War with CMI (n = 73) and without the condition (n = 111) were studied. Sociodemographic characteristics were similar. Veterans with CMI reported poorer mental and physical functioning, greater use of prescription medications, and more nonroutine clinic visits. These veterans were also more likely to have fibromyalgia syndrome, irritable bowel syndrome, metabolic syndrome, and among males, a larger waist-to-hip ratio. Lower values for a nonlinear heart-rate-variability parameter-the short-term fractal scaling exponent (DFA1), reflecting an increased randomness of beat-to-beat changes in heart rate-were observed in veterans with CMI than those veterans without it (1.28±0.16vs 1.35±0.15; p=0.005). Hypothalamic-pituitary-adrenal axis function measures were similar between the two groups. CONCLUSION: In this cohort of deployed veterans from the first Gulf War, we identified abnormal heart-rate variability in veterans with CMI compared to veterans without the condition, which suggests abnormal functioning of the autonomic nervous system and possible long-term cardiovascular effects.

Gulf War veterans' health: medical evaluation of a U.S. cohort.

BACKGROUND: United States military personnel reported various symptoms after deployment to the Persian Gulf during the 1991 Gulf War. However, the symptoms' long-term prevalence and association with deployment remain controversial. OBJECTIVE: To assess and compare the prevalence of selected medical conditions in a national cohort of deployed and nondeployed Gulf War veterans who were evaluated by direct medical and teledermatologic examinations. DESIGN: A cross-sectional prevalence study performed 10 years after the 1991 Gulf War. SETTING: Veterans were examined at 1 of 16 Veterans Affairs medical centers. PARTICIPANTS: Deployed (n = 1061) and nondeployed (n = 1128) veterans of the 1991 Gulf War. MEASUREMENTS: Primary outcome measures included fibromyalgia, the chronic fatigue syndrome, dermatologic conditions, dyspepsia, physical health-related quality of life (Short Form-36 [SF-36]), hypertension, obstructive lung disease, arthralgias, and peripheral neuropathy. RESULTS: Of 12 conditions, only 4 conditions were more prevalent among deployed than nondeployed veterans: fibromyalgia (deployed, 2.0%; nondeployed, 1.2%; odds ratio, 2.32 [95% CI, 1.02 to 5.27]); the chronic fatigue syndrome (deployed, 1.6%; nondeployed 0.1%; odds ratio, 40.6 [CI, 10.2 to 161]); dermatologic conditions (deployed, 34.6%; nondeployed, 26.8%; odds ratio, 1.38 [CI, 1.06 to 1.80]), and dyspepsia (deployed, 9.1%; nondeployed, 6.0%; odds ratio, 1.87 [CI, 1.16 to 2.99]). The mean physical component summary score of the SF-36 for deployed and nondeployed veterans was 49.3 and 50.8, respectively. LIMITATIONS: Relatively low participation rates introduce potential participation bias, and deployment-related illnesses that resolved before the research examination could not, by design, be detected. CONCLUSIONS: Ten years after the Gulf War, the physical health of deployed and nondeployed veterans is similar. However, Gulf War deployment is associated with an increased risk for fibromyalgia, the chronic fatigue syndrome, skin conditions, dyspepsia, and a clinically insignificant decrease in the SF-36 physical component score.

Late prevalence of respiratory symptoms and pulmonary function abnormalities in Gulf War I Veterans.

BACKGROUND: Published reports have documented an increased prevalence of self-reported respiratory symptoms among servicemen deployed during the 1990-1991 Gulf War. We evaluated whether this deployment resulted in long-term adverse respiratory effects. METHODS: A comprehensive medical history was taken and physical and laboratory evaluations, including pulmonary function tests, were performed in 1036 deployed and 1103 nondeployed veterans of the Gulf War. Participants were classified into 5 groups on the basis of their pulmonary function tests findings: normal pulmonary function; nonreversible airway obstruction; reversible airway obstruction; restrictive lung physiology; and small airway obstruction. RESULTS: Deployed veterans were younger, more commonly white, less educated, single, of lower mean family incomes, and more likely to have enlisted than nondeployed veterans. Deployed veterans were also statistically more likely to self-report a history of smoking and wheezing than nondeployed veterans, but comparisons of reported physician visits for pulmonary complaints, pulmonary hospitalizations, numbers of documented episodes of asthma, bronchitis, or emphysema, and pulmonary medications prescribed in the year prior to evaluation did not reveal any differences between deployed and nondeployed veterans. The distribution of pulmonary function test results was identical among deployed and nondeployed veterans. Among both deployed and nondeployed veterans, about 64% had normal pulmonary function, 16% to 18% had nonreversible airway obstruction, 10% to 12.2% had restrictive lung physiology, 6% to 6.7% had small airway obstruction, and the remaining 0.9% to 1.3% had reversible airway obstruction. CONCLUSION: Our findings did not confirm the hypothesis that deployment to the Gulf War in 1990-1991 resulted in an increased prevalence of clinically significant pulmonary abnormalities 10 years later.