Longitudinal study of fasting serum glucose concentrations in healthy elderly. The New Mexico Aging Process Study.

BACKGROUND: The American Diabetes Association s Expert Committee on the Diagnosis and Classification of Diabetes Mellitus has made the recommendation that all individuals over the age of 45 years should be screened for diabetes every 3 years. OBJECTIVE: This study was designed to determine the necessity for screening healthy elderly (> 65 years) this frequently using fasting serum glucose (FSG) determinations. DESIGN: This is a longitudinal study of initially healthy, upper middle class, community-based volunteers, mostly age 65 years and older at entry into the study. Participants were followed longitudinally with annual FSG concentrations and body mass indices (BMI) for periods up to 18 years (mean 12.4 years). RESULTS: Only 4 of 299 individuals with entry FSG < 126 mg/dl (mean + S.D. age at entry 71.6 + 4.8 years) and 6 or more annual visits have subsequently met the Expert Committee criteria for the diagnosis of diabetes (two consecutive FSGs > 126 mg/dl unless under treatment). When one examines the slopes of FSGs plotted over time (years) for each individual, more participants had a negative slope (220) than positive slope (79), i.e., their FSGs tended to decrease with age. None of the 68 individuals entered age > 75 years subsequently developed diabetes or a significantly positive slope. CONCLUSIONS: It does not appear necessary to screen non-obese elders (excluding minorities) age >65 years with a FSG < 100 mg/dl, or those age >75 years every 3 years as recommended.

A biethnic community survey of cognition in participants with type 2 diabetes, impaired glucose tolerance, and normal glucose tolerance: the New Mexico Elder Health Survey.

OBJECTIVE: To determine whether elderly individuals with type 2 diabetes or impaired glucose tolerance are at increased risk for cognitive impairment compared with individuals with normal glucose tolerance. RESEARCH DESIGN AND METHODS: Elderly Hispanic individuals (n = 414) and non-Hispanic white individuals (n = 469) aged > or =65 years, randomly selected from the Medicare rolls of Bernalillo County (Albuquerque), NM, were recruited for an interview/examination that included an evaluation of glucose tolerance. Information on nine tests of cognitive function and two measures of depression allowed comparisons between diabetic status and these functions. Comparisons also were made between glycosolated hemoglobin concentrations and these cognitive tests in the 188 participants with diabetes. RESULTS: None of the mean scores on the tests of cognitive function was significantly lower in the participants with diabetes compared with those participants with normal glucose tolerance after adjustments for ethnicity, sex, age, level of education, and presence of depression, with or without elimination of those with dementia (Mini-Mental State Exam <18). Interestingly, participants with impaired glucose tolerance tended to score higher than those with normal glucose tolerance. No significant associations were found between glycosolated hemoglobin concentrations and cognitive test scores in participants with diabetes. CONCLUSIONS: We could not show any increased risk for cognitive impairment in participants with diabetes compared with those with normal glucose tolerance after adjustments for ethnicity, sex, age, education, and presence of depression, before or after elimination of dementia in this random sample from a biethnic population of predominantly community-dwelling elders.

Prevalence of self-reported illnesses in elderly Hispanic and non-Hispanic Whites in New Mexico.

OBJECTIVE: To report on the prevalences of self-reported illnesses from the New Mexico Elder Health Survey. DESIGN: Randomized community-based cross-sectional survey of elderly (> or = 65 years of age) Hispanics and non-Hispanic Whites. METHOD: Analysis of data from the 883 participants in the New Mexico Elder Health Survey. RESULTS: Complete data on 848 subjects were available for this analysis: Hispanic males, 212; Hispanic females, 189; non-Hispanic White males, 236; non-Hispanic White females, 211. The mean age was 74 years (age range 65-98). Hispanics had fewer years of school and lower income. Hispanics reported a significantly (P<.05) higher prevalence of type 2 diabetes; leg ulcers/pressure sores; and Parkinson's Disease. Non-Hispanic Whites reported a significantly (P<.05) higher prevalence of asthma; circulatory problems; stomach (not ulcers), intestinal or gallbladder disease; urinary tract disorders (other than kidney disease); and cancer. Prevalence odds ratios and confidence intervals were calculated. Hispanic males reported a higher prevalence of type 2 diabetes (OR 1.88, CI 1.10-3.26, P = .02), and lower prevalences of asthma (OR 0.43, CI 0.18-0.93, P = .04); urinary tract disorders, other than kidney disease (OR 0.59, CI 0.38-0.91, P = .01); and cancer (OR 0.31, CI 0.13-0.68, P = .005). Hispanic females reported a higher prevalence of diabetes (OR 3.01, CI 1.48-6.50, P = .003), and a lower prevalence of glaucoma (OR 0.48, CI 0.22-1.00, P = .05). These differences remained significant after adjustment for age, education, income, and language. CONCLUSION: There are significant differences in the prevalences of self-reported illnesses between Hispanic and non-Hispanic White elderly.

Serum vitamin B12, C and folate concentrations in the New Mexico elder health survey: correlations with cognitive and affective functions.

OBJECTIVES: 1) To compare serum vitamin B12, C and folate concentrations in a randomly selected sample of elderly (age 65 years or older) male and female Hispanics and nonHispanic whites (NHW) and 2) to examine associations between serum B12, C and folate concentrations compared to measures of cognitive and affective (depression) functions. METHODS: Equal numbers of male and female Hispanics and NHW were randomly sampled from the Health Care Financing Administration (Medicare) registrant list for Bernalillo County, New Mexico, and asked to volunteer for a paid home interview followed by a paid comprehensive interview/examination covering health and health-related issues. In addition to serum determinations of B12, C and folate, associations were examined between these vitamins and measures of cognitive and affective functions. RESULTS: Males and Hispanics had lower serum vitamin B12, C and folate concentrations than females and NHW respectively. Participants taking a multivitamin supplement (MVI) had higher serum vitamin concentrations than those not taking MVI. There were significant associations between serum folate concentrations and measures of cognitive function, not seen with B12 or C, nor between any of the vitamins and affective function. CONCLUSIONS: Hispanics, even after adjustments for gender, age, vitamin supplementation, vitamin content of dietary foods, education and household income, had lower serum concentrations of B12, C and folate than NHW. The most significant associations observed were those between serum folate and various measures of cognitive function, even after adjusting for presence of depression.

Comparison of energy and nutrient sources of elderly Hispanics and non-Hispanic whites in New Mexico.

OBJECTIVE: Identification and comparison of frequently consumed foods and important food sources of energy, protein, total fat, vitamin A, vitamin C, vitamin E, vitamin B-6, folate, and calcium of elderly Hispanics and non-Hispanic whites. DESIGN: Dietary intake data were collected using a modified Health Habits and History Questionnaire (a food frequency questionnaire) for 735 subjects who participated in the New Mexico Elder Health Survey. SUBJECTS: The sample consisted of 330 Hispanics (176 men and 154 women) and 405 non-Hispanic whites (214 men and 191 women) between the ages of 65 and 96 years. Subjects were those with food frequency data among 883 participants who completed the clinical visit of the New Mexico Elder Health Survey. RESULTS: Results show the top-ranked frequently consumed foods by gender and ethnicity and top-ranked food sources of energy and 8 nutrients. Regional foods were important sources of nutrients in the diets of both Hispanics and non-Hispanic whites, however, more so for the Hispanics. Chile sauces were notable sources of vitamin A, vitamin C, and folate among both groups. Both ethnic groups demonstrated selection of low-fat and skim milk and moderation in consumption of red meat. APPLICATIONS: These data will be useful for designing nutrition education programs, for studying the relationship between diet and disease among elderly Hispanics and non-Hispanic whites, and for designing assessment instruments for the elderly and other ethnic populations.

Alcohol consumption is negatively associated with the prevalence of coronary heart disease in the New Mexico Elder Health Survey.

OBJECTIVE: To compare the prevalence of coronary heart disease (CHD) and the effects of various risk factors, including alcohol consumption, on prevalence rates in a randomly selected sample of older Hispanic and non-Hispanic white (NHW) men and women. DESIGN AND SETTING: A cross-sectional study of equal numbers of Hispanic and NHW men and women, selected randomly from Health Care Financing Authority (Medicare) rolls, recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. PARTICIPANTS: A total of 883 volunteers, mean age 74.1, years were interviewed/examined. MEASUREMENTS: CHD was identified by interview and electrocardiogram. Risk factors were identified by interview (hypertension, diabetes, medications, smoking, alcohol consumption) and by direct measurements (glucose tolerance, serum lipids, blood pressure, anthropometry). RESULTS: The age-adjusted prevalences of CHD were not significantly different when Hispanic men and women were compared with their NHW counterparts. Age-, ethnicity-, and gender-adjusted relative risk of CHD was inversely associated with alcohol consumption (OR .46; 95% CI, .28-.73; P < .001). Hypertension, diabetes mellitus, and male gender were also significant risk factors; age, anthropometric measurements, smoking, serum lipid concentrations, and level of education were not. HDL cholesterol levels were significantly lower in nondrinkers; other lipid levels were not associated with alcohol consumption. The type of alcoholic beverage was not associated with the prevalence of CHD. CONCLUSIONS: No significant differences in CHD prevalence existed between Hispanic and NHW participants despite a higher prevalence of diabetes and central obesity in Hispanics. Alcohol consumption was strongly negatively associated with the prevalence of CHD identified in this older, biethnic population.

Mosaicism in X-linked severe combined immunodeficiency.

We performed gamma c gene analysis of a boy with severe combined immunodeficiency whose brother died of the same condition. A base pair deletion in exon 6 was found, which was absent in his mother, indicating maternal mosaicism with important implications for genetic counseling and demonstrating the importance of mutation analysis in boys with severe combined immunodeficiency.

Epidemiology of sarcopenia among the elderly in New Mexico.

Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.

Outcome of recruitment and report on participation rate in the New Mexico Elder Health Survey.

The purpose of this paper is to report on the outcome of recruitment and participation rate in the New Mexico Elder Health Survey. This survey is the first community based epidemiological survey to examine health and health related issues of elderly (65 years or older) Hispanics and non-Hispanic whites in Bernalillo County (Albuquerque), New Mexico. This survey was conducted from May 1993 to September 1995. Subjects (N=2200) were randomly selected from the list of 50,700 Medicare recipients residing in Bernalillo County and stratified by ethnicity and gender. Hispanics were identified using a computer program that selects Hispanic surname patterns and ethnicity was verified by self report. Subjects participated in a home interview, followed by an interview and examination in a senior health clinic. Use of the Medicare list resulted in 75.7% (N=1666) of subjects being contacted. Of the 1666 subjects available, 1130 (67.8%) completed a home interview and 883 (54%) completed the full examination. There were no significant differences in participation by ethnicity, but there were significant differences by gender, with women less likely to participate. The mean age of participants was 74 years, age range 65 to 100. Hispanic elderly demonstrated greater economic poverty and lower levels of formal education. Our survey results show that the elderly and Hispanic elderly can be successfully recruited to participate in a research study. This paper is the first to summarize the details of the survey design, present the results of recruitment and participation, and describe the survey participants.

Comparison of cultural bias in two cognitive screening instruments in elderly Hispanic patients in New Mexico.

The authors compared the Mini-Mental State Examination (MMSE) and the Fuld Object-Memory Exam (FULD) in a Hispanic non-immigrant population in New Mexico. Results demonstrated that performance on the MMSE was affected by lower education and income levels. Performance on the FULD was not affected by these variables. Among persons with limited education and lower income, the FULD may provide a better means of screening for cognitive deficit than measures such as the MMSE.