Regional fat localizations and racial/ethnic variations in odds of hypertension in at-risk American adults.

The objective of this study was to determine the contribution of regional fat localizations defined as abdominal (AO) or truncal (TO) obesity in racial/ethnic differences to the prevalence odds of hypertension in overweight American adults. Data (n=5,694) from the 1999-2002 US National Health and Nutrition Examination Survey were utilized for this analysis. Abdominal obesity was defined as waist circumference >or=102 and >or=88 cm for men and women, respectively. Truncal obesity was defined using ratio of subscapular to triceps skinfold thickness and were >or=2.24 and >or=1.32, for men and women, respectively. Prevalence odds ratios from gender-specific logistic regression models were used to evaluate the contribution of regional fat localizations to racial/ethnic variation in hypertension. Statistical adjustment was made for age, education, alcohol intake and body mass index. In both men and women, coexistence of AO and TO was associated with much higher prevalence odds of hypertension than association due to each of the regional fat localizations. In men, coexistence of AO and TO was associated with 1.99, 2.47 and 2.10 increased prevalence odds of hypertension in Whites, Blacks and Mexican Americans, respectively. The corresponding values in women were 2.83, 4.07 and 3.61 in Whites, Blacks and Mexican Americans, respectively. The coexistence of AO and TO appears to be the culprit that contributes to high blood pressure on top of body mass index. Weight reduction programs that are targeted toward abdominal and truncal regions in at-risk populations and along racial/ethnic lines may help to alleviate racial/ethnic disparity in risk of hypertension.

Racial/ethnic differences in prehypertension in American adults: population and relative attributable risks of abdominal obesity.

To estimate the risk and population attributable risk of prehypertension that is due to abdominal obesity in White, Black and Hispanic American adults. To determine how much of the relative difference in the risk of prehypertension between high-risk Blacks and Hispanics and the low-risk group Whites that is attributable to their differences in abdominal obesity. Data (n=4016) from the 1999 to 2000 US National Health and Nutrition Examination Surveys were used in this study. Abdominal obesity was defined as waist circumference >/=102 and >/=88 cm in men and women, respectively. Prehypertension was defined as not being on antihypertensive medication and having systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg. Odds ratio from the logistic regression analysis was used to estimate the risk of prehypertension that was due to abdominal obesity. To estimate prehypertension risk differences between low-risk Whites and high-risk Blacks and Hispanics that was due to abdominal obesity, we estimated relative attributable risk. Statistical adjustments were made for age, blood glucose, total cholesterol, current smoking and exercise. Abdominal obesity was associated with increased odds of prehypertension in Whites, Blacks and Hispanics. In men, abdominal obesity was associated with 44, 90 and 98% increased odds of prehypertension in Whites, Blacks and Hispanics, respectively. The corresponding values in women were 112, 198 and 104%. Proportions of risk of prehypertension explained by abdominal obesity were 15.2, 22 and 25.8% in White men, Black men and Hispanic men, respectively. The corresponding values in women were 38.8, 58.6 and 32.5%. Approximately, 7% of the differences in the risk of developing prehypertension between White and Black men and between White and Hispanic men may be attributable to differences in rates of abdominal obesity. The analogous values for women were approximately 39.7 and approximately 16.5%, respectively. In conclusion, despite having lower rates of abdominal obesity than their counterparts, Black men, Hispanic men and Hispanic women had high population attributable risks, indicating that factors other than abdominal obesity may have important explanatory power for racial differences in prehypertension in these groups. However, in Black women reduction in risk of prehypertension could be possible by instituting public health measures to reduce abdominal obesity to the levels seen in White women. Intervention programmes designed to reduce overall obesity may also lead to reduction of abdominal obesity, and consequently may curb prehypertension in these population groups. Life-style modification, including diet and exercise, may have public health significance in reducing the incidence of prehypertension in these populations.

Measuring self-reported comfort with general family practice skills during a required third-year family practice clerkship.

BACKGROUND: To judge the effectiveness of a new required third-year family practice (FP) clerkship, we designed a 20-item FP comfort assessment (FPCA) to measure students' self-reported comfort with a wide range of FP skills. This report examines the behavior and characteristics of the FPCA. METHODS: During the 1990-91 academic year, 179 students who completed the FP clerkship were asked to complete the FPCA on the first and last days of the clerkship. RESULTS: Factor analysis of responses yielded four factors that explained 66.4% of the total variance: relationships and values, history and physical, diagnosis and management, and preventive medicine. After adjustment, internal consistency for each factor ranged from .77 to .89. All postclerkship factor scores were significantly greater than preclerkship factor scores, indicating that the FPCA performed as expected. All postclerkship factor scores and two of the change scores correlated significantly with the students' overall clerkship grade, indicating concurrent validity. CONCLUSION: The FPCA is a reliable and valid measure of student comfort with patient-centered FP skills.

Key issues in nutrition. Disease prevention through adulthood and old age.

Certain dietary practices are valid methods of lowering the risk of disease. Others, while popular, have unproven benefits or may even be associated with risks of their own. Careful evaluation of hypercholesterolemia is necessary. Persons with a high level of low-density lipoprotein (LDL) cholesterol and a low level of high-density lipoprotein (HDL) cholesterol need diet therapy, because they are at increased risk of cardiovascular disease. Weight reduction and fat restriction can lower blood pressure, help control hyperglycemia, and improve the LDL cholesterol-HDL cholesterol ratio. Some evidence indicates a protective role of beta carotene against cancer in animals. However, hypervitaminosis A is dangerous and relatively easy to accomplish, so supplementation beyond a multivitamin tablet is discouraged. Data about inhibition of cancer in humans through use of high doses of vitamin E or C or selenium are inconclusive, and studies of effects of long-term ingestion are not available. In general, megadoses of even healthy substances are thought to be dangerous. Decreased consumption of fat, increased consumption of foods high in fiber, and elimination of alcohol and tobacco are sensible recommendations. Consumption of cruciferous vegetables has not been proven to reduce the incidence of cancer, but a moderate amount of them in the diet would seem reasonable.

Key issues in nutrition. Supplementation through adulthood and old age.

A varied and balanced diet is usually adequate to meet the energy, protein, vitamin, and mineral requirements of adults and the elderly. However, some high-risk groups may require supplementation or special dietary recommendations. Some examples are persons on a weight-loss diet, alcoholics, premenopausal women, women taking oral contraceptives, postmenopausal women not taking estrogen, and patients with diminished immunity or cancer. An understanding of the nutritional needs of adult and elderly patients is vital if the primary care physician is to answer their questions and help them maintain good health through dietary adjustment or supplementation.

Key issues in nutrition. During childhood and adolescence.

Good nutrition is important between ages 2 and 18, because growth and maturation are taking place and because future eating habits are being established. The primary care physician can assist children and adolescents by evaluating high-risk factors, such as a family history of cardiovascular disease or hypercholesterolemia, and by recommending supplemental nutrients as indicated. Possibly more important, though, is the counseling the physician can give these patients and their parents to promote a life-style that may prevent disease.

Key issues in nutrition. From conception through infancy.

Pregnant and lactating women and infants are at nutritional risk because of their special needs; both require adequate dietary nutrition and, often, dietary supplementation. For example, the mother's increased requirements for iron, calcium, folic acid, and vitamin D usually must be met with increased milk intake and multivitamin-with-mineral supplements. Since the pregnant and the lactating woman can pass both nutrients and nonnutrients to the child, she should be advised on a well-balanced, high-quality diet that is free of drugs or other additives that may be harmful. Although either breastfeeding or the use of formula may fulfill energy and protein needs, the infant may require supplemental vitamins K and C, fluoride, and iron.