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Objective: To examine whether the effect of postmenopausal hormone therapy (HT) on brain volumes in women aged 65–79 years differs depending on type 2 diabetes status during postintervention follow-up of a randomized controlled clinical trial. Methods: The Women9s Health Initiative randomized clinical trials assigned women to HT (0.625 mg/day conjugated equine estrogens with or without 2.5 mg/day medroxyprogesterone acetate) or placebo for an average of 5.6 years. A total of 1,402 trial participants underwent brain MRI 2.4 years after the trials; these were repeated in 699 women 4.7 years later. General linear models were used to assess the interaction between diabetes status and HT assignment on brain volumes. Results: Women with diabetes at baseline or during follow-up who had been assigned to HT compared to placebo had mean decrement in total brain volume of −18.6 mL (95% confidence interval [CI] −29.6, −7.6). For women without diabetes, this mean decrement was −0.4 (95% CI −3.8, 3.0) (interaction p = 0.002). This interaction was evident for total gray matter ( p p = 0.006) volumes. It was not evident for changes in brain volumes over follow-up or for ischemic lesion volumes and was not influenced by diabetes duration or oral medications. Conclusions: For women aged 65 years or older who are at increased risk for brain atrophy due to type 2 diabetes, prescription of postmenopausal HT is associated with lower gray matter (total and hippocampal) volumes. Interactions with diabetes and insulin resistance may explain divergent findings on how estrogen influences brain volume among older women.

Introduction We previously published the case of a woman taking warfarin who was found to have scurvy, a disease caused by a deficiency of vitamin C. This led us to hypothesize that patients taking warfarin who consume a diet limited in vitamin K rich foods may be at risk for other nutrient deficiencies. To test our hypothesis, we studied dietary nutrient intake in patients taking warfarin compared to patients with heart disease not taking warfarin. Methods The warfarin (n=59) and control groups (n=24) comprised convenience samples of patients with heart disease over age 60 years. Patients completed a three-day food diary and reported use of supplements. Results Based on diet history, the most common deficiencies were vitamin D (100% both groups), vitamin E (93% warfarin, 92% control), vitamin A (71% warfarin, 71% control), vitamin K (66% warfarin, 58% control), vitamin C (58 % warfarin, 46% control) and pantothenic acid (69% warfarin, 71% control) with no significant differences in intake deficiencies between warfarin and control groups. Conclusion All of our patients had nutritional intake deficiencies. This may be due to Appalachian dietary habits and not the low vitamin K diet. It seems prudent to recommend multivitamins, however, universal multivitamin supplementation has not been supported by randomized controlled trials. More study is needed to determine the reason for poor nutritional intake in our Appalachian population and to determine whether similar results are evident in a larger sample.