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Telomere length (TL) has been implicated in the pathogenesis of age-related disorders. However, there are no prospective studies directly investigating the role of TL and relevant genes in diabetes development. [...]

OBJECTIVE--To determine the frequency that diabetes is reported on death certificates of decedents with known diabetes and describe trends in reporting over 8 years. RESEARCH DESIGN AND METHODS--Data were obtained [...]

OBJECTIVE--To examine whether lower serum levels of serum 25-hydroxyvitamin (OH) D [25(OH)D] are associated with increased risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS--A post hoc analysis of [...]

Background: The associations of serum omega-6 (n-6) fatty acids with lipoprotein subclasses at the population level are uncertain. Objective: We aimed to examine associations between major n-6 fatty acids lie, linoleic acid (LA, 18:2n-6) and arachidonic acid (AA, 20:4n-6)] and the lipoprotein subclasses VLDL, LDL, and HDL. Design: We conducted a cross-sectional study in 1098 participants using population-based data from US white, Japanese American, Japanese, and Korean men aged 40-49 y. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Lipoprotein subclasses were measured by nuclear magnetic resonance spectroscopy. Multiple linear regression models as a function of each fatty acid were used after adjustment for age, population, body mass index, pack-years of smoking, alcohol consumption, diabetes, hypertension, and omega-3 (n-3) and trans fatty acids. Results: Serum LA was inversely associated with large VLDL ([beta] = -0.62, P < 0.001), total LDL ([beta] = -22.08, P < 0.001), and small LDL ([beta] = -31.89, P < 0.001) particle concentrations and VLDL size ([beta] = -0.72, P < 0.001). Serum LA was positively associated with large HDL particle concentration ([beta] = 0.21, P < 0.001) and HDL size ([beta] = 0.03, P < 0.001). The patterns of association of AA with large VLDL and large HDL particle concentrations were comparable with those of LA. Conclusions: At the population level, higher serum concentrations of LA were significantly associated with lower concentrations of total LDL particles. Higher serum concentrations of LA and AA were significantly associated with a lower concentration of large VLDL particles and a higher concentration of large HDL particles. These associations were consistent across the population groups. This trial was registered at clinicaltrials.gov as NCT00069797. doi: 10.3945/ajcn.2009.28500.

Background: The association of serum polyunsaturated fatty acids (PUFAs) with lipids in different populations is not known. Objective: Our aim was to examine the association of serum n--6 (omega-6) or n--3 (omega-3) PUFAs with triglycerides or HDL-cholesterol concentrations in 261 white, 285 Japanese, and 212 Japanese American men aged 4049 y. Design: We used a population-based cross-sectional study. Of the original sample (n = 926), those taking lipid-lowering medications or who had diabetes (n = 168) were excluded. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Multiple regression models as a function of tertile groups of each PUFA were used. Results: Serum n--6 PUFAs were significantly inversely associated with triglycerides across populations after adjustment for age, body mass index, pack-years of smoking, and ethanol consumption [[beta] = -0.39 (P < 0.001), -0.38 (P < 0.001), and -0.33 (P < 0.001) in whites, Japanese, and Japanese Americans, respectively]. Marine n--3 PUFAs were significantly inversely associated with triglycerides across populations [[beta] = -0.15 (P < 0.001), -0.22 (P < 0.001), and - 0.13 (P < 0.001) in whites, Japanese, and Japanese Americans, respectively]. n--6 PUFAs were significantly positively associated with HDL cholesterol in whites ([beta] = 4.49, P < 0.001) and Japanese ([beta] = 3.73, P < 0.01). Marine n--3 PUFAs were significantly positively associated with HDL cholesterol in Japanese ([beta] = 2.15, P < 0.05), and eicosapentaenoic acid was significantly positively associated with HDL cholesterol in whites ([beta] = 2.68, P < 0.01). Conclusion: Serum n--6 and n--3 PUFAs are inversely associated with triglycerides across populations.

Background: In initial analyses, we found significant differences between serum adiponectin in Japanese living in Japan and Hawaii. Objective: We investigated whether differences in dietary and other lifestyle factors explain higher serum adiponectin concentrations in Japanese in Japan compared with Japanese emigrants living a Western lifestyle in Hawaii. Design: Serum adiponectin and nutrient intakes were examined by standardized methods in men and women aged 40-59 y from 2 population samples, one Japanese American in Hawaii (99 men, 104 women), the other Japanese in central Japan ( 124 men, 125 women). Multiple linear regression models were used to assess the role of dietary and other lifestyle traits in accounting for serum adiponectin difference between Hawaii and Japan. Results: Mean adiponectin was significantly higher in Japan than in Hawaii (10.5 [+ or -] 5.5/[micro]g/mL compared with 6.7 [+ or -] 3.2 [micro]g/mL in men, P = 0.002; 12.9 [+ or -] 5.9 [micro]g/mL compared with 9.4 [+ or -] 4.2 in women, P < 0.0001). In men, the difference in body mass index (BMI; in kg/[m.sup.2]) in the 2 populations explained [approximately equal to] 90% of the difference in serum adiponectin; in women, only 29%. In multiple linear regression analyses in women further adjustment for physical activity and 4 nutrients (nonvegetable protein, n-3 polyunsaturated fatty acid, arachidonic acid, dietary cholesterol) produced a further reduction in the coefficient for the difference (total 56%); P value for the difference became 0.074. Conclusions: The significantly higher mean serum adiponectin concentration in Japan than in Hawaii may be attributable largely to differences in BMI. Differences in nutrient intake in the 2 samples were associated with only modest relation to the adiponectin difference.

OBJECTIVE--Experimental and epidemiologic studies suggest that calcium and vitamin D may reduce the risk of developing diabetes. We examined the effect of calcium plus vitamin D supplementation on the incidence [...]

Type 2 diabetes is a common disorder associated with obesity. Lower plasma levels of adiponectin were associated with type 2 diabetes. Candidate regions on chromosomes 1 (~70 cM) and 14 (~30 cM) were evaluated for replication of suggestive linkage results for type 2 diabetes/impaired glucose homeostasis in an independent sample of Japanese Americans. Replication of independent linkage evidence for serum levels of adiponectin on chromosome 14 was also evaluated. We investigated 529 subjects from 175 sibships who were originally part of the Honolulu Heart Program. Analyses included nonparametric linkage and association using SAGE (Statistical Analysis for Genetic Epidemiology) and FBAT (family-based test of association) programs and Monte Carlo simulation of Fisher's exact test in SAS. For type 2 diabetes/impaired glucose metabolism, nominal linkage evidence (P < 0.02) followed-up by genotypic association (P = 0.016) was found with marker D14S297 at 31.8 cM; linkage analyses using only diabetes phenotype were also nominally significant at this marker (P < 0.02). Nominal evidence for genotypic association to adiponectin serum level phenotype (P = 0.04) was found with the marker D14S1032 at 23.2 cM. The present study was limited by relatively small sample size. Nevertheless, these results corroborate earlier studies, suggesting that further research is warranted in the candidate region ~30 cM on chromosome 14., Type 2 diabetes is a genetically influenced disorder associated with obesity, generally adult onset, affecting ~7% of the U.S. population (1-4). A GENNID (Genetics of NIDDM) genome scan (5) suggested [...]

The relationship between total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and the incidence of coronary heart disease (CHD) in elderly men are examined. The U-shaped association between TC and LDL-C and CHD implies a complex relationship between lipids and CHD in the late life.

Background: No studies have compared care in the Department of Veterans Affairs (VA) with that delivered in commercial managed care organizations, nor have studies focused in depth on care comparisons for chronic, outpatient conditions. Objective: To compare the quality of diabetes care between patients in the VA system and those enrolled in commercial managed care organizations by using equivalent sampling and measurement methods. Design: Cross-sectional patient survey with retrospective review of medical records. Setting: 5 VA medical centers and 8 commercial managed care organizations in 5 matched geographic regions. Participants: 8205 diabetic patients: 1285 in the VA system and 6920 in commercial managed care. Measurements: We compared scores on identically specified quality measures for 7 diabetes care processes and 3 diabetes intermediate outcomes and on 4 dimensions of satisfaction. Scores were expressed as the percentage of patients receiving indicated care and were adjusted for patients' demographic and health characteristics. Results: Patients in the VA system had better scores than patients in commercial managed care on all process measures (for example, 93% vs. 83% for annual hemoglobin [A.sub.1c]; P = 0.006; 91% vs. 75% for annual eye examination; P< 0.001). Blood pressure control was poor in both groups (52% to 53% of persons had blood pressure < 140/90 mm Hg), but patients in the VA system had better control of low-density lipoprotein cholesterol and hemoglobin [A.sub.1c] (for example, 86% vs. 72% for low-density lipoprotein cholesterol level < 3.37 mmol/L [ Limitations: Our results may not be generalizable to all regions or health plans, and some of the differences in performance could reflect differences in documentation. Conclusions: Diabetes processes of care and 2 of 3 intermediate outcomes were better for patients in the VA system than for patients in commercial managed care. However, both VA and commercial managed care had room for improvement, especially for blood pressure control.

OBJECTIVE--To examine the association between the organizational model and diabetes processes of care. RESEARCH DESIGN AND METHODS--We used data from the Translating Research into Action lot Diabetes (TRIAD), a multicenter [...]

OBJECTIVE--Despite the increased shifting of health care costs to consumers, little is known about the impact of financial barriers on health care utilization. This study investigated the effect of out-of-pocket [...]

Their impact on diabetes prevalence and total and cardiovascular disease mortality in elderly Japanese-American men OBJECTIVE -- To compare the prevalence of diabetes according to the American Diabetes Association (ADA) [...]

3,497 Japanese American older men in Oahu, Hawaii were studied to see how their longevity related to their social structures and psychological health. Study participants took the Lubben Social Networks Scale test and those who scored poorly tended to die earlier.

Background: Previous studies often of short duration have raised concerns that antihypertensive therapy with diuretics and [Beta]-blockers adversely alters levels of other cardiovascular disease risk factors. Methods: The Systolic Hypertension in the Elderly Program was a community-based, multicenter, randomized, double-blind, placebo-controlled clinical trial of treatment of isolated systolic hypertension in men and women aged 60 years and older. This retrospective analysis evaluated development of diabetes mellitus in all 4736 participants in the Systolic Hypertension in the Elderly Program, including changes in serum chemistry test results in a subgroup for 3 years. Patients were randomized to receive placebo or treatment with active drugs, with the dose increased in stepwise fashion if blood pressure control goals were not attained: step 1, 12.5 mg of chlorthalidone or 25.0 mg of chlorthalidone; and step 2, the addition of 25 mg of atenolol or 50 mg of atenolol or reserpine or matching placebo. Results: After 3 years, the active treatment group had a 13/4 min Hg greater reduction in systolic and diastolic blood pressure than the placebo group (both groups, P [is less than] 001). New cases of diabetes were reported by 8.6% of the participants in the active treatment group and 7.5% of the participants in the placebo group (P = .25). Small effects of active treatment compared with placebo were observed with fasting levels of glucose (+0.20 mmol/L [+3.6 mg/dL]; P [is less than] 01), total cholesterol (+0.09 mmol/L [+3.5 mg/dL]; P [is less than] .01), high-density lipoprotein cholesterol (0.02 mmol/L [-0.77 mg/dL]; P [is less than] 01) and creatinine (+2.8 [micro]mol/L [+0.03 mg/dL]; P [is less than] 001). Larger effects were seen with fasting levels of triglycerides (+0.9 mmol/L [+17 mg/dL]; P [is less than] 001), uric acid (+35 [micro]mol/L [+.06 mg/dL]; P [is less than] 001), and potassium (-0.3 mmol/L; P [is less than] 001). No evidence was found for a subgroup at higher risk of risk factor changes with active treatment. Conclusions: Antihypertensive therapy with low-dose chlorthalidone (supplemented if necessary) for isolated systolic hypertension lowers blood pressure and its cardiovascular disease complications and has relatively mild effects on other cardiovascular disease risk factor levels. Arch Intern Med. 1998;158:741-751

Objective: To identify lifestyle, anthropometric, biochemical, and clinical characteristics associated with pulmonary function in elderly men. Design: Cross-sectional population-based study. Participants: Japanese-American men (n=3,111) aged 71 to 93 years, who [...]

Obesity has been associated with an increased risk for developing high blood pressure and high blood levels of sugar (glucose) and cholesterol. These conditions are known to be related to the development of coronary heart disease (CHD). However, the exact relationship between obesity and CHD is not clear. Few studies have examined this relationship in US minority populations. To determine if obesity actually increases the risk of developing CHD, 8,006 Japanese men who participated in the Honolulu Heart Program (1965-1968) were examined during a 20-year follow-up study. Body weight, height, blood pressure, and blood levels of glucose and cholesterol were measured during the initial study period and 20 years later. Out of the original group, 7,585 were available for follow-up. Body mass index (BMI, body weight in kilograms divided by height measured in square meters, kg/m2) and skinfold thickness were used as measures of obesity. The results show that the risk of developing CHD increases as the BMI increases, but there was no relationship between BMI and the risk of stroke. However, the risk of CHD and stroke were related to the subscapular skinfold thickness (the thickness of the skin located just beneath the shoulder blades). The risk of developing CHD increased with increasing obesity in men with high and normal blood pressure, and in men with diabetes. It is concluded that lifestyles that lead to an increase in obesity may increase the risk for developing CHD among Japanese men. (Consumer Summary produced by Reliance Medical Information, Inc.)

The relationship between obesity and coronary heart disease (CHD) has been well established. Previous studies have shown that populations that have a high incidence of obesity also have a high incidence of diseases that are associated with obesity. It has been known for some time that CHD is more common in the US than in Japan. More recently, a study reported that the incidence of CHD among Japanese men who had migrated to the US fell between the incidence of CHD reported in Japan and in the US. To further investigate this area, body weight, body height, and dietary habits of Japanese men living in California and Hawaii were compared with Japanese men living in Japan. The study included more than 12,000 Japanese men between the ages of 45 and 69. Body weight and height were used to determine the body mass index (BMI, a measure of obesity calculated as body weight in kilograms divided by height measured in square meters, kg/m2). The average BMI of Japanese men living in California was similar to the average BMI of those living in Hawaii. However, the mean BMI of Japanese men living in Japan was lower than the mean BMI of Japanese men living in the US for all age groups studied. Even though the Japanese men living in Japan had a lower BMI and lower incidence of obesity than those living in the US, the amount of calories consumed on a daily basis was the same for both groups. The subjects living in Hawaii ate twice as much fat as those living in Japan. Based on these findings, it is concluded that Japanese immigrants to the US experience an increase in body weight, which may increase their risk for CHD. (Consumer Summary produced by Reliance Medical Information, Inc.)

A study on performance-based tests used in clinical research, is examined. The tests relate to physical functioning of human beings.

MARJORIE K. MAU [1,2] KAREN GLANZ [3] RICHARD SEVERINO [4] JOHN S. GROVE [5] BRUCE JOHNSON [2] J. DAVID CURB [1,2] Initial findings from the Native Hawaiian Diabetes Intervention Program [...]

Blood pressure dysregulation syndrome is characterized by abnormal swings in blood pressure following postural changes, meals, exercise, and during sleep. Although the syndrome may occur in normotensive individuals, a growing [...]

Background: Recognition and medical record documentation of dementia in the primary care setting are thought to be poor. To our knowledge, previous studies have not examined these issues in private practice office settings within the United States. Objective: To determine the rate of unrecognized and undocumented dementia in a primary care internal medicine private practice. Methods: This was a cross-sectional study of 297 ambulatory persons aged 65 years and older attending an internal medicine private group practice within an Asian American community of Honolulu, Hawaii. Of the subjects, 95% had been with their current primary care physician for at least 1 year. Each subject's primary care physician noted the presence or absence of dementia by questionnaire at the time of an office visit. An investigating physician (V.G.V.) subsequently assessed cognitive function using the Cognitive Abilities Screening Instrument, and confirmed the presence of dementia and its severity, if present, using Benson and Cummings' criteria and the Clinical Dementia Rating Scale, respectively. A trained research assistant completed telephone interviews to proxy informants for collateral information concerning cognition, behavior, and occupational or social function. Subjects' outpatient medical records were reviewed for documentation of problems with cognition. Results: Twenty-six cases of dementia were identified. Of these 26, 17 (65%) (95% confidence interval, 44.3-82.8) were not documented in outpatient medical records; of 18 patients, 12 (67%) (95% confidence interval, 40.9-86.7) were not thought to have dementia by their physicians at the time of the office visit. Recognition and documentation rates increased with advancing stage of disease. Conclusion: Dementia is often unrecognized and undocumented in private practice settings. Arch Intern Med. 2000;160:2964-2968

Increased relative bodyweight is a major risk factor for Type 2 Diabetes Mellitus (T2DM). The Native Hawaiian Health Research Project previously reported high prevalence of overweight ([is greater than] 80% [...]

Background: Recent studies have identified potential beneficial effects of eating nuts, most of which have substantial amounts of monounsaturated fats. Macadamia nuts are 75% fat by weight, 80% of which is monounsaturated. Objective: To examine variations in serum lipid levels in response to a high-monounsaturated fat diet based on macadamia nuts. Methods: A randomized crossover trial of three 30-day diets was conducted in 30 volunteers aged 18 to 53 years from a free-living population. Each was fed a 'typical American' diet high in saturated fat (37% energy from fat); an American Heart Association Step 1 diet (30% energy from fat); and a macadamia nut-based monounsaturated fat diet (37% energy from fat) in random order. Serum total cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were measured. Results: Mean total cholesterol level after the typical American diet was 5.20 mmol/L (201 mg/dL). After the Step 1 diet and the macadamia nut diet, total cholesterol level was 4.99 mmol/L (193 mg/dL) and 4.95 mmol/L (191 mg/dL), respectively. Low-density lipoprotein cholesterol level was 3.37 mmol/L (130 mg/dL) (typical diet), 3.21 mmol/L (124 mg/dL) (Step 1 diet), and 3.22 mmol/L (125 mg/dL) (macadamia nut diet). High-density lipoprotein cholesterol level was 1.43 mmol/L (55 mg/dL) (typical), 1.34 mmol/L (52 mg/dL) (Step 1), and 1.37 mmol/L (53 mg/dL) (macadamia nut). Lipid values after the Step 1 and macadamia nut diets were significantly different from those after the typical diet (P[is less than].05). Conclusions: The macadamia nut-based diet high in monounsaturated fat and the moderately low-fat diet both had potentially beneficial effects on cholesterol and low-density lipoprotein cholesterol levels when compared with a typical American diet. Arch Intern Med. 2000;160:1154-1158

The Native Hawaiian Diabetes Intervention Program developed a culturally-responsive lifestyle program for native Hawaiians (NH) in collaboration with NH communities. The primary objective was to test whether family support would [...]

The Native Hawaiian Health Research (NHHR) Project, RCMI Program, previously reported data to support the existence of insulin resistance (IR) among native Hawaiians as well as a high prevalence of [...]

Recent studies on correlation between cardiovascular health and dementia and Alzheimer's disease are discussed.