Reversible States of Physical and/or Cognitive Dysfunction: A 9-Year Longitudinal Study.

OBJECTIVES: To determine 1) age-adjusted transition probabilities to worsening physical/cognitive function states, reversal to normal cognition/physical function, or maintenance of normal state; 2) whether these transitions are modulated by sex, BMI, education, hypertension (HTN), health status, or APOE4; 3) whether worsening gait speed preceded cognition change, or vice versa. DESIGN: Analysis of 9-year prospective cohort data from the New Mexico Aging Process Study. SETTING: Healthy independent-living adults. PARTICIPANTS: 60+ years of age (n= 598). MEASUREMENTS: Gait speed, cognitive function (3MSE score), APOE4, HTN, BMI, education, health status. RESULTS: Over 9 years, 2129 one-year transitions were observed. 32.6% stayed in the same state, while gait speed and cognitive function (3MSE scores) improved for 38% and 43% of participants per year, respectively. Transitions to improved function decreased with age (P< 0.001), APOE4 status (P=0.02), BMI (P=0.009), and health status (P=0.009). Transitions to worse function were significantly increased for the same factors (all P<0.05). Times to lower gait speed and cognitive function did not precede each other (P=0.91). CONCLUSIONS: Transitions in gait speed and cognition were mutable with substantial likelihood of transition to improvement in physical and cognitive function even in oldest-old, which may have clinical implications for treatment interventions.

Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update.

Sarcopenia is the loss of skeletal muscle mass and function with aging. Although the term sarcopenia was first coined in 1989, its etiology is still poorly understood. Moreover, a consensus for defining sarcopenia continues to elude us. Sarcopenic changes in the muscle include losses in muscle fiber quantity and quality, alpha-motor neurons, protein synthesis rates, and anabolic and sex hormone production. Other factors include basal metabolic rate, increased protein dietary requirements, and chronic inflammation secondary to age-related changes in cytokines and oxidative stress. These changes lead to decreased overall physical functioning, increased frailty, falls risk, and ultimately the loss of independent living. Because the intertwining relationships of these factors are complex, effective treatment options are still under investigation. The published data on sarcopenia are vast, and this review is not intended to be exhaustive. The aim of this review is to provide an update on the current knowledge of the definition, etiology, consequences, and current clinical trials that may help address this pressing public health problem for our aging populations.

The New Mexico aging process study (1979-2003). A longitudinal study of nutrition, health and aging.

In 1979, Dr. James S. Goodwin, M.D., assisted by Philip J. Garry, Ph.D., submitted a grant proposal to the United States Public Health Service/ National Institute on Aging (NIA) entitled, "A prospective study of nutrition in the elderly". This study was approved and funded by the NIA beginning in 1979. Initially, approximately 300 men and women over 65 years of age with no known medical illnesses and no prescription medications were selected for this study. The primary purpose of this multi disciplinary study, known in the literature as the New Mexico Aging Process Study (NMAPS), was to examine the role of nutrition and resultant changes in body composition and organ function in relation to the aging process and health status of the elderly. This was accomplished by following prospectively healthy elderly volunteers, obtaining in-depth information about dietary habits, lifestyle, body composition, organ function, cognitive status, vitamin metabolism, genetic markers, and biochemical measures of nutritional status and then examining these data in relationship to age and health status and changes in health status. Some of the specific aims of the study were modified over the course of this longitudinal study because of availability of University of New Mexico School of Medicine faculty with expertise in different areas of aging research. In 1988, Dr. Bruno Vellas from the University Hospital in Toulouse, France became an on-going visiting professor at the University of New Mexico School of Medicine. From 1988, until the study was terminated in 2003, Dr. Vellas has collaborated with the faculty involved in the NMAPS on a number of research projects. In this article, we provide information about the studies overall design and briefly describe some of the major finding of the NMAPS.

Estrogen receptor beta dinucleotide (CA) repeat polymorphism is significantly associated with bone mineral density in postmenopausal women.

Significant associations between the lengths of a highly polymorphic dinucleotide (CA) repeat located within the human estrogen receptor beta (ESR2) gene on chromosome 14, bone mineral density (BMD) and androgen levels have been reported previously in premenopausal women. We measured the size of this microsatellite repeat in 226 healthy women (60-98 years). After adjustment for age, body mass index, hormone replacement status, and other variables known to influence BMD, women with < 25 CA repeats had significantly higher BMD measured in the total skeleton, lumbar spine, and femoral neck when compared with women having longer alleles. Women with shorter alleles also had higher circulating estrone and estradiol levels that approached statistical significance as compared with women harboring longer alleles after appropriate adjustments were performed in linear regression models. Women having both short and long CA repeats had BMD values in all regions of the skeleton that were midway between those found in women homozygous for longer or shorter repeat sizes. Because the ESR2 CA repeat size was neither associated with change in BMD nor serum levels of biochemical markers of bone turnover, it is likely that ESR2 CA repeat genotype is significantly linked to the attainment of peak bone mass in women.

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.

Diagnostic efficacy of serum cross-linked N-telopeptide (NTx) and aminoterminal procollagen extension propeptide (PINP) measurements for identifying elderly women with decreased bone mineral density.

The purpose of this study was to determine the diagnostic sensitivity, specificity, predictive value and overall efficiency of serum cross-linked N-telopeptides of bone collagen (NTx) and aminoterminal procollagen extension propeptide (PINP) measurements for identifying women with decreased spine, femoral neck and total body bone mineral density (BMD). Serum NTx and PINP levels and dual X-ray absorptiometry were performed on 196 healthy elderly women, aged 60-90 years. Twelve women were classified as having decreased BMD on the basis of regional and total skeletal densitometric values that were 1.5 to 2.5 standard deviations (SD) below the respective, age-stratified means and were compared with 184 women with BMD values greater than 1.5 SD below the mean. The results of receiver operating characteristic analysis revealed that a cutoff level of more than 15.0 nmol BCE/L for serum NTx, as measured by the Osteomark assay (Ostex International, Seattle WA USA) was associated with a 100% sensitivity and 70% specificity rate for identifying postmenopausal women with low BMD. The positive likelihood ratio was 3.3 and the negative predictive value was 1.0 using the 15.0 nmol decision level for NTx. The overall diagnostic efficiency of a single NTx measurement for identifying women with low BMD was 89%. A cutoff level of >45.0 microg/L for PINP as measured by the Orion Diagnostica RIA assay (Espoo, Finland) had a diagnostic sensitivity of 83% and specificity of 64% for identifying women with decreased BMD. The positive likelihood ratio was 2.3. the negative predictive value 0.98 and the overall diagnostic efficiency 73% using the 45.0 microg/L decision level for PINP. These results warrant future studies using larger populations that are inclusive of more women with low bone mineral density.

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.

Total body water reference values and prediction equations for adults.

BACKGROUND: The clinical interpretation of total body water (TBW) necessitates the availability of timely comparative reference data. The prediction of TBW volume in renal disease is critical in order to prescribe and monitor the dose of dialysis in the determination of Kt/V. In clinical practice, urea distribution (V) is commonly predicted from anthropometric equations that are several decades old and for white patients only. This article presents new reference values and prediction equations for TBW from anthropometry for white and black adults. METHODS: The study sample included four data sets, two from Ohio and one each from New Mexico and New York, for a total of 604 white men, 128 black men, 772 white women, and 191 black women who were 18 to 90 years of age. The TBW concentration was measured by the deuterium or tritium oxide dilution method, and body composition was measured with a Lunar DXA machine. An all-possible-subsets of regression was used to predict TBW. The accuracy of the selected equations was confirmed by cross-validation. RESULTS: Blacks had larger TBW means than whites at all age groups. The 75th TBW percentile for whites approximated the TBW median for blacks at most ages. The white men and black men and women had the largest TBW means ever reported for healthy individuals. The race- and sex-specific TBW prediction equations included age, weight, and stature, with body mass index (BMI) substituted for weight in the white men. The root mean square errors (RMSEs) and standard errors for the individual (SEIs) ranged from approximately 3.8 to 5.0 L for the men and from 3.3 to 3.6 L for the women. In both men and women, high values of TBW were associated with high levels of total body fat (TBF) and fat-free mass (FFM). CONCLUSION: : TBW in these healthy adults is relatively stable through a large portion of adulthood. There are significant race and sex differences in TBW. These accurate and precise equations for TBW provide a useful tool for the clinical prediction of TBW in renal disease for white and black adults. These are the first TBW prediction equations that are specific for blacks.

Association of folate intake and serum homocysteine in elderly persons according to vitamin supplementation and alcohol use.

BACKGROUND: The serum total homocysteine concentration (tHcy), an indicator of folate status and a possible risk factor for vascular disease, is elevated with impaired renal function and poor vitamin B-12 status, which are common in the elderly. OBJECTIVE: Our objective was to determine the association between tHcy, folate intake, alcohol consumption, and other lifestyle factors in elderly persons. DESIGN: This cross-sectional study used linear regression to model changes in tHcy. Subjects were 278 men and women aged 66-94 y studied in 1993. RESULTS: Total folate intake was negatively associated with tHcy in models adjusted for age, sex, serum creatinine, and serum albumin. We found an interaction between food folate intake and supplement use. Food folate intake had an inverse dose-response relation with tHcy that was limited to nonusers of supplements. Predicted tHcy was 1.5 micromol/L lower in users of supplements containing folate and vitamin B-12 than in nonusers and was independent of food folate intake. We found a positive dose-response relation of coffee and tea intake with tHcy, a positive association for alcohol intake of > or = 60 drinks/mo compared with low intake, and an interaction of alcohol use with folate intake and supplement use. Compared with alcohol users, nonusers had higher predicted tHcy and a lower inverse dose-response relation of food folate intake with tHcy. CONCLUSIONS: The inverse association between folate intake and tHcy was strongest among nonusers of supplements and among alcohol drinkers. Identifying modifiable factors related to tHcy, a possible risk factor for vascular disease, is especially important in elderly persons.

Prevalence of mild impairment in renal function in a random sample of elders from a biethnic community survey.

The purpose of this study was to compare the prevalences of renal impairment, notably an elevation in serum urea nitrogen and/or serum creatinine concentration, in a randomly selected, biethnic population of Hispanic and non-Hispanic white men and women, and to determine the associations with coronary heart disease and its risk factors (diabetes, hypertension, and dyslipidemia). A survey of health and health-related issues was conducted on 883 volunteers, mean age 74.1 years, randomly selected from the Medicare rolls of Bernalillo County (Albuquerque), New Mexico. Equal numbers of Hispanic and non-Hispanic white men and women were selected and recruited. A fasting serum creatinine and serum urea nitrogen was included in the battery of laboratory tests. Mild elevations of SUN and serum creatinine concentrations are common (9.2%) in an aging, randomly selected population (mean age 74.1 years). Males were more commonly affected than females. There were no differences between Hispanics and non-Hispanic whites, even though diabetes was twice as prevalent in Hispanics. Mild elevations of SUN and serum creatinine were more common in participants with coronary heart disease and its risk factors (diabetes, hypertension, and dyslipidemia). All participants with mild renal impairment had either increased total cholesterol or decreased HDL-cholesterol. One cannot determine from a cross-sectional study whether the dyslipidemia consistently associated with mild renal impairment was a cause of the renal impairment or a result of the renal impairment; however, biological explanations do exist to explain how the dyslipidemias can lead to progressive glomerulosclerosis.

Critical differences in the serial measurement of three biochemical markers of bone turnover in the sera of pre- and postmenopausal women.

OBJECTIVES: The purpose of this investigation was to quantify the biologic, day-to-day variability and critical differences in serum levels of crosslinked collagen N-telopeptides (NTx), procollagen aminoterminal extension propeptides (PINP) and bone specific alkaline phosphatase (bAP) in healthy women. DESIGN AND METHODS: Seven blood samples were collected from 12 pre- and 15 postmenopausal women over 4 to 6 months. NTx, PINP and bAP levels were determined utilizing enzyme- and radioimmunoassay techniques. RESULTS: The within-subject coefficient of variation (C.V.) in serum bAP, NTx and PINP levels was 7.1, 10.6 and 12.4% respectively. These variances did not differ significantly among premenopausal women when compared with postmenopausal subjects. Combining terms for analytical and biologic variability revealed that a critical difference between 2 successive serial measurements is 24% for bAP, 34% for NTx and 38% for PINP. CONCLUSION: Circulating levels of NTx, PINP and bAP are stable over time periods of several months, allowing for the determination of significant changes in skeletal metabolism of women.

Relationships between nutritional markers and the mini-nutritional assessment in 155 older persons.

OBJECTIVE: To investigate the relationships between nutritional status measured by a comprehensive nutritional assessment including anthropometric measurements, nutritional biological markers, evaluation of dietary intake, and the Mini-Nutritional Assessment (MNA) nutrition screening tool. DESIGN: A prospective study. PARTICIPANTS: One hundred fifty-five older subjects (53 men and 102 women; mean age = 78 years; range = 56-97 years). These participants were hospitalized in a geriatric evaluation unit (n = 105) or free living in the community (n = 50). MEASUREMENT: Weight, height, knee height, midarm and calf circumferences, triceps and subscapular skinfolds, albumin, transthyretin (prealbumin), transferrin, ceruloplasmin, C-reactive protein, alpha1-acid glycoprotein, cholesterol, vitamins A, D, E, B1, B2, B6, B12, folate, copper, zinc, a 3 day food record combined with a food-frequency questionnaire; the MNA nutritional screening. RESULTS: The MNA scores have been found to be significantly correlated to nutritional intake (P < .05 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), anthropometric and biological nutritional parameters (P < .001 for albumin, transthyretin, transferrin, cholesterol, retinol, alpha-tocopherol, 25-OH cholecalciferol zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition in which nutrition intervention may be effective. CONCLUSIONS: The MNA is a practical, noninvasive, and cost-effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons.

Sarcopenia: current perspectives.

The development of sarcopenia is a complex multi-factorial process which begins in mid-life and accelerates after the age of 75 years. Although exercise, nutritional supplementation, hormone replacement and pro-inflammatory cytokine therapy may improve health status and reduce mortality, a better understanding of the complex interactions between these factors are needed. This review will focus on current information regarding the roles that physical activity, hormonal changes, energy intake, oxidative stress, and inflammatory processes play on the development and progression of sarcopenia.

Do elderly persons need to be encouraged to drink more fluids?

BACKGROUND: A recently published and widely quoted modified food guide pyramid encourages persons over the age of 70 years to ingest eight glasses (2 liters) of fluids per day. We challenge the need for this much fluid intake and even question whether it may do more harm than good. METHODS: Equal numbers of Hispanic and non-Hispanic white men and women were selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. Questionnaires and examinations were used to determine usual daily self-reported intake of fluids, lying and standing blood pressures, history of falls over the past year, and the presence of chronic constipation and chronic fatigue or tiredness. Serum samples were obtained for determination of sodium, urea nitrogen (SUN) and creatinine concentrations, and calculation of SUN/creatinine ratios. RESULTS: Interviews/examinations were conducted on 883 volunteers (mean age of 74.1 years). Most participants (71%) estimated that their usual fluid intake was equal to or exceeded six glasses per day. Evidence of hypernatremia (serum sodium concentration > 146 mEq/l) was not observed in the 227 individuals ingesting less than this. Hyponatremia also was rare in this population. Fluid intake showed no significant associations with lying and standing blood pressures, a history of falling, or the frequency of chronic constipation or fatigue/tiredness. CONCLUSION: Until we have more evidence-based documentation that fluid intake of eight glasses (2 liters) per day improves some aspect of an elderly person's health, encouraging a fluid intake above a level that is comfortable for the individual seems to serve little useful purpose.

Effects of iron intake on iron stores in elderly men and women: longitudinal and cross-sectional results.

OBJECTIVE: For middle aged and elderly subjects there is a concern that increased iron intake, especially heme iron associated with consumption of red meat, leads to increased iron stores resulting in disturbed glucose homeostasis and risk for cardiovascular disease and certain types of cancer. The aim of this study was to investigate the influence of heme, non-heme and iron supplementation on iron stores in healthy elderly men and women. METHOD: We conducted a 10 year longitudinal study (48 men and 77 women) and a one year cross-sectional study (165 men and 226 women) in healthy elderly men and women enrolled in the New Mexico Aging Process Study. Iron stores were estimated by serum ferritin concentrations and iron intake was determined by three-day food records in the longitudinal study and by a food frequency questionnaire in the cross-sectional study. RESULTS: We found no association between heme iron intake and iron stores in either the longitudinal or cross sectional study. In the cross-sectional study we found in women, but not in men, that age and supplemental iron intake were significantly and positively associated with increased iron stores. CONCLUSION: Iron stores in elderly men are thought to reach steady state levels where iron absorption is adjusted to a level just sufficient to cover basal iron losses. In elderly women, we speculate that not enough time has elapsed for postmenopausal women to reach steady state levels of iron stores resulting in increases in iron absorption with age. Another factor is that use of hormone replacement therapy could further delay some women in reaching steady state iron levels due to continued menstrual blood losses.

Bone mineral density and serum levels of aminoterminal propeptides and cross-linked N-telopeptides of type I collagen in elderly men.

Serum levels of aminoterminal extension propeptides (PINP), the carboxyterminal telopeptide (ICTP), and the cross-linked N-telopeptides (NTx) of type I collagen were determined in 78 healthy, elderly men aged 76 +/- 5 years in 1993 and 1996 and compared with bone mineral density (BMD) measurements of their lumbar spine, femoral neck, and total body regions made using dual X-ray absorptiometry. Compared with 11 men who had normal lumbar spine (SBMD) and femoral neck BMD (NBMD), 13 of the subjects with SBMD and NBMD classified as osteopenic by t-score criterion had higher mean serum levels of PINP and alkaline phosphatase activity, but these increases were not statistically significant at the 95% confidence interval. In osteopenic men, a correlation between SBMD and NTx was detected (r = -0.66, p = 0.01). Within the entire population, the serum NTx level correlated with NBMD (r = -0.26, p < 0.05) and PINP (r = +0.63, p < 0.0001), and the change in the circulating concentration of PINP over the 3 year interval correlated with the magnitude of change in total body BMD (r = -0.28, p = 0.02), NBMD (r = -0.24, p = 0.05), and SBMD (r = -0.36, p = 0. 03) as well as with the change in serum NTx levels (r = 0.43, p < 0. 001). The change in the circulating ICTP level was also related to the change in NBMD (r = -0.24, p = 0.01). Together, weight and the serum PINP level accounted for 25% of total body BMD variance in elderly men. These results indicate that larger populations of men and women should be screened over longer time intervals to explore the value of serial measurement of serum collagen metabolites in predicting bone loss in the spine and hip.

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.

Estrogen replacement therapy, serum lipids, and polymorphism of the apolipoprotein E gene.

BACKGROUND: Pharmacogenomics, the study of genetic loci that modulate drug responsiveness, may help to explain why estrogen replacement therapy (ERT) has differential effects on serum lipid and lipoprotein concentrations in postmenopausal women who inherit distinct alleles of the apolipoprotein E gene (APOE). METHODS: We compared total-cholesterol, triglyceride, and lipoprotein (LDL and HDL) concentrations in 66 postmenopausal women receiving ERT ([+]ERT) with 174 postmenopausal women not receiving ERT ([-]ERT), controlling for three APOE genotypes divided into three groups: E2 (epsilon2/epsilon3, n = 31), E3 (epsilon3/epsilon3, n = 160), and E4 (epsilon3/epsilon4 + epsilon4/epsilon4, n = 49). RESULTS: Mean total-cholesterol concentrations were lower in all three [+]ERT groups compared with their [-]ERT counterparts but were statistically significant only for women in group E4 (P = 0.014). The mean LDL-cholesterol concentrations were significantly lower in all three [+]ERT groups compared with their [-]ERT counterparts (P