Prevalence of thyroid autoantibodies in ambulatory elderly women.

Major improvements in thyroid autoantibody testing have now become widely available. Seventy-five elderly ambulatory women from a senior citizens' center (mean age 74.5 yrs) were studied to reassess the prevalence of thyroid autoantibodies and to demonstrate how such tests related to clinical signs and symptoms of thyroid disease. We used the enzyme-linked immunoassay (ELISA) technique for the measurement of autoantibodies to thyroglobulin (hTg) and thyroid peroxidase (hTPO) (as microsomal antigen), since ELISA systems are economical, highly sensitive and specific for population screening. Autoantibodies to hTPO (hTPO-Ab) were present in 44% and hTg autoantibodies (hTg-Ab) in 32% of the study group. Ten women (13.3%) had elevated thyrotropin (TSH) levels. An elevated serum TSH was associated with the presence of hTPO-Ab in varying concentrations. The mean TSH value of 7.2 microIU/mL in those women with hTPO-Ab was significantly higher than the mean of 4.7 microIU/mL found in those women without thyroid autoantibodies (p < 0.01). However, additional testing for hTg-Ab was of little clinical value. These data indicate the high prevalence of thyroid autoimmune disease in the elderly female population. We conclude that screening for thyroid dysfunction is best achieved by the measurement of serum TSH in all women over the age of 60 years. The measurement of hTPO-Ab, but not hTg-Ab, was helpful in confirming the cause of thyroid failure in the elderly female population.

Health and nutrition survey in a group of urban homeless adults.

Homeless persons eat foods from municipal and privately run shelters, fast-food restaurants, delicatessens, and garbage bins. Data on the adequacy of the diets and the nutritional status of homeless persons are sparse. Therefore, we surveyed the nutritional adequacy of the dietary intake, the quality of shelter meals, and objective clinical parameters indicative of nutritional status in a heterogeneous group of urban homeless persons. The group comprised mentally ill persons, alcohol and illicit drug users, and temporarily unemployed persons. Although 86 of the 96 subjects (90%) in our survey reported that they obtained enough to eat, a low dietary adequacy score, which was based on the basic four food groups, of 10.7 (norm = 16) indicated that the quality of their diets was inadequate. Shelter meals and diet records showed a high level of saturated fat and cholesterol. Serum cholesterol levels above the desirable limit of 5.17 mmol/L (200 mg) were observed in 79 subjects (82%). In addition to a prevalence of hypertension and obesity (observed in 37 subjects [39%], these homeless persons were at high risk for development of or worsening of cardiovascular disease. We conclude that homeless persons who obtain meals at shelters are getting enough to eat. However, the shelter meals should be modified to meet the nutritional needs and dietary prescriptions of the large number of clients who suffer from various health disorders.

Assessment of the nutritional status of urban homeless adults.

Homeless people eat foods at municipal and charity run shelters, fast-food restaurants, delicatessens, and from garbage bins. Data on the adequacy of the diets and the nutritional status of homeless persons are sparse. Therefore, nutritional indicators of 55 urban homeless subjects were assessed, and a high prevalence of risk factors was identified. Although 93 percent of subjects reported that they obtained enough to eat, a low dietary adequacy score of 10.1 (norm = 16) indicated that the quality of the diet was inadequate. Diet records showed a high intake of sodium, saturated fat, and cholesterol. Serum cholesterol levels above the desirable limit of 200 mg per dl were prevalent. Anthropometric measurements were significantly different from percentile distributions of the U.S. population (P less than .001). Triceps skinfold measurement was above the 95th percentile in 25 percent of subjects. Upper arm muscle area, which reflects lean body mass, was below the 5th percentile in 23.3 percent of women and 44 percent of the men. These decreased levels of lean body mass and increased levels of body fat, together with the elevated serum cholesterol levels and the shortages of essential nutrients in the diet, may place the homeless at risk of developing nutrition-related disorders.