The women's health initiative dietary modification trial: overview and baseline characteristics of participants

Ritenbaugh, Cheryl; Patterson, Ruth E.; Chlebowski, Rowan T.; Caan, Bette J.; Fels-Tinker, Lesley; Howard, Barbara V.; Ockene, Judy

doi:10.1016/s1047-2797(03)00044-9

Cited by 187 publications

(141 citation statements)

References 36 publications

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“…Biomarker data, including fasting insulin levels, were measured in 2 clinical trial subcohorts: the SNP Health Association Resource cohort (SHARe; n=11 967) and the European American Hormone Trial subcohort (EA HT; n=10 161). The SHARe CVD biomarkers study comprised African American and Hispanic participants from either the clinical trials 9,10 or observational study cohorts, 11 whereas the EA HT CVD biomarkers study primarily comprised white women from the menopausal hormone therapy trials. The scientific rationale, study design, eligibility criteria, and baseline characteristics of patients enrolled in these studies have been reported.…”

Section: Study Populationmentioning

confidence: 99%

Insulin Resistance and Risk of Cardiovascular Disease in Postmenopausal Women

Schmiegelow

Hedlin

Stefanick

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-Insulin resistance is associated with diabetes mellitus, but it is uncertain whether it improves cardiovascular disease (CVD) risk prediction beyond traditional cardiovascular risk factors. Methods and Results-We identified 15 288 women from the Women's Health Initiative Biomarkers studies with no history of CVD, atrial fibrillation, or diabetes mellitus at baseline (1993)(1994)(1995)(1996)(1997)(1998). We assessed the prognostic value of adding fasting serum insulin, HOMA-IR (homeostasis model assessment-insulin resistance), serum-triglyceride-to-serum-highdensity lipoprotein-cholesterol ratio TG/HDL-C, or impaired fasting glucose (serum glucose ≥110 mg/dL) to traditional risk factors in separate Cox multivariable analyses and assessed risk discrimination and reclassification. The study end point was major CVD events (nonfatal and fatal coronary heart disease and ischemic stroke) within 10 years, which occurred in 894 (5.8%) women. Insulin resistance was associated with CVD risk after adjusting for age and race/ethnicity with hazard ratios (

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Section: Study Populationmentioning

confidence: 99%

Insulin Resistance and Risk of Cardiovascular Disease in Postmenopausal Women

Schmiegelow

Hedlin

Stefanick

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Section: Women's Health Initiativementioning

confidence: 99%

“…All participants in WHI gave informed consent and were followed prospectively. Details of the scientific rationale, eligibility requirements and baseline characteristics of the participants in the WHI have been published elsewhere (Hays et al, 2003;Jackson et al, 2003;Langer et al, 2003;Ritenbaugh et al, 2003;Stefanick et al, 2003).The following participants were excluded from the original cohort of 161 808 : 14 849 with a history of cancer (except nonmelanoma skin cancer) at baseline, 668 with no follow-up, 7491 with missing values of main exposures and confounders (including weight, height, waist circumference, hip circumference, smoking, and diabetes), and 297 (0.18%) with waist-to-hip ratio (WHR) values of beyond 4 s.d. (WHRo0.4 or WHR41.2), leaving 138 503 women for analysis.…”

mentioning

confidence: 99%

Obesity and risk of pancreatic cancer among postmenopausal women: the Women's Health Initiative (United States)

et al. 2008

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A total of 138 503 women in the Women's Health Initiative in the United States were followed (for an average of 7.7 years) through 12 September 2005 to examine obesity, especially central obesity in relation to pancreatic cancer (n ¼ 251). Women in the highest quintile of waist-to-hip ratio had 70% (95% confidence interval 10 -160%) excess risk of pancreatic cancer compared with women in the lowest quintile. (Ekbom and Hunter, 2007). Besides tobacco smoking and chronic pancreatitis (Lowenfels et al, 1999), little is known of its aetiology, but recently, increasing evidence has suggested that obesity is a risk factor (Berrington de Gonzalez et al, 2003;Larsson et al, 2007). However, in most studies, the association seems to be weaker in women -who tend to gain weight more peripherally -than in men, suggesting that central adiposity may be a stronger risk factor for pancreatic cancer than body mass index (BMI). Few studies have investigated this aspect and the findings are inconsistent (Larsson et al, 2005;Sinner et al, 2005;Ansary-Moghaddam et al, 2006;Berrington de Gonzalez et al, 2006).We have used the large prospective Women's Health Initiative (WHI) study, with measured anthropometric factors, including hip and waist circumference, to examine the relationship between BMI, central adiposity, and pancreatic cancer risk. MATERIALS AND METHODS Women's Health InitiativeThe WHI, an ongoing, ethnically and geographically diverse, multi-centre clinical trial (CT) and observational study (OS), was designed to address some of the major causes of morbidity and mortality in postmenopausal women. Briefly, a total of 161 808 women aged 50 -79 years were recruited at 40 clinical centres throughout the United States from 1 September 1993 through 1998. The WHI includes three overlapping CT components (hormone trial, dietary modification trial, and calcium/vitamin D supplementation trial) and an OS. All participants in WHI gave informed consent and were followed prospectively. Details of the scientific rationale, eligibility requirements and baseline characteristics of the participants in the WHI have been published elsewhere (Hays et al, 2003;Jackson et al, 2003;Langer et al, 2003;Ritenbaugh et al, 2003;Stefanick et al, 2003).The following participants were excluded from the original cohort of 161 808 : 14 849 with a history of cancer (except nonmelanoma skin cancer) at baseline, 668 with no follow-up, 7491 with missing values of main exposures and confounders (including weight, height, waist circumference, hip circumference, smoking, and diabetes), and 297 (0.18%) with waist-to-hip ratio (WHR) values of beyond 4 s.d. (WHRo0.4 or WHR41.2), leaving 138 503 women for analysis.All exposures in our analyses were collected at baseline for all participants. During the baseline clinical visit, trained and certified staff performed anthropometric measurements, including height, weight, hip and waist circumferences, and blood pressure. Body mass index was calculated as weight in kilograms divided by the square of height in metres. Wa...

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“…7 Past large-scale women's health studies, such as the Women's Health Initiative (WHI) and Nurses' Health Study, primarily focused on risk factors for individual diseases or general health characteristics of women, without focusing on the prevalence of coexisting conditions or the effect of coexisting conditions on HRQoL. [8][9][10][11] The Observational Study of the WHI studied the primary causes of morbidity and mortality, and the Nurses' Health Study did not report on the coexistence of the conditions studied. Rather, publications have primarily focused on the incidence of a single condition (e.g., the incidence of urinary incontinence) 12 or risk factors for developing a select condition (e.g., relationship between diet and chronic kidney disease).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Multimorbidity on Quality of Life Among Midlife Women: Findings from a U.S. Nationally Representative Survey

Lang¹,

Alexander²,

Simon³

et al. 2015

Journal of Women's Health

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Background: Little is known about the prevalence and cumulative burden of coexisting health conditions including chronic joint and muscular pain, urinary incontinence (UI), depression, osteoporosis risk, moderate/ severe vasomotor symptoms, and vulvar/vaginal atrophy (VVA). We surveyed a nationally representative U.S. sample of midlife (age 40-64 years) women to ascertain the prevalence, general health-related quality of life (HRQoL), and health-seeking behaviors associated with these six conditions. Methods: This cross-sectional, telephone survey collected data from a sample of English-and Spanish-speaking U.S. women. The survey contained demographic and menopausal status questions, and also five conditionspecific symptom/disease risk-screening instruments. The EuroQol 5 dimensions (EQ-5D) questionnaire was used to measure HRQoL. Health-seeking behavior was measured based on clinician discussion of and recent treatment for each condition. Results: Three thousand fifty eight women (mean age 53.4 years) completed the survey. The majority were white (75.6%), married (60.5%), employed full-or part-time (59.0%), and postmenopausal (69.8%; based on self-report). The prevalence [95% confidence interval] of 0, 1, 2, and ‡ 3 conditions was 35.2% [33.5-36.9], 34.2% [32.5-35.9], 17.9% [16.6-19.3], and 12.7% [11.5-13.9], respectively. Osteoporosis risk (30.6%) was most prevalent, followed by VVA (27.8%) and UI (26.6%). UI and VVA coexisted most frequently (11.3%), followed by osteoporosis risk and VVA (9.8%). EQ-5D scores decreased with increasing number of illnesses (0, 1, 2, and ‡ 3 conditions, means: 0.92, 0.87, 0.77, 0.61, respectively; p < 0.01). Health-seeking behavior varied by condition. Conclusion: Over 25% of women surveyed had multiple coexisting conditions. Lower HRQoL was associated with multiple conditions and with each added condition.

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The women's health initiative dietary modification trial: overview and baseline characteristics of participants

Cited by 187 publications

References 36 publications

Insulin Resistance and Risk of Cardiovascular Disease in Postmenopausal Women

Insulin Resistance and Risk of Cardiovascular Disease in Postmenopausal Women

Obesity and risk of pancreatic cancer among postmenopausal women: the Women's Health Initiative (United States)

The Impact of Multimorbidity on Quality of Life Among Midlife Women: Findings from a U.S. Nationally Representative Survey

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