Long-term Predictors of Morbidity in Older Age

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DESCRIPTION (provided by applicant): In the past three decades, the prevalence of obesity and type 2 diabetes mellitus (diabetes) has been increasing in epidemic proportions. Steady progress has been made in understanding their complex causes and diverse health consequences. However, important scientific, clinical, and practical questions remain and await further elucidation to combat and reverse the worsening twin epidemics of obesity and diabetes. In response to PA-03-015 (R21 new investigator "Innovative Research Grant Program"), this proposal pinpoints several issues related to obesity and diabetes for which the Chicago Heart Association (CHA) Detection Project in Industry and the Western Electric (WE) Company studies offer an unusual and unique opportunity for elucidation in a cost-effective and innovative way. We will use extensive existing data from the CHA [20,854 men and 16,049 women aged 18-64 at baseline (1967-73)] and WE [2,107 men aged 40- 55 at baseline (1957-58)] that include four comprehensive sources of outcomes: 1) mortality data from long-term follow-up; 2) morbidity and other data from Medicare claims for 19 years from 1984 to 2000; 3) multiple health questionnaires (CHA); and 4) repeated measures of adiposity from 8 annual re-examinations after baseline (WE) to address the following Specific Aims: 1) to investigate in-depth the longitudinal associations of adiposity as assessed by several indices (body mass index, weight gain, subscapular and triceps skinfolds, and derived percent body fat) during young adulthood and middle age with mortality and morbidity from congestive heart failure later in life; 2) to delineate the relationships of adiposity assessed earlier in life with older-age multimorbidity, the coexistence of multiple pathological conditions of varying severity -- a very common but under-studied phenomenon among older adults; 3) to examine in-depth the associations of heart rate and changes in heart rate with incident diabetes, stratified by obesity status at baseline. As an exploratory aim, we will assess whether a) higher fruit and vegetable and lower sugar intake; and b) higher dairy and calcium intake are associated with lower adiposity, smaller weight gain, and lower incidence of diabetes. The proposed work has the potential to provide fundamental new knowledge on several under-explored scientific and practical issues related to obesity and diabetes, contributing to strategic primary prevention of obesity, diabetes, and other chronic conditions, and towards achievement of the goals of "Healthy People 2010" by "helping individuals gain the knowledge, motivation, and opportunities they need to make informed decisions about their health."