%0 Journal Article %J Neurology %D 2017 %T Physical activity, but not body mass index, predicts less disability before and after stroke. %A Pamela M. Rist %A Benjamin D Capistrant %A Elizabeth R Mayeda %A Sze Y Liu %A M. Maria Glymour %K BMI %K Disabilities %K Older Adults %K Physical activity %K Stroke %X

OBJECTIVE: To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free.

METHODS: Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates.

RESULTS: Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke.

CONCLUSIONS: Physical inactivity predicts a higher risk of being dependent both before and after stroke.

%B Neurology %V 88 %P 1718-1726 %8 05/2017 %G eng %N 18 %R 10.1212/WNL.0000000000003888 %0 Journal Article %J The American Journal of Geriatric Psychiatry %D 2016 %T Families and Disability Onset: Are Spousal Resources Less Important for Individuals at High Risk of Dementia? %A Pamela M. Rist %A Sze Y Liu %A M. Maria Glymour %K Demographics %K Disabilities %K Health Conditions and Status %K Healthcare %X Objective To determine whether social contacts and spousal characteristics predict incident instrumental or basic activities of daily living (I/ADL) limitations and whether effects differ for individuals with high risk of dementia. Design Cohort study. Setting Biennial interviews of Health and Retirement Study participants over up to 12 years. Participants 4,125 participants aged 65 years and older without baseline I/ADL limitations. Measurements Participants' family characteristics (living arrangements, proximity to children, contacts with friends, marital status, and spouse's depression, employment, and education) and dementia probability (high versus low risk of dementia based on direct and proxy cognitive assessments) were characterized at baseline. Family characteristics and their interactions with dementia probability were used to predict incident I/ADL limitations in pooled logistic regressions. Results ADL limitation incidence was higher among the unmarried (odds ratio OR versus married: 1.14; 95 CI: 1.01 1.30); those married to a depressed spouse (OR versus nondepressed spouse: 1.56, 95 CI: 1.21 2.00); or whose spouse had less than high school education (OR versus spouse with high school or more: 1.29, 95 CI: 1.06 1.57). Living with someone other than a spouse compared with living with a spouse predicted higher risk of both incident ADL (OR: 1.35; 95 CI: 1.11 1.65), and IADL (OR: 1.30; 95 CI: 1.06 1.61) limitations. Effects were similar for respondents with high and low dementia probability. Conclusions Regardless of dementia risk, older adults may receive important marriage benefits, which help delay disability. The salience of spouse's education and depression status implicate modifiable mechanisms, such as information and instrumental support, which may be amenable to interventions. %B The American Journal of Geriatric Psychiatry %V 24 %P 585-594 %G eng %U http://www.sciencedirect.com/science/article/pii/S1064748116001561 %N 7 %4 disability/disability/cognitive function/epidemiology/social ties %$ 999999 %& 585 %R 10.1016/j.jagp.2016.02.003 %0 Journal Article %J Soc Sci Med %D 2015 %T Genetic vulnerability to diabetes and obesity: does education offset the risk? %A Sze Y Liu %A Stefan Walter %A Jessica R Marden %A David Rehkopf %A Laura D Kubzansky %A Thu T Nguyen %A M. Maria Glymour %K Aged %K Body Mass Index %K Diabetes Mellitus, Type 2 %K Educational Status %K European Continental Ancestry Group %K Female %K Genetic Predisposition to Disease %K Genotype %K Glycated Hemoglobin A %K Health Status Disparities %K Humans %K Male %K Middle Aged %K Obesity %K Risk Factors %K Social determinants of health %X

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n = 8398), we tested whether education modifies genetic risk for obesity and T2D, offsetting genetic effects; whether this effect is larger for individuals who have high risk for other (unobserved) reasons, i.e., at higher quantiles of HbA1c and BMI; and whether effects differ by gender. We measured T2D risk using Hemoglobin A1c (HbA1c) level, and obesity risk using body-mass index (BMI). We constructed separate genetic risk scores (GRS) for obesity and diabetes respectively based on the most current available information on the single nucleotide polymorphism (SNPs) confirmed as genome-wide significant predictors for BMI (29 SNPs) and diabetes risk (39 SNPs). Linear regression models with years of schooling indicate that the effect of genetic risk on HbA1c is smaller among people with more years of schooling and larger among those with less than a high school (HS) degree compared to HS degree-holders. Quantile regression models show that the GRS × education effect systematically increased along the HbA1c outcome distribution; for example the GRS × years of education interaction coefficient was -0.01 (95% CI = -0.03, 0.00) at the 10th percentile compared to -0.03 (95% CI = -0.07, 0.00) at the 90th percentile. These results suggest that education may be an important socioeconomic source of heterogeneity in responses to genetic vulnerability to T2D.

%B Soc Sci Med %V 127 %P 150-8 %8 2015 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S0277953614005760 %1 http://www.ncbi.nlm.nih.gov/pubmed/25245452?dopt=Abstract %R 10.1016/j.socscimed.2014.09.009