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Chronic Illness

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Certain biological factors that may represent insulin resistance are associated with a decline in physical functioning

Relatively healthy working age men and women with certain risk factors for development of coronary heart disease (CHD) are more likely to suffer from functional decline than others, according to a study supported in part by the Agency for Healthcare Research and Quality (HS06516). Those with a high waist-to-hip ratio and elevated levels of fasting insulin, triglycerides, and HDL cholesterol had twice the decline in physical functioning over a 3-year period as adults without these problems. This relationship was independent of exercise, smoking, and alcohol intake, which explained only 17 percent and 5.4 percent of the association in men and women, respectively.

These variables clustered with total cholesterol and may represent insulin resistance, note Michael Marmot, F.R.C.P., of University College London, and his colleagues. This suggests that insulin resistance may be an important determinant of subsequent physical functioning and a potential area of intervention to prevent functional decline. The size of the functional declines observed were small compared with observed disease-related declines, and their impact on daily life was unclear. However, they occurred in a relatively young and healthy working age group in a short followup period of 36 months. If continued at the same rate, this decline would lead to marked disability, caution the researchers.

The researchers analyzed data from phase 3 (1991-1993) and phase 4 (1995) of the Whitehall II study of nearly 7,000 British civil servants. They correlated weight, height, fasting insulin, 2-hour post-load glucose, total and HDL cholesterol, fibrinogen, von Willebrand factor, blood pressure, and waist-to-hip ratio measured during phase 3 with functioning 3 years later.

See "Biological predictors of change in functioning in the Whitehall II study," by Meena Kumari, Ph.D., Teresa Seeman, Ph.D., and Dr. Marmot, in the April 2004 Annals of Epidemiology 14, pp. 250-257.

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