Validity and reproducibility of a food frequency interview in a Multi-Cultural Epidemiology Study

Matrix Gla protein and the long-term incidence and progression of coronary artery and aortic calcification in the Multi-Ethnic Study of Atherosclerosis

BACKGROUND AND AIMS

Matrix Gla protein (MGP) is an inhibitor of calcification that requires carboxylation by vitamin K for activity. The inactive form of MGP, dephosphorylated-uncarboxylated matrix Gla protein (dp-ucMGP), has been associated with increased calcification. However, it is not known whether there is a longitudinal relationship between dephosphorylated-uncarboxylated matrix Gla protein levels and coronary and aortic calcification in large population cohorts.

METHODS

The Multi-Ethnic Study of Atherosclerosis (MESA) followed participants with serial cardiac computed tomography (CT) measures of vascular calcification. Dp-ucMGP was measured at baseline in a subset of participants who completed baseline and follow-up CTs approximately 10 years later and had available plasma specimens (n = 2663). Linear mixed effects models (LMMs) were used to determine the association of dp-ucMGP with the simultaneous incidence and progression of coronary artery, ascending thoracic aortic, or descending thoracic aortic calcification (CAC, ATAC, DTAC)].

RESULTS

For every one standard deviation (SD, 178 pmol/L) increment in dp-ucMGP, CAC increased by 3.44 ([95% CI = 1.68, 5.21], p < 0.001) Agatston units/year (AU/year), ATAC increased by 0.63 ([95% CI = 0.27, 0.98], p = 0.001) AU/year, and DTAC increased by 8.61 ([95% CI = 4.55, 12.67], p < 0.001) AU/year. The association was stronger for DTAC in those ≥65 years and with diabetes.

CONCLUSIONS

We found a positive association of the inactive form of matrix Gla protein, dp-ucMGP, and long-term incidence/progression of CAC, ATAC, and DTAC. Future studies should investigate dp-ucMGP as a calcification regulator and MGP as a possible therapeutic target to slow progression of calcification in the vasculature.

Financial strain is associated with poorer cardiovascular health: The multi-ethnic study of atherosclerosis

Objective

Psychosocial stress is associated with increased cardiovascular disease (CVD) risk. The relationship between financial strain, a toxic form of psychosocial stress, and ideal cardiovascular health (CVH) is not well established. We examined whether financial strain was associated with poorer CVH in a multi-ethnic cohort free of CVD at baseline.

Methods

This was a cross-sectional analysis of 6,453 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis. Financial strain was assessed by questionnaire and responses were categorized as yes or no. CVH was measured from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood glucose and blood pressure). A CVH score of 14 was calculated by assigning points to the categories of each metric (poor = 0 points, intermediate = 1 point, ideal = 2 points). Multinomial logistic regression was used to examine the association of financial strain with the CVH score (inadequate 0-8, average 9-10, and optimal 11-14 points) adjusting for sociodemographic factors, depression and anxiety.

Results

The mean age (SD) was 62 (10) and 53 % were women. Financial strain was reported by 25 % of participants. Participants who reported financial strain had lower odds of average (OR, 0.82 [95 % CI, 0.71, 0.94]) and optimal (0.73 [0.62, 0.87]) CVH scores. However, in the fully adjusted model, the association was only significant for optimal CVH scores (0.81, [0.68, 0.97]).

Conclusion

Financial strain was associated with poorer CVH. More research is needed to understand this relationship so the burden of CVD can be decreased, particularly among people experiencing financial hardship.

Higher diet quality relates to better cardiac function in cancer survivors: The multi-ethnic study of atherosclerosis

BACKGROUND

Cancer therapies induce cardiac injury and increase cardiovascular disease (CVD) risk. In non-cancer populations, higher diet quality is associated with protection against CVD, but the relationship between diet and cardiac function in cancer survivors is unknown.

METHODS

This cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort included 113 cancer survivors (55 breast, 53 prostate, three lung, and three blood) and 4233 non-cancer controls. Dietary intake was reported via validated food frequency questionnaire. Alternate healthy eating index (AHEI) was calculated as a measure of quality. Cardiac function, determined as left ventricular ejection fraction (LVEF), was assessed by cardiac magnetic resonance.

RESULTS

Cancer survivors had a lower LVEF compared to controls (61.3 ± 6.5% v 62.4 ± 6.1%, p = 0.04). In all participants, total fat (β ± SE: -0.04 ± 0.01, p = 0.004), saturated fat (-0.11 ± 0.03, p < 0.001), and trans-fat (-0.36 ± 0.12, p = 0.002) intake were inversely associated with LVEF while AHEI (0.03 ± 0.01, p < 0.001) was positively associated with LVEF. Among cancer survivors only, sucrose intake was negatively related to LVEF (-0.15 ± 0.06, p = 0.02), and the ratio of unsaturated fat to saturated fat (2.7 ± 1.1, p = 0.01) and fiber intake (0.42 ± 0.14, p = 0.003) were positively related to LVEF.

DISCUSSION

In cancer survivors, improved dietary fat and carbohydrate quality (i.e., greater consumption of unsaturated fatty acids and fiber) was associated with favorable cardiac function, while higher sucrose was associated with worse cardiac function. Further research is needed to confirm these findings and test whether changes in the identified dietary factors will modulate cardiac function in cancer survivors.

Reliability and validity of a semi-quantitative food frequency questionnaire: dietary intake assessment among multi-ethnic populations in Northwest China

BACKGROUND

Few multi-ethnic dietary culture-sensitive food frequency questionnaires (FFQ) have been developed due to the complexity and diversity of cooking methods and styles. This study aimed to develop and validate a specific FFQ among multi-ethnic groups in Northwest China.

METHODS

In the reliability study, 139 participants aged 20-65 completed two identical FFQs separated by 3 months. The relative validation of the FFQ was assessed by three 24-h recalls (24HR) employed in the interval of two FFQs, as a reference. Stratified analyses were also conducted by the major ethnic groups (Han nationality or Ethnic minority).

RESULTS

For reproducibility, the median (range) of Spearman's correlation coefficients (SCC) was 0.71 (0.43-0.84) for nutrients. The intra-class correlation coefficients (ICC) covered a spectrum from 0.39 to 0.78 (median: 0.64). Meanwhile, the weighted kappa values ranged from 0.11 to 0.64. For validity, the median (range) of Pearson's correlation coefficients derived from the energy unadjusted and the adjusted values between FFQ and 24HR were 0.61 (0.12-0.79) and 0.56 (0.12-0.77), respectively. The results of correlation coefficients were similar between the two ethnic groups. Moreover, the Bland-Altman plots likewise demonstrated a satisfactory level of agreement between the two methods.

CONCLUSIONS

The FFQ showed acceptable reproducibility and moderate relative validity for evaluating dietary intake among multi-ethnic groups in northwest China. It could be a credible nutritional screening tool for forthcoming epidemiological surveys of these populations.

Associations between Metabolomic Biomarkers of Avocado Intake and Glycemia in the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Avocado consumption is linked to better glucose homeostasis, but small associations suggest potential population heterogeneity. Metabolomic data capture the effects of food intake after digestion and metabolism, thus accounting for individual differences in these processes.

OBJECTIVES

To identify metabolomic biomarkers of avocado intake and to examine their associations with glycemia.

METHODS

Baseline data from 6224 multi-ethnic older adults (62% female) included self-reported avocado intake, fasting glucose and insulin, and untargeted plasma proton nuclear magnetic resonance metabolomic features (metabolomic data were available for a randomly selected subset; N = 3438). Subsequently, incident type 2 diabetes (T2D) was assessed over an ∼18 y follow-up period. A metabolome-wide association study of avocado consumption status (consumer compared with nonconsumer) was conducted, and the relationship of these features with glycemia via cross-sectional associations with fasting insulin and glucose and longitudinal associations with incident T2D was examined.

RESULTS

Three highly-correlated spectral features were associated with avocado intake at metabolome-wide significance levels (P < 5.3 ∗ 10-7) and combined into a single biomarker. We did not find evidence that these features were additionally associated with overall dietary quality, nor with any of 47 other food groups (all P > 0.001), supporting their suitability as a biomarker of avocado intake. Avocado intake showed a modest association only with lower fasting insulin (β = -0.07 +/- 0.03, P = 0.03), an association that was attenuated to nonsignificance when additionally controlling for body mass index (kg/m2). However, our biomarker of avocado intake was strongly associated with lower fasting glucose (β = -0.22 +/- 0.02, P < 2.0 ∗ 10-16), lower fasting insulin (β = -0.17 +/- 0.02, P < 2.0 ∗ 10-16), and a lower incidence of T2D (hazard ratio: 0.68; 0.63-074, P < 2.0 ∗ 10-16), even when adjusting for BMI.

CONCLUSIONS

Highly significant associations between glycemia and avocado-related metabolomic features, which serve as biomarkers of the physiological impact of dietary intake after digestion and absorption, compared to modest relationships between glycemia and avocado consumption, highlights the importance of considering individual differences in metabolism when considering diet-health relationships.

Association Between Alcohol Consumption and Ectopic Fat in the Multi-Ethnic Study of Atherosclerosis

Background The relationship between alcohol consumption and ectopic fat distribution, both known factors for cardiovascular disease, remains understudied. Therefore, we aimed to examine the association between alcohol consumption and ectopic adiposity in adults at risk for cardiovascular disease. Methods and Results In this cross-sectional analysis, we categorized alcohol intake among participants in MESA (Multi-Ethnic Study of Atherosclerosis) as follows (drinks/day): <1 (light drinking), 1 to 2 (moderate drinking), >2 (heavy drinking), former drinking, and lifetime abstention. Binge drinking was defined as consuming ≥5 drinks on 1 occasion in the past month. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using noncontrast computed tomography. Using multivariable linear regression, we examined the associations between categories of alcohol consumption and natural log-transformed fat in ectopic depots. We included 6756 MESA participants (62.1±10.2 years; 47.2% women), of whom 6734 and 1934 had chest computed tomography (pericardial and hepatic fat) and abdominal computed tomography (subcutaneous, intermuscular, and visceral fat), respectively. In adjusted analysis, heavy drinking, relative to lifetime abstention, was associated with a higher (relative percent difference) pericardial 15.1 [95% CI, 7.1-27.7], hepatic 3.4 [95% CI, 0.1-6.8], visceral 2.5 [95% CI, -10.4 to 17.2], and intermuscular 5.2 [95% CI, -6.6 to 18.4] fat but lower subcutaneous fat -3.5 [95% CI, -15.5 to 10.2]). The associations between alcohol consumption and ectopic adiposity exhibited a J-shaped pattern. Binge drinking, relative to light-to-moderate drinking, was also associated with higher ectopic fat. Conclusions Alcohol consumption had a J-shaped association with ectopic adiposity. Both heavy alcohol intake and binge alcohol drinking were associated with higher ectopic fat.

Reproducibility and validity of the Toronto-modified Harvard food frequency questionnaire in a multi-ethnic sample of young adults

BACKGROUND/OBJECTIVES

To assess the reproducibility and validity of a Toronto-modified Harvard food frequency questionnaire (FFQ) among a multi-ethnic sample of young adults.

SUBJECTS/METHODS

A total of 150 participants recruited from the Toronto Nutrigenomics and Health Study cohort who had existing dietary intakes assessed by FFQ (FFQ1) and reassessment one year later (FFQ2). Of these, 100 participants also completed a three-day food record to evaluate the validity of the FFQ for 38 nutrients (energy, 14 macronutrients, 22 micronutrients, and 1 bioactive). Analyses were also stratified between the two major ethnic groups (Caucasian and East Asian).

RESULTS

Among the full sample, mean intakes of most nutrients (27/38) did not differ significantly between estimates derived from FFQ2 compared to the three-day food record. Energy, sex, and ethnicity adjusted deattenuated Pearson correlation coefficients ranged from 0.20 to 0.92 (mean r = 0.52 ± 0.15), and 34/38 validity coefficients were r ≥ 0.32. Gross misclassification of intakes between FFQ2 and the three-day food record was low (<6%), but energy, polyunsaturated fatty acids (PUFA), and sodium were underestimated by FFQ2. Mean intakes between FFQ1 and FFQ2 did not differ significantly for any nutrient. Between the two major ethnic groups, mean validity coefficients were similar, but varied for individual nutrients with saturated fat, PUFA, and omega 3 being among the most discrepant.

CONCLUSIONS

Compared to a three-day food record, the Toronto-modified Harvard FFQ is a reproducible and valid tool to estimate dietary intake among a multi-ethnic sample of young adults. However, incorporation of protocols to improve the assessment of culturally diverse diets should be considered.

Association Between Coffee Consumption and Incident Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis [MESA])

This study aimed to elucidate a potential dose-dependent relation between coffee intake and atrial fibrillation (AF) incidence in a multi-ethnic setting. Previous studies were comprised mainly of White populations, and an exploration of dose dependency is limited. To address these gaps, we analyzed the Multi-Ethnic Study of Atherosclerosis data, a prospective cohort study. In the primary analysis, we crudely divided patients into 3 groups: nonconsumers, 1 to 3 cups/month, and ≥1 cup/week. For the secondary analysis, we stratified the cohort into 9 groups of gradual increments for coffee consumption. A multivariable cox proportional hazards regression model was adjusted for 6 potential confounders: age, gender, smoking, hypertension, diabetes mellitus, and alcohol. Subjects who drank ≥1 cup of coffee/week had a higher incidence of AF (adjusted hazard ratio 1.40, p = 0.015) than nonconsumers. Furthermore, in the secondary analysis, there was an overall trend, albeit not consistent, of increasing adjusted hazard ratio with progressively increasing doses of coffee in the following groups: 1 to 3 cups/month, 2 to 4 cups/week, 2 to 3 cups/day and ≥6 cups/day. Notably, AF incidence was highest (9.8%) for the group consuming the most coffee, that is, ≥6 cups/day (p = 0.02). Stratification by race/ethnicity suggested the results may be driven by White and Hispanic rather than Black or Chinese-American subgroups. In conclusion, the findings suggest an association between coffee consumption and incident AF in contrast to most previous studies.

Redefining Cardiovascular Health to Include Sleep: Prospective Associations With Cardiovascular Disease in the MESA Sleep Study

Background Although sufficient and healthy sleep is inversely associated with cardiovascular disease (CVD) and its risk factors, the American Heart Association's Life's Simple 7 (LS7), as a measure of cardiovascular health (CVH), did not include sleep. We evaluated an expanded measure of CVH that includes sleep as an eighth metric in relation to CVD risk. Methods and Results The analytic sample consisted of MESA (Multi-Ethnic Study of Atherosclerosis) Sleep Study participants who had complete data on sleep characteristics from overnight polysomnography, 7-day wrist actigraphy, validated questionnaires, and the outcome. We computed the LS7 score and 4 iterations of a new CVH score: score 1 included sleep duration, score 2 included sleep characteristics linked to CVD in the literature (sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnea), scores 3 and 4 included sleep characteristics associated with CVD in MESA (score 3: sleep duration and efficiency, daytime sleepiness, and obstructive sleep apnea; score 4: score 3+sleep regularity). Multivariable-adjusted logistic and Cox proportional hazards models evaluated associations of the LS7 and CVH scores 1 to 4 with CVD prevalence and incidence. Among 1920 participants (mean age: 69±9 years; 54% female), there were 95 prevalent CVD events and 93 incident cases (mean follow-up, 4.4 years). Those in the highest versus lowest tertile of the LS7 score and CVH scores 1 to 4 had up to 80% lower odds of prevalent CVD. The LS7 score was not significantly associated with CVD incidence (hazard ratio, 0.62 [95% CI, 0.37-1.04]). Those in the highest versus lowest tertile of CVH score 1, which included sleep duration, and CVH score 4, which included multidimensional sleep health, had 43% and 47% lower incident CVD risk (hazard ratio, 0.57 [95% CI, 0.33-0.97]; and hazard ratio, 0.53 [95% CI, 0.32-0.89]), respectively. Conclusions CVH scores that include sleep health predicted CVD risk in older US adults. The incorporation of sleep as a CVH metric, akin to other health behaviors, may enhance CVD primordial and primary prevention efforts. Findings warrant confirmation in larger cohorts over longer follow-up.

Individual Nutrition Is Associated with Altered Gut Microbiome Composition for Adults with Food Insecurity

Diet is widely recognized as a key contributor to human gut microbiome composition and function. However, overall nutrition can be difficult to compare across a population with varying diets. Moreover, the role of food security in the relationship with overall nutrition and the gut microbiome is unclear. This study aims to investigate the association between personalized nutrition scores, variation in the adult gut microbiome, and modification by food insecurity. The data originate from the Survey of the Health of Wisconsin and the Wisconsin Microbiome Study. Individual nutrition scores were assessed using My Nutrition Index (MNI), calculated using data from food frequency questionnaires, and additional health history and demographic surveys. Food security and covariate data were measured through self-reported questionnaires. The gut microbiome was assessed using 16S amplicon sequencing of DNA extracted from stool samples. Associations, adjusted for confounding and interaction by food security, were estimated using Weighted Quantile Sum (WQS) regression models with Random Subset and Repeated Holdout extensions (WQSRSRH), with bacterial taxa used as components in the weighted index. Of 643 participants, the average MNI was 66.5 (SD = 31.9), and 22.8% of participants were food insecure. Increased MNI was significantly associated with altered gut microbial composition (β = 2.56, 95% CI = 0.52−4.61), with Ruminococcus, Oscillospira, and Blautia among the most heavily weighted of the 21 genera associated with the MNI score. In the stratified interaction WQSRSRH models, the bacterial taxa most heavily weighted in the association with MNI differed by food security, but the level of association between MNI and the gut microbiome was not significantly different. More bacterial genera are important in the association with higher nutrition scores for people with food insecurity versus food security, including Streptococcus, Parabacteroides Faecalibacterium, and Desulfovibrio. Individual nutrition scores are associated with differences in adult gut microbiome composition. The bacterial taxa most associated with nutrition vary by level of food security. While further investigation is needed, results showed a higher nutrition score was associated with a wider range of bacterial taxa for food insecure vs. secure, suggesting nutritional quality in food insecure individuals is important in maintaining health and reducing disparities.

Metabolomic profiling of the Dietary Approaches to Stop Hypertension diet provides novel insights for the nutritional epidemiology of type 2 diabetes mellitus

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is inversely associated with type 2 diabetes mellitus (T2DM) risk. Metabolic changes due to DASH adherence and their potential relationship with incident T2DM have not been described. The objective is to determine metabolite clusters associated with adherence to a DASH-like diet in the Insulin Resistance Atherosclerosis Study cohort and explore if the clusters predicted 5-year incidence of T2DM. The current study included 570 non-diabetic multi-ethnic participants aged 40–69 years. Adherence to a DASH-like diet was determined a priori through an eighty-point scale for absolute intakes of the eight DASH food groups. Quantitative measurements of eighty-seven metabolites (acylcarnitines, amino acids, bile acids, sterols and fatty acids) were obtained at baseline. Metabolite clusters related to DASH adherence were determined through partial least squares (PLS) analysis using R. Multivariable-adjusted logistic regression was used to explore the associations between metabolite clusters and incident T2DM. A group of acylcarnitines and fatty acids loaded strongly on the two components retained under PLS. Among strongly loading metabolites, a select group of acylcarnitines had over 50 % of their individual variance explained by the PLS model. Component 2 was inversely associated with incident T2DM (OR: 0·89; (95 % CI 0·80, 0·99), P-value = 0·043) after adjustment for demographic and metabolic covariates. Component 1 was not associated with T2DM risk (OR: 1·02; (95 % CI 0·88, 1·19), P-value = 0·74). Adherence to a DASH-type diet may contribute to reduced T2DM risk in part through modulations in acylcarnitine and fatty acid physiology.

Cross-Sectional and Longitudinal Associations of Lifestyle Behaviors with Pericardial Adipose Tissue: The MESA Study

PURPOSE

We examined associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) with pericardial adipose tissue (PAT).

METHODS

Adults from the Multi-Ethnic Study of Atherosclerosis were included from exam years 1 (2000-2002; N = 6057; mean age, 62.2 yr; 52.9% female, 38.0% White; 12.8% Chinese American, 26.7% African American, 22.5% Hispanic American), 2 (2002-2004), and 3 (2004-2005). Weekly volume of SB, LPA, and MVPA (in MET-hours per week) was reported using a questionnaire. PAT volume (in cubic centimeters) was quantified using computed tomography, analysis of covariance, and repeated-measures linear mixed models with adjustment for covariates (sociodemographics, cardiovascular disease risk factors, inflammation, waist circumference) tested cross-sectional and longitudinal associations, respectively.

RESULTS

In cross-sectional analysis, the highest tertile of SB (β = 2.71; 95% confidence interval (CI), 0.69 to 4.73; P < 0.01) and the middle tertile of MVPA (β = -1.97; 95% CI, -3.92 to -0.02; P < 0.05) were associated with PAT, whereas no association was observed for LPA in fully adjusted models. In longitudinal models, SB, LPA, and MVPA were not associated with PAT in the full study sample; however, LPA was inversely associated with PAT among Whites in stratified analysis (β = -0.54; 95% CI, -0.95 to -0.13; P < 0.05).

CONCLUSIONS

Lower SB and higher LPA (among Whites only) and MVPA may be associated with lower PAT, but additional longitudinal research is needed.

Relationship of American Heart Association's Life Simple 7, Ectopic Fat, and Insulin Resistance in 5 Racial/Ethnic Groups

BACKGROUND

The inverse association between ideal cardiovascular health (CVH) as measured by the American Heart Association's Life Simple 7 (LS7) and cardiovascular disease (CVD) incidence is well documented. However, research exploring the association between CVH and specific risk factors for cardiometabolic disease is sparse in diverse cohorts.

METHODS

This study included 7717 participants from the Mediators of Atherosclerosis in South Asians Living in America and the Multi-Ethnic Study of Atherosclerosis cohorts. We assigned each LS7 component a 0, 1, and 2 and summed these scores to derive an overall CVH score. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using noncontrast computed tomography. Multivariable linear regression was used to examine associations between CVH categories and each log-transformed ectopic fat depot, as well as the homeostatic assessment for insulin resistance (HOMA-IR).

RESULTS

In adjusted analysis, compared to those with ideal CVH, participants with poor CVH demonstrated 63.4% (95% CI, 54.3-73.0) higher visceral fat area, 84.0% (95% CI, 76.5-92.1) higher pericardial fat volume, 61.6% (95% CI, 50.7-73.2) higher subcutaneous fat area, and 40.6% (95% CI, 30.2-52.0) higher intermuscular fat area, and 15.1% (95% CI, 13.1-17.2) higher hepatic fat (all Ps < 0.001). Also, poor CVH was associated with 148.2% (95% CI, 131.1-166.7) higher HOMA-IR. We also found significant heterogeneity in the strengths of association by race/ethnicity for each ectopic fat depot.

CONCLUSION

Poor and intermediate CVH, as defined by LS7 metrics, were associated with significantly higher measures of ectopic fat and insulin resistance among individuals from 5 racial/ethnic groups.

Favorable Cardiovascular Health Is Associated With Lower Prevalence, Incidence, Extent, and Progression of Extracoronary Calcification: MESA

BACKGROUND

Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease. Extracoronary calcification (ECC)-measured at the aortic valve, mitral annulus, ascending thoracic aorta, and descending thoracic aorta-is an indicator of systemic atherosclerosis. This study examined whether favorable CVH was associated with a lower risk of ECC.

METHODS

We analyzed data from MESA (Multi-Ethnic Study of Atherosclerosis) participants aged 45 to 84 years without cardiovascular disease at baseline. ECC was measured by noncontrast cardiac computed tomography scan at baseline and after an average of 2.4 years. Prevalent ECC was defined as an Agatston score >0 at the baseline scan. Incident ECC was defined as Agatston score >0 at the follow-up scan among participants with Agatston score of 0 at the baseline scan. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) was scored 0 to 2 points, with 2 indicating ideal; 1, intermediate; and 0, poor. The aggregated CVH score was 0 to 14 points (0-8, inadequate; 9-10, average; 11-14, optimal). We used Poisson and linear mixed-effects regression models to examine the association between CVH and ECC adjusted for sociodemographic factors.

RESULTS

Of 6504 participants, 53% were women with a mean age (SD) of 62 (10) years. Optimal and average CVH scores were associated with lower ECC prevalence, incidence, and extent. For example, optimal CVH scores were associated with 57%, 56%, 70%, and 54% lower risk of incident aortic valve calcification, mitral annulus calcification, ascending thoracic aorta calcification, and descending thoracic aorta calcification, respectively. In addition, optimal and average CVH scores were associated with lower ECC progression at 2 years, although these associations were only significant for mitral annulus calcification and descending thoracic aorta calcification.

CONCLUSIONS

In this multiethnic cohort, favorable CVH was associated with a lower risk of extracoronary atherosclerosis. These findings emphasize the importance of primordial prevention as an intervention to reduce the burden of cardiovascular disease.

Favorable Cardiovascular Health Is Associated With Lower Hepatocyte Growth Factor Levels in the Multi-Ethnic Study of Atherosclerosis

Introduction: Hepatocyte growth factor (HGF) is a cytokine released in response to endothelial injury and a potential biomarker of cardiovascular disease (CVD) risk. We examined the association between cardiovascular health (CVH) and HGF in a multi-ethnic cohort of adults free from CVD at baseline. Methods: This cross-sectional study conducted between 2020 and 2021 used MESA baseline examination data (2000-2002) from 6,490 US adults aged 45-84 years. The independent variable was CVH measured by the CVH score and number of ideal metrics. The score was derived from seven metrics: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose. Each metric was scored 0 points (poor), 1 point (intermediate) and 2 points (ideal). The total CVH score ranged from 0 to 14. An inadequate score was 0-8, average, 9-10 and optimal, 11-14. The dependent variable was logarithmically transformed HGF. We used regression analyses to estimate associations between CVH and HGF adjusting for sociodemographic factors. Results: Participants' mean (SD) age was 62 (10) years. Fifty-three percent were female. A one-unit increment in the CVH score was significantly associated with 3% lower HGF levels. Average and optimal CVH scores were significantly associated with 8% and 12% lower HGF levels, respectively, compared to inadequate scores. Additionally, a greater number of ideal metrics was associated with lower HGF levels. Conclusion: Favorable CVH was significantly associated with lower HGF levels in this ethnically diverse cohort. Interventions aimed at promoting and preserving favorable CVH may reduce the risk of endothelial injury as indicated by lower serum HGF levels.

Correlates of cardiorespiratory fitness among overweight or obese individuals with type 2 diabetes

INTRODUCTION

Mechanistic studies suggest that type 2 diabetes is independently associated with low cardiorespiratory fitness (CRF). Little is known about the CRF profile in type 2 diabetes; we assessed the correlates of low CRF among overweight/obese adults with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 4215 participants with type 2 diabetes and without cardiovascular disease underwent maximal exercise testing in the Look AHEAD (Action for Health in Diabetes) study. Low CRF was defined based on the Aerobics Center Longitudinal Study reference standards. Calorie intake and physical activity were assessed using questionnaires. Body fat composition was assessed using dual-energy X-ray absorptiometry.

RESULTS

Waist circumference, systolic blood pressure, glycemic measures, whole body fat, caloric intake, and fat-free mass were inversely associated with fitness across sex (all p<0.001). Comparing with moderate or high CRF groups, the low CRF group was associated with higher adjusted odds of obesity (OR 3.19 (95% CI 1.95 to 5.20) in men, 3.86 (95% CI 2.55 to 5.84)) in women), abdominal obesity (OR 3.99 (95% CI 2.00 to 7.96) in men, 2.28 (95% CI 1.08 to 4.79) in women), hypertension (OR 1.74 (95% CI 1.09 to 2.77) in men, 1.44 (95% CI 1.02 to 2.05) in women), metabolic syndrome (OR 5.52 (95% CI 2.51 to 12.14) in men, 2.25 (95% CI 1.35 to 3.76) in women), use of beta-blocker (1.22 (95% CI 0.86 to 1.73) in men, 1.33 (95% CI 1.03 to 1.73) in women), and ACE inhibitor/angiotensin-receptor blocker (1.86 (95% CI 1.39 to 2.50) in men, 1.07 (95% CI 0.86 to 1.32) in women). Women with low CRF had higher odds of current smoking (2.02 (95% CI 1.25 to 3.28)).

CONCLUSIONS

Low CRF was associated with increased odds of cardiometabolic correlates in a large cohort of adults with type 2 diabetes.

A Prospective Analysis of Red and Processed Meat Intake in Relation to Colorectal Cancer in the Black Women's Health Study

BACKGROUND

Black Americans have the highest incidence of colorectal cancer (CRC) of any racial/ethnic group in the United States. High intake of red and processed meats has been associated with an increased CRC risk in predominately White populations. However, 3 prior studies in Black populations, who have been reported to have high intakes of red and processed meats, have reported no associations. Data on a possible association between CRC risk and SFAs and MUFAs, the primary types of fat in red and processed meats, are inconclusive.

OBJECTIVES

We prospectively assessed intakes of processed and unprocessed red meat, SFAs, and MUFAs in relation to CRC risk, utilizing data from the Black Women's Health Study (BWHS, 1995-2018).

METHODS

Dietary data were derived from validated FFQs completed in 1995 and 2001. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.

RESULTS

Among 52,695 BWHS participants aged 21-69 y at baseline and followed for ≤22 y, 564 women developed incident CRC. Unprocessed red meat intake was associated with a 33% increased CRC risk per 100 g/d (HR: 1.33; 95% CI: 1.03-1.71). Examination of CRC anatomic sites revealed that unprocessed red meat was associated with 2-times increased rectal cancer risk (HR: 2.22; 95% CI: 1.15-4.26). There was no evidence of an interaction with age (pinteraction = 0.4), but unprocessed red meat intake was only associated with a significant increased risk of late-onset CRC (≥50 y of age, HR: 1.41; 95% CI: 1.05-1.88). Processed red meat and total SFA and MUFA intakes were not associated with CRC risk.

CONCLUSIONS

Unprocessed red meat intake was associated with an increased CRC risk in the present study, the first positive evidence that red meat plays a role in the etiology of CRC in Black women. The findings suggest prevention opportunities.

DASH diet adherence and cognitive function: Multi-ethnic study of atherosclerosis

BACKGROUND AND AIMS

The Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been associated with better cognitive function in studies of predominantly White participants; few studies have examined this association in diverse cohorts. Our objective was to examine the association between the DASH diet and cognitive function in the diverse Multi-Ethnic Study of Atherosclerosis (MESA) cohort.

METHODS

Among 4169 MESA participants, we evaluated prospectively, the association between DASH diet adherence and cognitive function. Participants completed a food frequency questionnaire at baseline (2000-2002) and cognitive function was assessed using the Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span (DS) at Exam 5 in 2010-2012 and Exam 6 (2016-2019). Regression analyses were used to evaluate the association between quintiles of DASH diet adherence with CASI, DSC, and DS performance and decline, adjusting for potential confounders. Effect modification by hypertension, diabetes, race/ethnicity, acculturation, and exercise were evaluated.

RESULTS

DASH diet adherence was not associated with cognitive performance or decline for any of the measures. There were no differences by racial/ethnic groups, with the exception that Hispanic participants reporting greater DASH diet adherence, performed worse on DS at Exam 5 (p = 0.05). Components of the DASH diet were differentially correlated with test performance: increased consumption of nuts/legumes was associated with better performance on the CASI at Exam 5 (p = 0.003) and Exam 6 (p = 0.007). Increased consumption of whole grains was associated with better DSC performance at Exam 5 (p = 0.04) and better DS performance at Exam 6 (p = 0.01).

CONCLUSIONS

DASH diet adherence was nominally associated with cognitive function with a suggestion of differences by race/ethnicity. Future work should examine more closely, the relationships between racial and ethnic groups and the impact of diet on cognitive function.

Does NAFLD mediate the relationship between obesity and type 2 diabetes risk? evidence from the multi-ethnic study of atherosclerosis (MESA)

PURPOSE

To estimate the effect of obesity on type 2 diabetes (T2DM) risk and evaluate to what extent non-alcoholic fatty liver disease (NAFLD) mediates this association.

METHODS

Data came from 4,522 adults ages 45-84 participating in the Multi-Ethnic Study of Atherosclerosis cohort. Baseline obesity was defined using established BMI categories. NAFLD was measured by CT scans at baseline and incident T2DM defined as fasting glucose ≥126 mg/dL or use of diabetes medications.

RESULTS

Over a median 9.1 years of follow-up between 2000 and 2012, 557 new cases of T2DM occurred. After adjusting for age, sex, race/ethnicity, education, diet and exercise, those with obesity had 4.5 times the risk of T2DM compared to normal weight (hazard ratio [HR] = 4.5, 95% confidence interval [CI]: 3.0, 5.9). The mediation analysis suggested that NAFLD accounted for ~36% (95% CI: 27, 44) of the effect (direct effect HR = 3.2, 95% CI: 2.3, 4.6; indirect effect through NAFLD, HR = 1.4, 95% CI: 1.3, 1.5).

CONCLUSIONS

These data suggest that the association between obesity and T2DM risk is partially explained by the presence of NAFLD. Future studies should evaluate if NAFLD could be an effective target to reduce the effect of obesity on T2DM.

Associations Between Lipoprotein Subfractions and Area and Density of Abdominal Muscle and Intermuscular Adipose Tissue: The Multi-Ethnic Study of Atherosclerosis

Skeletal muscle quantity and quality decrease with older age, which is partly attributed to ectopic fat infiltration and has negative metabolic consequences. To inform efforts to preserve skeletal muscle with aging, a better understanding of biologic correlates of quantity and quality of muscle and intermuscular adipose tissue (IMAT) is needed. We used targeted lipidomics of lipoprotein subfractions among 947 Multi-Ethnic Study of Atherosclerosis participants to provide a detailed metabolic characterization of area and density of abdominal muscle and IMAT. Serum lipoprotein subfractions were measured at the first visit using 1H-Nuclear Magnetic Resonance spectroscopy. Muscle and IMAT area (cm2) and density (Hounsfield units) were estimated at visit 2 or 3 using computed tomography of the total abdominal, locomotion (psoas), and stabilization (paraspinal, oblique, rectus abdominis) muscles. We identified lipoprotein subfractions associated with body composition using linear regression adjusting for demographics, lifestyle, and multiple comparisons. Among 105 lipoprotein subfractions, 24 were associated with total muscle area (absolute standardized regression coefficient range: 0.07-0.10, p-values ≤ 0.002), whereas none were associated with total muscle density. When examining muscle subgroups, 25 lipoprotein subfractions were associated with stabilization muscle area, with associations strongest among the obliques. For total IMAT area, there were 27 significant associations with lipoprotein subfractions (absolute standardized regression coefficient range: 0.09-0.13, p-values ≤ 0.002). Specifically, 27 lipoprotein subfractions were associated with stabilization IMAT area, with associations strongest among the oblique and rectus abdominis muscles. For total IMAT density, there were 39 significant associations with lipoprotein subfractions (absolute standardized regression coefficient range: 0.10-0.19, p-values ≤ 0.003). Specifically, 28 and 33 lipoprotein subfractions were associated with IMAT density of locomotion and stabilization (statistically driven by obliques) muscles, respectively. Higher VLDL (cholesterol, unesterified cholesterol, phospholipids, triglycerides, and apolipoprotein B) and lower HDL (cholesterol and unesterified cholesterol) were associated with higher muscle area, higher IMAT area, and lower IMAT density. Several associations between lipoprotein subfractions and abdominal muscle area and IMAT area and density were strongest among the stabilization muscles, particularly the obliques, illustrating the importance of examining muscle groups separately. Future work is needed to determine whether the observed associations indicate a lipoprotein profile contributing to worse skeletal muscle with fat infiltration.

Sugar-Sweetened Beverage Consumption May Modify Associations Between Genetic Variants in the CHREBP (Carbohydrate Responsive Element Binding Protein) Locus and HDL-C (High-Density Lipoprotein Cholesterol) and Triglyceride Concentrations

Supplemental Digital Content is available in the text.

Background:

ChREBP (carbohydrate responsive element binding protein) is a transcription factor that responds to sugar consumption. Sugar-sweetened beverage (SSB) consumption and genetic variants in the CHREBP locus have separately been linked to HDL-C (high-density lipoprotein cholesterol) and triglyceride concentrations. We hypothesized that SSB consumption would modify the association between genetic variants in the CHREBP locus and dyslipidemia.

Methods:

Data from 11 cohorts from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (N=63 599) and the UK Biobank (N=59 220) were used to quantify associations of SSB consumption, genetic variants, and their interaction on HDL-C and triglyceride concentrations using linear regression models. A total of 1606 single nucleotide polymorphisms within or near CHREBP were considered. SSB consumption was estimated from validated questionnaires, and participants were grouped by their estimated intake.

Results:

In a meta-analysis, rs71556729 was significantly associated with higher HDL-C concentrations only among the highest SSB consumers (β, 2.12 [95% CI, 1.16–3.07] mg/dL per allele; P<0.0001), but not significantly among the lowest SSB consumers (P=0.81; P_Diff <0.0001). Similar results were observed for 2 additional variants (rs35709627 and rs71556736). For triglyceride, rs55673514 was positively associated with triglyceride concentrations only among the highest SSB consumers (β, 0.06 [95% CI, 0.02–0.09] ln-mg/dL per allele, P=0.001) but not the lowest SSB consumers (P=0.84; P_Diff=0.0005).

Conclusions:

Our results identified genetic variants in the CHREBP locus that may protect against SSB-associated reductions in HDL-C and other variants that may exacerbate SSB-associated increases in triglyceride concentrations.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005133, NCT00005121, NCT00005487, and NCT00000479.

Validity and Reproducibility of a Food Frequency Questionnaire to Assess Macro and Micro-Nutrient Intake among a Convenience Cohort of Healthy Adult Qataris

This study aimed at developing a valid culture-sensitive quantitative food frequency questionnaire (FFQ) for Qatari adults. A convenient sample of healthy Qataris (n = 107) were recruited from family members of Qatar University students. The Diet History Questionnaire II of the US National Cancer Institute was translated to Arabic language, back-translated to English, pilot tested, and then modified accordingly to be used in Qatari setting. Participants were asked to complete the translated version of the FFQ. This FFQ was then validated against three 24 h diet recall (24 hDR) including a weekend day. Participants were asked to complete the FFQ again after one-month period to measure its repeatability. Dietary data were analyzed using the dietary analysis software ESHA. The validity and reliability of FFQ were assessed by comparing the median intake of nutrients and foods and by calculating the Pearson correlation coefficients. The median nutrient intakes assessed by the second FFQ were higher than that reported in the baseline FFQ1 except for fat. The percentage of increase varies between 1.5% and 96%. Results of the second FFQ indicated an overestimation of intake for most nutrients (macro and micro). Macronutrient intakes assessed by the two FFQ and 24 hDR were strongly correlated. The correlation coefficients for micronutrient intakes between FFQ2 and 24hDR were lower than that of the two FFQs except for calcium (r = 0.55) and sodium (r = 0.643). They ranged from (-0.17) for fluorine to (0.643) for sodium. The agreement rates for classifying macronutrient intakes into same or adjacent quartile were between 79.4% and 100% for the two FFQs and between 71% and 100% for the second FFQ and 24hDR. The reported consumption of food groups estimated by FFQ2 was significantly higher than that reported by FFQ1. In conclusion, the developed FFQ was sufficiently valid to assess energy and macronutrients but not micronutrients. The reliability was adequate for most nutrients.

Protein foods from animal sources, incident cardiovascular disease and all-cause mortality: a substitution analysis

BACKGROUND

Protein-rich foods are major parts of the human diet and are highly heterogeneous in nutrient composition and health effects. Designing healthy diets for disease prevention requires careful consideration of substituting unhealthier protein foods with healthier protein foods.

METHODS

This was a pooled analysis of six prospective cohort studies of 29 682 US participants. Data were collected in 1985-2016. Adjusted hazard ratios (HRs) and 30-year absolute risk differences (ARDs) were calculated for the associations between simultaneous substitution of one or more animal protein foods with other animal or plant protein foods at various amounts, and incident cardiovascular disease (CVD) and all-cause mortality.

RESULTS

Substituting eggs, processed meat, unprocessed red meat or poultry with nuts, whole grains, legumes or fish was associated with lower risks of incident CVD and all-cause mortality. According to different substitution amounts (varying from one serving per week to one serving per day) and different numbers of protein foods being simultaneously substituted (varying from one to four), estimates ranged between 1%: HR, 0.99 [95% confidence interval (CI), 0.98-1.00], and 54%: HR, 0.46 (0.35-0.60), lower risks on the relative scale and between 0.3%: ARD, -0.29% (-0.48% to -0.05%), and 14.0%: ARD, -13.96% (-17.29% to -9.96%) lower risks on the absolute scale.

CONCLUSIONS

Nuts, whole grains, legumes and fish appeared to be healthier protein sources than eggs, processed meat, unprocessed red meat and poultry for preventing incident CVD and premature death. The magnitude of lower risk for incident CVD and all-cause mortality was driven by amount and number of animal protein foods substituted.

Are neighbourhood restaurants related to frequency of restaurant meals and dietary quality? Prevalence and changes over time in the Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

To examine whether the density of neighbourhood restaurants affected the frequency of eating restaurant meals and subsequently affected diet quality.

DESIGN

Cross-sectional and longitudinal designs. Structural equation models assessed the indirect relationship between restaurant density (≤3 miles (4·8 km) of participant addresses) and dietary quality (Healthy Eating Index 2010 (HEI)) via the frequency of eating restaurant meals, after adjustment for sociodemographics, select health conditions, region, residence duration and area-level income.

SETTING

Urbanised areas in multiple regions of the USA, years 2000-2002 and 2010-2012.

PARTICIPANTS

Participants aged 45-84 years were followed for 10 years (n 3567).

RESULTS

Median HEI (out of 100) was fifty-nine at baseline and sixty-two at follow-up. The cross-sectional analysis found that residing in areas with a high density of restaurants (highest-ranked quartile) was associated with 52 % higher odds of frequently eating restaurant meals (≥3 times/week, OR: 1·52, 95 % CI 1·18, 1·98) and 3 % higher odds of having lower dietary quality (HEI lowest quartile < 54, OR: 1·03, 95 % CI 1·01, 1·06); associations were not sustained in longitudinal analyses. The cross-sectional analysis found 34 % higher odds of having lower dietary quality for those who frequently ate at restaurants (OR: 1·34, 95 % CI 1·12, 1·61), and more restaurant meals (over time increase ≥ 1 time/week) were associated with higher odds of having worse dietary quality at follow-up (OR: 1·21, 95 % CI 1·00, 1·46).

CONCLUSIONS

Restaurant density was associated with frequently eating out in cross-sectional and longitudinal analyses but was associated with the lower dietary quality only in cross-sectional analyses. Frequent restaurant meals were negatively related to dietary quality. Interventions that encourage less frequent eating out may improve population dietary quality.

Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis

Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi-ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross-sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign-born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non-Hispanic White-, 26% non-Hispanic Black-, 12% Chinese- and 22% Hispanic-Americans. US-born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50-0.79], P<0.001) compared with foreign-born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08-3.36], P=0.03; and 1.65 [1.04-2.63], P=0.03, respectively). Foreign-born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43-0.91], P=0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.

Sleep, Sedentary Behavior, Physical Activity, and Cardiovascular Health: MESA

INTRODUCTION

Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). It is unknown how substituting time in sedentary behavior with sleep or physical activity affects overall CVH.

METHODS

Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis Sleep Ancillary Study. Eligible participants (N = 1718) wore Actiwatch accelerometers for 24 h and had at least 3 d of valid accelerometry. The American Heart Association's Life's Simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 min of sedentary time for an equivalent amount of sleep, light-intensity physical activity (LIPA), or moderate to vigorous physical activity (MVPA).

RESULTS

Substituting 30 min of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β (95% confidence interval) = 0.077 (0.056), 0.039 (0.033), and 0.485 (0.127), respectively]. Substituting 30 min of sedentary time to sleep was associated with lower body mass index (BMI). Substituting 30 min of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Substituting 30 min of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI.

CONCLUSIONS

Sleep, LIPA, and MVPA are all associated with more favorable overall CVH and several key risk factors for cardiovascular disease. These findings underscore the importance of lifestyle modifications in improving CVH.

Diet Quality and Long-Term Absolute Risks for Incident Cardiovascular Disease and Mortality

BACKGROUND

Long-term absolute risks for cardiovascular disease and mortality and cardiovascular disease-free survival according to diet quality at different adult ages are unclear.

METHODS

Data from 6 prospective cohorts collected in 1985-2016 were analyzed (n = 29,497). Baseline diet quality was assessed by alternate Healthy Eating Index 2010 (aHEI-2010), alternate Mediterranean (aMED) diet score, and Dietary Approaches to Stop Hypertension (DASH) score. Absolute risks were estimated using modified Kaplan-Meier analysis and cardiovascular disease-free survival using Irwin's restricted mean. Analyses were stratified by sex and baseline age: young (20-39 years), middle-aged (40-59), and older (60-79).

RESULTS

Comparing participants in the lowest quintile with those in the highest quintile of aHEI-2010 score, the 40-year risks for incident cardiovascular disease were 14.3% (95% confidence interval [CI]: 10.0-18.6) compared to 5.9% (3.0-8.9) in young men, 8.8% (4.3-13.3) compared to 3.0% (1.6-4.4) in young women, 39.6% (36.1-43.2) compared to 30.8% (26.2-35.3) in middle-aged men, and 32.9% (28.0-37.8) compared to 19.5% (16.6-22.4) in middle-aged women. For older adults, the 30-year risks for incident cardiovascular disease were 54.7% (49.3-60.2) compared to 49.7% (44.5-55.0) in men and 48.3% (44.0-52.5) compared to 42.4% (38.2-46.7) in women. Similar inverse associations were identified for all-cause mortality. Compared with participants in the lowest quintile of aHEI-2010 score, those in the highest quintile had ~0.5-2.2 years of longer cardiovascular disease-free survival. Results based on DASH score, but not aMED score, were similar to results based on aHEI-2010 score.

CONCLUSIONS

Consuming a higher quality diet was associated with lower long-term absolute risks for cardiovascular disease and mortality and longer cardiovascular disease-free survival, regardless of sex or age at dietary assessment.

Interaction of diabetes genetic risk and successful lifestyle modification in the Diabetes Prevention Programme

AIM

To test whether diabetes genetic risk modifies the association of successful lifestyle changes with incident diabetes.

MATERIALS AND METHODS

We studied 823 individuals randomized to the intensive lifestyle intervention (ILS) arm of the Diabetes Prevention Programme who were diabetes-free 1 year after enrolment. We tested additive and multiplicative interactions of a 67-variant diabetes genetic risk score (GRS) with achievement of three ILS goals at 1 year (≥7% weight loss, ≥150 min/wk of moderate leisure-time physical activity, and/or a goal for self-reported total fat intake) on the primary outcome of incident diabetes over 3 years of follow-up.

RESULTS

A lower GRS and achieving each or all three ILS goals were each associated with lower incidence of diabetes (all P < 0.05). Additive interactions were significant between the GRS and achievement of the weight loss goal (P < 0.001), physical activity goal (P = 0.02), and all three ILS goals (P < 0.001) for diabetes risk. Achievement of all three ILS goals was associated with 1.8 (95% CI 0.3, 3.4), 3.1 (95% CI 1.5, 4.7), and 3.9 (95% CI 1.6, 6.2) fewer diabetes cases/100-person-years in the first, second and third GRS tertiles (P < 0.001 for trend). Multiplicative interactions between the GRS and ILS goal achievement were significant for the diet goal (P < 0.001), but not for weight loss (P = 0.18) or physical activity (P = 0.62) goals.

CONCLUSIONS

Genetic risk may identify high-risk subgroups for whom successful lifestyle modification is associated with greater absolute reduction in the risk of incident diabetes.

The Cancer Prevention Study-3 FFQ Is a Reliable and Valid Measure of Nutrient Intakes among Racial/Ethnic Subgroups, Compared with 24-Hour Recalls and Biomarkers

BACKGROUND

Valid assessment of dietary intake in diverse populations is important for studies of chronic disease risk in the United States.

OBJECTIVES

We evaluated the reproducibility and validity of a food frequency questionnaire (FFQ) modified for the American Cancer Society's Cancer Prevention Study-3 (CPS-3) prospective cohort, among a racially/ethnically diverse subgroup.

METHODS

The Diet Assessment Substudy included 677 CPS-3 participants (64% women; 61% non-Hispanic white, 24% non-Hispanic black, 15% Hispanic), aged 31-70 y, who completed 2 FFQs 1 y apart (FFQ1, FFQ2), 4-6 telephone-administered 24-h dietary recalls (24HRs), and 2 fasting blood samples and 24-h urine collections ∼6 mo apart in the interim. Spearman rank correlation coefficients (ρ) were used to evaluate FFQ reproducibility and validity compared with 24HRs for 67 nutrient exposures. For 18 of these nutrients, we used the method of triads to calculate validity coefficients (VCs, ρ) from pairwise correlations of FFQ2, 24HRs, and biomarkers. Analyses were stratified by sex, race/ethnicity, education, and BMI.

RESULTS

Mean (range) FFQ reproducibility correlations were ρ = 0.65 (0.50-0.91) for men and ρ = 0.63 (0.37-0.89) for women; mean (range) energy-adjusted, deattenuated correlations of FFQ2 with 24HRs were ρ = 0.60 (0.33-0.84) for men and ρ = 0.55 (0.21-0.79) for women. FFQ2 VCs (ρ) among men ranged from 0.42 for β-cryptoxanthin to 0.91 for omega-3 (n-3) fatty acids and, among women, from 0.41 for sodium to 0.79 for total vitamin D. Mean FFQ reproducibility and validity were highest among whites (ρ = 0.68, ρ = 0.58, respectively) and slightly lower among blacks (ρ = 0.57, ρ = 0.49, respectively) and Hispanics (ρ = 0.59, 0.55, respectively). FFQ reproducibility and validity were slightly lower among those with less than a 4-y college degree, and those with a BMI ≥30 kg/m2.

CONCLUSIONS

Reproducibility and validity of the CPS-3 FFQ were comparable with similar studies for most nutrients, among all subgroups. These findings support future dietary analyses in the contemporary CPS-3 cohort and other similar cohorts.

Effect of Kidney Function on Relationships between Lifestyle Behaviors and Mortality or Cardiovascular Outcomes: A Pooled Cohort Analysis

BACKGROUND

Adherence to healthy behaviors reduces risks of cardiovascular disease and death in the general population. However, among people with kidney disease, a group at higher risk for cardiovascular disease, such benefits have not been established.

METHODS

We pooled data from three cohort studies with a total of 27,271 participants. Kidney function was categorized on the basis of eGFR (≥60, 45 to <60, and <45 ml/min per 1.73 m²). We used proportional hazard frailty models to estimate associations between healthy behaviors (not smoking, at recommended body mass index [BMI], physical activity, healthy diet, and moderate to no alcohol intake) and outcomes (all-cause death, major coronary events, ischemic stroke, and heart failure events).

RESULTS

All recommended lifestyle behaviors were significantly associated with lower risks of death, regardless of eGFR. Not smoking (versus current) and any moderate to vigorous physical activity (versus none) was significantly associated with reduced risks of major coronary and heart failure events, regardless of eGFR. Any (versus no) moderate or vigorous physical activity significantly associated with decreased risk of ischemic stroke events only among those with eGFR ≥60. Moderate to no daily alcohol intake (versus excessive) was significantly associated with an increased risk of major coronary events, regardless of eGFR. For heart failure events, a BMI of 18.5 to 30 associated with decreased risk, regardless of eGFR. Across all eGFR categories, the magnitude of risk reduction for death and all cardiovascular outcomes increased with greater numbers of recommended lifestyle behaviors.

CONCLUSIONS

Recommended lifestyle behaviors are associated with lower risk of death and cardiovascular disease events among individuals with or without reduced kidney function, supporting lifestyle behaviors as potentially modifiable risk factors for people with kidney disease.

Alcohol type and ideal cardiovascular health among adults of the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Light to moderate alcohol consumption is associated with favorable cardiovascular health (CVH). However, the association between alcohol type and ideal CVH has not been well-established. We examined the relationship between alcohol type and ideal CVH as measured by the American Heart Association's seven CVH metrics.

METHODS

We analyzed data from 6,389 men and women aged 45-84 years from a multi-ethnic cohort free of cardiovascular disease. Alcohol type (wine, beer and liquor) was categorized as never, former, 0 but drink other alcohol types, >0 but <1 drink/day, 1-2 drinks/day and >2 drinks/day. A CVH score ranging from 0 to 14 points was created from the seven CVH metrics (Inadequate score, 0-8; average, 9-10; optimal, 11-14). We used multinomial logistic regression to examine the association between alcohol type and CVH, adjusting for age, sex, race/ethnicity, education, income, health insurance, field site and total calorie intake.

RESULTS

The mean (SD) age of participants was 62 (10) years and 53 % were women. Participants who consumed 1-2 drinks/day of wine had higher odds of optimal CVH scores compared to those who never drank wine [adjusted prevalence odds ratio (POR) 1.64 (1.12-2.40)]. In comparison to participants who never drank beer, those who consumed >2 drinks/day of beer had lower odds of optimal CVH scores [0.31 (0.14-0.69)]. Additionally, those who consumed >2 drinks/day of liquor had lower odds of optimal scores compared to those who never drank liquor [0.32 (0.16-0.65)].

CONCLUSION

Moderate consumption of wine was associated with favorable CVH. However, heavy consumption of beer or liquor was associated with poorer CVH.

Diet quality, weight loss, and diabetes incidence in the Diabetes Prevention Program (DPP)

BACKGROUND

We evaluated whether diet quality is a predictor of weight loss and reduced diabetes risk, independent of caloric intake in the Diabetes Prevention Program (DPP) cohort, a randomized clinical trial of adults at risk for diabetes.

METHODS

This secondary analysis included 2914 participants with available data (964 intensive lifestyle (ILS), 977 metformin, 973 placebo). Dietary intake was assessed using a 117-item food frequency questionnaire. Diet quality was quantified using the Alternative Healthy Eating Index 2010 (AHEI). AHEI ranges from 0 to 110, with higher scores corresponding to higher quality diets. ILS participants had greater improvement (p < 0.001) in AHEI over 1-year (4.2 ± 9.0) compared to metformin (1.2 ± 8.5) and placebo (1.4 ± 8.4). We examined the association between AHEI change and weight change from baseline to 1-year using linear regression, and that between 1-year AHEI change and incident diabetes, using hazard models over an average 3 years follow-up. Models were evaluated within treatment group and adjusted for relevant characteristics including caloric intake, physical activity, BMI and AHEI. Models testing incident diabetes were further adjusted for baseline fasting and 2 h glucose.

RESULTS

An increase in AHEI score was associated with weight loss in ILS [β per 10-point increase (SE) -1.2 kg (0.3, p < 0.001)], metformin [- 0. 90 kg (0.2, p < 0.001)] and placebo [- 0.55 kg (0.2, p = 0.01)]. However, AHEI change was not associated with incident diabetes in any group before or after adjustment for weight change.

CONCLUSIONS

Controlling for weight, diet quality was not associated with diabetes incidence but helps achieve weight loss, an important factor in diabetes prevention.

Soft Drink Consumption in Young Mexican Adults Is Associated with Higher Total Body Fat Percentage in Men but Not in Women

A high consumption of soft drinks (SDs) has been linked with the development of anthropometric and metabolic alterations. We evaluate the association between SD consumption and some anthropometric and metabolic variables. This study is an observational study, using a sample of 394 university students, of which 158 were men (40.1%) and 238 women (59.9%), between 18 and 30 years. An SD intake questionnaire provided the consumption of different SDs. The participants' weight, height, and waist and hip circumferences were collected. Metabolic biomarkers were analyzed. The average intake of caloric SDs (CSDs) was 1193.6 ± 1534.8 mL/week and 84.5 ± 115.02 mL/week for non-caloric SDs (NCSDs). Sex differences were found in the amount of SD consumption and these statistical differences were driven by those men subjects with a high total body fat percentage (TBF%). In men, correlations were found between the intake of CSDs and the body mass index, waist and hip circumferences, TBF%, and visceral fat percentage. In woman, a correlation was found with glucose and triglycerides. The prediction model revealed that the intake of CSDs predicts TBF% and low-density lipoprotein only in men. A high amount of CSD consumption in men was associated with a high TBF%, and this may be predictive of future development of metabolic abnormalities.

A Prospective Analysis of Intake of Red and Processed Meat in Relation to Pancreatic Cancer among African American Women

BACKGROUND

African Americans have the highest incidence of pancreatic cancer of any racial/ethnic group in the United States. There is evidence that consumption of red or processed meat and foods containing saturated fats may increase the risk of pancreatic cancer, but there is limited evidence in African Americans.

METHODS

Utilizing the Black Women's Health Study (1995-2018), we prospectively investigated the associations of red and processed meat and saturated fats with incidence of pancreatic adenocarcinoma (n = 168). A food frequency questionnaire was completed by 52,706 participants in 1995 and 2001. Multivariable-adjusted HRs and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. We observed interactions with age (P _interaction = 0.01). Thus, results were stratified at age 50 (<50, ≥50).

RESULTS

Based on 148 cases among women aged ≥50 years, total red meat intake was associated with a 65% increased pancreatic cancer risk (HR_{Q4 vs. Q1} = 1.65; 95% CI, 0.98-2.78; P _trend = 0.05), primarily due to unprocessed red meat. There was also a nonsignificant association between total saturated fat and pancreatic cancer (HR_{Q4 vs. Q1} = 1.85; 95% CI, 0.92-3.72; P _trend = 0.08). Red meat and saturated fat intakes were not associated with pancreatic cancer risk in younger women, and there was no association with processed meat in either age group.

CONCLUSIONS

Red meat-specifically, unprocessed red meat-and saturated fat intakes were associated with an increased risk of pancreatic cancer in African-American women aged 50 and older, but not among younger women.

IMPACT

The accumulating evidence-including now in African-American women-suggests that diet, a modifiable factor, plays a role in the etiology of pancreatic cancer, suggesting opportunities for prevention.

Differences in Diet Quality among Multiple US Racial/Ethnic Groups from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Diet quality is an important risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). Little is known about the diet quality of South Asians in the United States, a group with higher rates of T2D and CVD compared with other racial/ethnic groups.

OBJECTIVE

This study determined whether diet quality differs between South Asian adults in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and whites, Chinese Americans, African Americans, and Hispanics in the Multi-Ethnic Study of Atherosclerosis (MESA).

METHODS

Cross-sectional data from 3926 participants free of CVD from MESA visit 5 (2010-2011) and 889 South Asian participants from MASALA visit 1 (2010-2013) were pooled. Diet quality was assessed using the Alternative Healthy Eating Index (AHEI-2010) derived using FFQs. Multivariable linear regression models adjusted for age, sex, and total energy intake were used to compare mean differences in diet quality between the racial/ethnic groups.

RESULTS

MESA participants were, on average, 14 y older than MASALA participants. The adjusted mean (95% CI) scores for the AHEI-2010 were 70.2 (69.5, 70.9) among South Asians, 66.2 (66.3, 68.2) among Chinese Americans, 61.1 (60.7, 61.6) among whites, 59.0 (58.4, 59.7) among Hispanics, and 57.5 (56.9, 58.1) among African Americans. The mean AHEI scores among South Asians were 3.1 (1.8, 4.3), 9.2 (8.3, 10.1), 11.2 (10.2, 12.3), and 12.8 (11.8, 13.7) points higher compared with Chinese Americans, whites, Hispanics, and African Americans, respectively.

CONCLUSIONS

South Asian adults in the United States have a higher diet quality compared with other racial/ethnic groups. This paradoxical finding is not consistent with the observed higher rates of T2D and CVD compared with other groups. This is further evidence of the importance of studying the South Asian population to better understand the causes of chronic disease not explained by diet quality.

Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality

IMPORTANCE

Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, or fish consumption with CVD and all-cause mortality are still uncertain.

OBJECTIVE

To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019.

EXPOSURES

Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables.

MAIN OUTCOMES AND MEASURES

Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations.

RESULTS

Among the 29 682 participants (mean [SD] age at baseline, 53.7 [15.7] years; 13 168 [44.4%] men; and 9101 [30.7%] self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 [95% CI, 1.04-1.11]; adjusted ARD, 1.74% [95% CI, 0.85%-2.63%]), unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.06]; adjusted ARD, 0.62% [95% CI, 0.07%-1.16%]), or poultry (adjusted HR, 1.04 [95% CI, 1.01-1.06]; adjusted ARD, 1.03% [95% CI, 0.36%-1.70%]) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 [95% CI, 0.98-1.02]; adjusted ARD, 0.12% [95% CI, -0.40% to 0.65%]). Intake of processed meat (adjusted HR, 1.03 [95% CI, 1.02-1.05]; adjusted ARD, 0.90% [95% CI, 0.43%-1.38%]) or unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.05]; adjusted ARD, 0.76% [95% CI, 0.19%-1.33%]) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 [95% CI, 0.97-1.02]; adjusted ARD, -0.28% [95% CI, -1.00% to 0.44%]) or fish (adjusted HR, 0.99 [95% CI, 0.97-1.01]; adjusted ARD, -0.34% [95% CI, -0.88% to 0.20%]) was not significantly associated with all-cause mortality.

CONCLUSIONS AND RELEVANCE

These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.

Dietary characteristics associated with plasma concentrations of per- and polyfluoroalkyl substances among adults with pre-diabetes: Cross-sectional results from the Diabetes Prevention Program Trial

Diet is assumed to be the main source of exposure to per- and polyfluoroalkyl substances (PFAS) in non-occupationally exposed populations, but studies on the diet-PFAS relationship in the United States are scarce. We extracted multiple dietary variables, including daily intakes of food group, diet scores, and dietary patterns, from self-reported dietary data collected at baseline (1996-1999) from adults with pre-diabetes enrolled in the Diabetes Prevention Program, and used linear regression models to evaluate relationships of each dietary variable with plasma concentrations of six PFAS (perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), 2-(N-ethyl-perfluorooctane sulfonamido) acetic acid (EtFOSAA), 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (MeFOSAA), perfluorononanoic acid (PFNA) adjusting for covariates. Participants (N = 941, 65% female, 58% Caucasian, 68% married, 75% with higher education, 95% nonsmoker) had similar PFAS concentrations compared to the general U.S. population during 1999-2000. Using a single food group approach, fried fish, other fish/shellfish, meat and poultry had positive associations with most PFAS plasma concentrations. The strongest effect estimate detected was between fried fish and PFNA [13.6% (95% CI: 7.7, 19.9) increase in median concentration per SD increase]. Low-carbohydrate and high protein diet score had positive association with plasma PFHxS. Some food groups, mostly vegetables and fruits, and the Dietary Approaches to Stop Hypertension diet score had inverse associations with PFOS and MeFOSAA. A vegetable diet pattern was associated with lower plasma concentrations of MeFOSAA, while high-fat meat and low-fiber and high-fat grains diet patterns were associated with higher plasma concentrations of PFOS, PFHxS, MeFOSAA and PFNA. We summarized four major dietary characteristics associated with variations in PFAS plasma concentrations in this population. Specifically, consuming more meat/fish/shellfish (especially fried fish, and excluding Omega3-rich fish), low-fiber and high-fat bread/cereal/rice/pasta, and coffee/tea was associated with higher plasma concentrations while dietary patterns of vegetables, fruits and Omega-3 rich fish were associated with lower plasma concentrations of some PFAS.

Impact of a 3-Month Anti-inflammatory Dietary Intervention Focusing on Watermelon on Body Habitus, Inflammation, and Metabolic Markers: A Pilot Study

An anti-inflammatory dietary intervention called the Inflammation Management Intervention (IMAGINE) was adapted to emphasize watermelon due to its anti-inflammatory properties. This pilot study (n = 23) tested the effect of a watermelon-enhanced IMAGINE intervention (n = 15) on body habitus and markers of inflammation and metabolism. This 3-month self-selection trial, consisting of weekly in-person classes and online education for 12 weeks, focused on incorporating watermelon into an already anti-inflammatory diet. Controls (n = 8) received basic health education via email and blogs. Measurements, including diet, anthropometrics, actigraphy, and a blood draw, were made at baseline and immediately postintervention. Linear regression analyses were conducted using intervention status as the main exposure. Post hoc analyses then ignored intervention assignment and grouped participants based on their change in their energy-adjusted Dietary Inflammatory Index (E-DII^TM) score. There were no group-by-time interactions for any of the studied outcomes. However, some intervention participants’ diets became more proinflammatory, and several control participants’ diets became more anti-inflammatory. Those participants below the median of E-DII change (ie, more anti-inflammatory changes) showed reductions in body fat percent (–1.27% vs +0.90%, respectively, P = .01), body mass index (–0.66 vs +0.38 kg/m², respectively, P = .06) and body weight (–0.99 vs +0.54 kg, respectively, P = .08) compared to those above the median of E-DII change. This study demonstrates that individuals who adopt a more anti-inflammatory diet containing watermelon will have improvements in body anthropometrics. Future studies should focus on increasing adherence and compliance to intervention prescriptions, exploring options to extend interventions to evaluate long-term changes, and further examining changes in inflammatory biomarkers.

Clinical Trials Registration: NCT03158740

Interaction Between Type 2 Diabetes Prevention Strategies and Genetic Determinants of Coronary Artery Disease on Cardiometabolic Risk Factors

Coronary artery disease (CAD) is more frequent among individuals with dysglycemia. Preventive interventions for diabetes can improve cardiometabolic risk factors (CRFs), but it is unclear whether the benefits on CRFs are similar for individuals at different genetic risk for CAD. We built a 201-variant polygenic risk score (PRS) for CAD and tested for interaction with diabetes prevention strategies on 1-year changes in CRFs in 2,658 Diabetes Prevention Program (DPP) participants. We also examined whether separate lifestyle behaviors interact with PRS and affect changes in CRFs in each intervention group. Participants in both the lifestyle and metformin interventions had greater improvement in the majority of recognized CRFs compared with placebo (P < 0.001) irrespective of CAD genetic risk (P interaction > 0.05). We detected nominal significant interactions between PRS and dietary quality and physical activity on 1-year change in BMI, fasting glucose, triglycerides, and HDL cholesterol in individuals randomized to metformin or placebo, but none of them achieved the multiple-testing correction for significance. This study confirms that diabetes preventive interventions improve CRFs regardless of CAD genetic risk and delivers hypothesis-generating data on the varying benefit of increasing physical activity and improving diet on intermediate cardiovascular risk factors depending on individual CAD genetic risk profile.

Ideal cardiovascular health and resting heart rate in the Multi-Ethnic Study of Atherosclerosis

Elevated resting heart rate (RHR) is associated with an increased cardiovascular disease (CVD) risk, but little is known about its association with cardiovascular health (CVH), assessed by the Life's Simple 7 (LS7) metrics. We explored whether ideal CVH was associated with RHR in a cohort free from clinical CVD. We conducted a cross-sectional analysis of baseline data (2000-2002) of 6457 Multi-Ethnic Study of Atherosclerosis participants in 2018. Each LS7 metric (smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose) was scored 0-2. Total score ranged from 0 to 14. Scores of 0-8 indicate inadequate, 9-10 average, and 11-14 optimal CVH. RHR was categorized as <60, 60-69, 70-79 and ≥80 bpm. We used multinomial logistic regression to determine associations between CVH score and RHR, adjusting for age, sex, race/ethnicity, education, income, health insurance, and atrioventricular nodal blockers. Mean age of participants (standard deviation) was 62 (10) years; 53% were women; 47% had inadequate CVH, 33% average, and 20% optimal. Favorable CVH was associated with lower odds of having higher RHR. Compared to RHR <60 bpm, participants with optimal CVH had adjusted odds ratio (95% CI) of 0.55 (0.46-0.64) for RHR of 60-69 bpm, 0.34 (0.28-0.43) for 70-79 bpm, and 0.14 (0.09-0.22) for ≥80 bpm. A similar pattern was observed in the stratified analysis by sex, race/ethnicity and age. Favorable CVH was less likely to be associated with elevated RHR irrespective of sex, race/ethnicity and age. More research is needed to explore the usefulness of promoting ideal CVH to reduce elevated RHR, a known risk factor for CVD.

Multiparity is associated with poorer cardiovascular health among women from the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Multiparity is associated with a greater risk of incident cardiovascular disease. However, the relationship of parity with cardiovascular health, as measured by the American Heart Association Life's Simple 7 metrics, is uncertain.

OBJECTIVE

We aimed to examine the association between parity and ideal cardiovascular health among 3430 women, aged 45-84 years, free of clinical cardiovascular disease enrolled in the Multi-Ethnic Study of Atherosclerosis.

STUDY DESIGN

The Multi-Ethnic Study of Atherosclerosis is a prospective cohort study that recruited middle-aged to older women and men from 6 centers in the United States between 2000 and 2002. The study population comprised 38% White, 28% Black, 23% Hispanic, and 11% Chinese American subjects. Parity (total number of live births) was self-reported and categorized as 0, 1-2, 3-4 and ≥5. The Life's Simple 7 metrics, defined according to American Heart Association criteria, include health behaviors (smoking, physical activity, body mass index, diet) and health factors (blood pressure, total cholesterol, and blood glucose). We categorized each metric into ideal (2 points), intermediate (1 point), and poor (0 points). A total cardiovascular health score of 0-8 was considered inadequate; 9-10, average; and 11-14, optimal. We used multinomial logistic regression to examine the cross-sectional association between parity and the cardiovascular health score, adjusted for sociodemographics, field site, hormone therapy, and menopause.

RESULTS

The mean (standard deviation) age was 62 (10) years. The mean (standard deviation) cardiovascular health score was lower with higher parity (8.9 [2.3], 8.7 [2.3], 8.5 [2.2], and 7.8 [2.0] for 0, 1-2, 3-4, and ≥5 live births, respectively). In comparison to inadequate cardiovascular health scores, the adjusted odds of average cardiovascular health scores were significantly lower for all parity categories relative to nulliparity (prevalence odds ratios [OR] for parity of 1-2, 0.64 [95% confidence interval 0.49-0.83]; 3-4, 0.65 [0.49-0.86]; ≥5, 0.64 [0.45-0.91]). Women with ≥5 live births had a lower prevalence of optimal cardiovascular health scores (OR 0.50 [0.30-0.83]). In the fully adjusted models, the association between parity and each Life's Simple 7 metric was only statistically significant for body mass index. Women with ≥5 live births had lower prevalence of ideal body mass index (OR 0.52 [0.35-0.80]). In addition, the test for interaction showed that the association between parity and cardiovascular health was not modified by race/ethnicity (P = .81 for average cardiovascular health scores and P = .20 for optimal cardiovascular health scores).

CONCLUSION

Multiparity was associated with poorer cardiovascular health, especially for women with ≥5 live births. More research is required to explore the mechanisms by which parity may worsen cardiovascular health.

Dietary Approaches to Stop Hypertension Diet Concordance and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis

INTRODUCTION

In observational studies, the association between the Dietary Approaches to Stop Hypertension (DASH) diet and incident heart failure has been inconsistent. It was hypothesized that higher DASH diet concordance has a protective effect on heart failure in a multi-ethnic cohort.

METHODS

The Multi-Ethnic Study of Atherosclerosis cohort includes men and women of multiple ethnicities who were aged 45-84 years and free of clinical cardiovascular disease at baseline. Participants were recruited between 2000 and 2002 from six U.S. communities and followed for incident cardiovascular health events through 2015 for the purpose of this data set. Diet was measured using food-frequency questionnaires. Cox proportional hazards analysis was used to investigate the associations of the DASH diet concordance with incident heart failure in 2017-2018.

RESULTS

During a median 13 years of follow-up, 179 of 4,478 participants developed heart failure, corresponding to a rate of 3.4 per 1,000 person years. Heart failure incidence rates did not vary significantly by DASH quintile for the population as a whole. In participants younger than 75 years, highest DASH concordance was associated with a lower risk of incident heart failure compared with those in the lowest quintile (hazard ratio=0.4, 95% CI=0.2, 0.9 vs all participants hazard ratio=1.0, 95% CI=0.2, 0.9) after adjusting for demographics, energy consumption, and known cardiovascular confounders.

CONCLUSIONS

This study supports the hypothesis that DASH is beneficial in heart failure prevention within the individuals aged less than 75 years subgroup, an idea that to date was substantiated only by much smaller studies or in less diverse patient populations.

Ethnic, geographic and dietary differences in arsenic exposure in the multi-ethnic study of atherosclerosis (MESA)

Differences in residential location as well as race/ethnicity and dietary habits may result in differences in inorganic arsenic (iAs) exposure. We investigated the association of exposure to iAs with race/ethnicity, geography, and dietary intake in a random sample of 310 White, Black, Hispanic, and Chinese adults in the Multi-Ethnic Study of Atherosclerosis from 6 US cities with inorganic and methylated arsenic (ΣAs) measured in urine. Dietary intake was assessed by food-frequency questionnaire. Chinese and Hispanic race/ethnicity was associated with 82% (95% CI: 46%, 126%) and 37% (95% CI: 10%, 70%) higher urine arsenic concentrations, respectively, compared to White participants. No differences were observed for Black participants compared to Whites. Urine arsenic concentrations were higher for participants in Los Angeles, Chicago, and New York compared to other sites. Participants that ate rice ≥2 times/week had 31% higher urine arsenic compared to those that rarely/never consumed rice. Participants that drank wine ≥2 times/week had 23% higher urine arsenic compared to rare/never wine drinkers. Intake of poultry or non-rice grains was not associated with urinary arsenic concentrations. At the low-moderate levels typical of the US population, exposure to iAs differed by race/ethnicity, geographic location, and frequency of rice and wine intake.

Association of Pro-inflammatory Dietary Intake and Non-Alcoholic Fatty Liver Disease: Findings from Iranian case-control study

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is considered as a major health problem in the world. There is much evidence that diet and dietary factors play an important role in inflammation, and consequently pathogenesis of NAFLD. To investigate the role of diet in the development of inflammation, we can use the Dietary Inflammatory Index (DII), which has been shown to be predictive of levels of inflammatory markers. Methods: 295 incident cases were selected using the convenience-sampling procedure, and 704 controls randomly were selected from the same clinic and among the patients who had no hepatic steatosis and were frequency-matched on age (±5 years) and sex. The DII was computed based on dietary intake from 168-item FFQ. Logistic regression models were used to estimate multivariable ORs. Results: Subjects in tertile 3 had 1.57 (95% CI: 1.13-2.20), 1.78 (95% CI: 1.19-2.67), and 2.02 (95% CI: 1.32-3.09) times higher odds of developing NAFLD, compared to subjects in tertile 1 in models 1 (adjusted for age), 2 (model 1 + BMI, education, smoking, alcohol, diabetes, low density lipoprotein, triglycerides) and 3 (model 2 + aspartate transaminase/alanine transaminase), respectively. When used as a continuous variable, one unit increase in DII was associated with 1.16 (95% CI: 1.05, 1.29), 1.21 (95% CI: 1.107, 1.37) and 1.25 (95% CI: 1.10, 1.43) increase in odds of NAFLD in models one, 2 and 3 respectively. Conclusion: Subjects who consumed a more pro-inflammatory diet were at increased odds of NAFLD.

The Vitamins Involved in One-Carbon Metabolisms are Associated with Reduced Risk of Breast Cancer in Overall and Subtypes

Background: Some micronutrients like folate, vitamin B12, B6, and B2 are the source of coenzymes, which participate in one-carbon metabolism. Any disruption in this metabolism can interfere with DNA replication, repair and regulation of gene expression and ultimately promote the likelihood of carcinogenesis. This study aimed at investigating the relationship between the intakes of micronutrients involved in one-carbon metabolism with breast cancer (BrCa) and its subtype's odds. Methods: Nutrients' intake from diet and supplements were collected through interviewing 151 cases and 154 controls by a 168-item semiquantitative food frequency questionnaire. Logistic regression was used to determine the relationship between dietary and/or total intake of studied nutrients and odds of BrCa and its subtypes. Results: After adjusting the effects of confounding variables in the models, the odds of BrCa was significantly lower in the highest intake quartile compared with the lowest quartile for total intake of vitamin B2 (OR = 0.17, 95% CI, 0.07-0.39; P_trend < 0.001), vitamin B6 (OR = 0.11, 95% CI, 0.05-0.27; P_trend < 0.001), vitamin B12 (OR = 0.20, 95% CI, 0.09-0.43; P_trend < 0.001) and folate (OR = 0.09, 95% CI, 0.04-0.21; P_trend < 0.001). Also, those with the highest quartile of vitamin B6, B12, B2 and folate intake compared with the lowest quartile were less likely to develop estrogen receptor (ER)+ and progesterone receptor (PR)+ subtypes, ER- status, PR- and human epidermal growth factor receptor 2 (HER2)+ subtypes and HER2- status. Conclusion: High intakes of vitamins B2, B6 and folate are associated with reduced odds of BrCa in overall and all ER, PR and HER2 subtypes. Also, high intakes of vitamin B12 reduced the odds of all subtypes of BrCa except ER- subtype.

Life's Simple 7 and Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis

INTRODUCTION

In 2010, the American Heart Association initiated Life's Simple 7 with the goal of significantly improving cardiovascular health by the year 2020. The association of Life's Simple 7 with risk of peripheral artery disease has not been thoroughly explored.

METHODS

Racially diverse individuals from the Multi-Ethnic Study of Atherosclerosis (2000-2012) were followed for incident peripheral artery disease (ankle brachial index ≤0.90) and decline in ankle brachial index (≥0.15) over approximately 10 years of follow-up. Cox and logistic regression were used to assess associations of individual Life's Simple 7 components (score 0-2) and overall Life's Simple 7 score (score 0-14) with incident peripheral artery disease and ankle brachial index decline, respectively, adjusted for age, sex, race/ethnicity, education, and income. Analyses were performed in 2016-2018.

RESULTS

Of 5,529 participants, 251 (4.5%) developed incident peripheral artery disease; 419 (9.8%) of 4,267 participants experienced a decline in ankle brachial index. Each point higher for the overall Life's Simple 7 score was associated with a 17% lower rate of incident peripheral artery disease (hazard ratio=0.83, 95% CI=0.78, 0.88, p<0.001). Additionally, each point higher in overall Life's Simple 7 was associated with a 0.94-fold lower odds of decline in ankle brachial index (OR=0.94, 95% CI=0.87, 0.97, p=0.003). Four components (smoking, physical activity, glucose, and blood pressure) were associated with incident peripheral artery disease and two (smoking and glucose) with decline in ankle brachial index.

CONCLUSIONS

Better cardiovascular health as measured by Life's Simple 7 is associated with lower incidence of peripheral artery disease and less decline in ankle brachial index. Use of the Life's Simple 7 to target modifiable health behaviors may aid in decreasing the population burden of peripheral artery disease-related morbidity and mortality.

Risk of diabetes associated with fatty acids in the de novo lipogenesis pathway is independent of insulin sensitivity and response: the Insulin Resistance Atherosclerosis Study (IRAS)

OBJECTIVE

To examine the associations of fatty acids in the de novo lipogenesis (DNL) pathway, specifically myristic acid (14:0), palmitic acid (16:0), cis-palmitoleic acid (c16:1 n-7), cis-myristoleic acid (c14:1n5), stearic acid (18:0) and cis-oleic acid (c18:1 n-9), with 5-year risk of type 2 diabetes. We hypothesized that DNL fatty acids are associated with risk of type 2 diabetes independent of insulin sensitivity.

RESEARCH DESIGN AND METHODS

We evaluated 719 (mean age 55.1±8.5 years, 44.2% men, 42.3% Caucasians) participants from the Insulin Resistance Atherosclerosis Study. Multivariable logistic regression models with and without adjustment of insulin sensitivity were used to assess prospective associations of DNL fatty acids with incident type 2 diabetes.

RESULTS

Type 2 diabetes incidence was 20.3% over 5 years. In multivariable regression models, palmitic, palmitoleic, myristic, myristoleic and oleic acids were associated with increased risk of type 2 diabetes (p<0.05). Palmitic acid had the strongest association (OR per standard unit of palmitic acid 1.46; 95% CI 1.23 to 1.76; p<0.001), which remained similar with addition of insulin sensitivity and acute insulin response (AIR) to the model (OR 1.36; 95% CI 1.09 to 1.70, p=0.01). Oleic and palmitoleic acids were also independently associated with incident type 2 diabetes. In multivariable models, ratios of fatty acids corresponding to stearoyl CoA desaturase-1 and Elovl6 enzymatic activity were significantly associated with risk of type 2 diabetes independent of insulin sensitivity and AIR.

CONCLUSIONS

We observed associations of DNL fatty acids with type 2 diabetes incidence independent of insulin sensitivity.

Comparison of the NHANES dietary screener questionnaire to the Automated Self-Administered 24-Hour Recall for Children in the Healthy Communities Study

Background

A dietary screener questionnaire (DSQ) was used to assess dietary outcomes among children in the Healthy Communities Study (HCS), a study of the relationships between programs and policies to prevent child obesity and child diet, physical activity and weight outcomes.

Methods

To compare dietary intake estimates derived from the DSQ against those from the Automated Self-Administered 24-Hour Recalls for Children (ASA24-Kids) among children, a measurement error model, using structural equation modelling, was utilized to estimate slopes, deattenuated correlation coefficients, and attenuation factors by age and sex, ethnicity, and BMI status.

Participants/setting

A randomly selected sub-sample of HCS participants aged 4–15 years in 130 communities throughout the U.S. who completed the DSQ and up to two ASA24-Kids recalls (n = 656;13% of HCS participants).

Results

For most nutrient/foods examined, the DSQ yielded larger mean intake estimates than the ASA24-Kids, and agreement between the two measures varied by food/nutrient, age and sex, ethnicity, and BMI category. Deattenuated correlation coefficients of 0.4 or greater were observed for added sugars from SSBs (0.54), fruits and vegetables (0.40), and dairy foods (0.50). Lower deattenuated correlation coefficients were seen for total added sugars (0.37), whole grains (0.34), and fiber (0.34). Attenuation factors were most severe for total added sugars intake among overweight children, and for several other dietary outcomes among children aged 9–11 years.

Conclusions

The DSQ was found to be a tool with acceptable agreement with the ASA24-Kids for measuring multiple dietary outcomes of interest in the HCS, although there may be potential due to measurement error to underestimate results (bias towards the null). In future studies, measurement error modelling and regression calibration may be possible solutions to correct for bias due to measurement error in most food/nutrient intake estimates from the DSQ when used among children.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0415-1) contains supplementary material, which is available to authorized users.

Associations of ideal cardiovascular health with GlycA, a novel inflammatory marker: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Unhealthy lifestyles and inflammation contribute to cardiovascular disease (CVD). GlycA is a novel biomarker of systemic inflammation representing post-translational glycosylation of acute phase reactants and associated with increased clinical CVD risk.

HYPOTHESIS

We hypothesized that ideal cardiovascular health (CVH), as assessed by (higher) Life's Simple 7 (LS7) scores, would be associated with lower GlycA levels among individuals free of CVD in a multiethnic community-based population.

METHODS

This was a cross-sectional study of 6479 Multi-Ethnic Study of Atherosclerosis participants [53% women; mean age 62 ± 10 years] with GlycA levels measured at baseline by nuclear magnetic resonance spectroscopy. The LS7 metrics (smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose) were each scored as ideal (2), moderate (1), or poor (0). Total scores were summed and categorized as optimal (12-14), average (8-11), and inadequate (0-7). Linear regression assessed percent difference in GlycA by LS7 scores, after adjusting for age, sex, ethnicity, education, income, family history of CVD, and other inflammatory biomarkers.

RESULTS

GlycA levels were 403.4 ± 63.1, 374.4 ± 59.2, and 350.3 ± 56.2 micromoles per liter (μmol/L) for inadequate, average, and optimal CVH, respectively (P-trend <0.001). After multivariable adjustment, GlycA remained independently and inversely associated with CVH categories, with a lower mean GlycA level of 5 μmol/L (95% confidence interval 4.5-5.8) for each one unit increment in LS7 score.

CONCLUSIONS

Among this group of ethnically diverse individuals without CVD, suboptimal CVH is associated with higher GlycA levels, independent of traditional inflammatory biomarkers. Strategies aimed at improving CVH might reduce GlycA, which could be a marker of reduced risk of future CVD events.

Dietary assessment of pre-diabetic patients by using food frequency questionnaire. A systematic review of study quality, study outcome, study questionnaire and their relative validity and reliability

BACKGROUND

The contribution of dietary factors in the development and progression of pre-diabetes has been increasingly recognized. However, due to high variability in dietary habits measurement of dietary intake remains one of the most challenging tasks in this population. Food frequency questionnaire (FFQ) which investigates usual dietary intake can be used to identify frequent consumption of foods such as dietary fat, fiber, grains that are linked to the risk of pre-diabetes.

METHOD

This systematic review was conducted to identify and describe FFQs that measure dietary intake of pre-diabetic patients and to examine their relative validity and reliability. The systematic search was done through electronic databases such as PubMed, CINAHL, PsycINFO, ProQuest and Scopus. Methodological quality of included studies and results of study outcome was also summarized in this review.

RESULT

The search identified 445 papers, of which 18 studies reported 15 FFQs, met inclusion criteria. Most of the FFQs (n = 12) were semi-quantitative while three were frequency measures with portion size estimation of selected food items. Test-retest reliability of FFQ was reported in 7 (38.3%) studies with the correlation coefficient of 0.33-0.92. Relative validity of FFQ was reported in 16 (88.8%) studies with the range of correlation coefficient of 0.08-0.83. Dietary patterns rich in carbohydrate, fat, animal protein and n-3 fatty acids were associated with increased risk of pre-diabetes.

CONCLUSION

No well-established disease-specific FFQ identified in the literature. Development of a valid, practical and reliable tool is needed for better understanding of the impact of diet in pre-diabetic population.