Experiences of Discrimination Are Associated With Worse Metabolic Syndrome Severity Among African Americans in the Jackson Heart Study

The Association of Sedentary Behavior and Physical Activity with Different Measurements of Metabolic Syndrome: The Jackson Heart Study

Purpose: Cross-sectional investigation of the association of sedentary behavior and physical activity with metabolic syndrome (MetS) among the African American participants in the Jackson Heart Study (JHS). Methods: Prevalence, number of individual components, and MetS severity z-score (MetS-Z) were examined. MetS was classified using ATP-III thresholds. MetS-Z was calculated using sex-, race-, and ethnicity-specific formulas. Sedentary behavior and physical activity were calculated from the JHS Physical Activity Cohort survey (JPAC). Associations between sedentary behavior and physical activity with MetS were assessed by logistic, negative binomial, and ordinary least squares regressions. Results: The mean participant age (N = 3370) was 61.7 ± 11.9 years and most were female (63.9%). Among all participants, 60.5% were classified with MetS. Overall MetS-Z was moderately high (.31 ± 1.07). Most waking hours were sedentary, with just under 40 daily minutes of self-reported physical activity. Physical activity was associated with lower prevalence of MetS, the number of individual components, and MetS-Z score (p < .05). Sedentary behavior was not associated with MetS in any fully adjusted models (p > .05). Conclusions: Physical activity was associated with lower cardiometabolic risk, irrespective of sedentary behavior. Further studies are needed to better understand why no relation was found between sedentary behavior and cardiometabolic risk in this cohort of African American adults.

Diet Quality, Metabolic Syndrome, and Nativity Status: Elucidating Metabolic Advantage and Disadvantage Among Non-US-Native and US-Native Populations Using NHANES Data (2013-2018)

BACKGROUND/OBJECTIVES

Nutrient-poor diet quality is a major driver of the global burden of metabolic syndrome (MetS). The US ranks among the lowest in diet quality and has the highest rate of immigration, which may present unique challenges for non-US-native populations who experience changes in access to health-promoting resources. This study examined associations among MetS, nativity status, diet quality, and interaction effects of race-ethnicity among Hispanic, Asian, Black, and White US-native and non-US-native adults.

METHODS

We examined data from 5482 adult participants (≥20 years of age) in the National Health and Nutrition Examination Survey (2013-2018). MetS (per the ATP III panel guidelines) was assessed continuously (MetS z-score) and dichotomously. Dietary recalls were used to compute HEI-2015 scores. Nativity status and sociodemographic variables were assessed. Age-adjusted and multivariate-adjusted logistic regressions were conducted to examine the associations between nativity status and MetS and interaction effects by race-ethnicity.

RESULTS

Non-US-native participants displayed more guideline-adherent diet quality (55.23% vs. 49.38%, p < 0.001) compared to their US-native counterparts-even when stratified by racial-ethnic groups. US-native participants had larger waist circumferences and elevated triglyceride levels. Non-US-native Black Americans had a 60% lower risk of having MetS even after adjusting for diet quality (OR: 0.39, 95% CI: 0.17, 0.88) compared to their US-native counterparts. For MetS components, non-US-native Asian participants reported a lower risk for dyslipidemia, while non-US-native multiracial participants had higher triglycerides.

CONCLUSIONS

Non-US-native groups display better diet quality compared to their US-native counterparts. However, the findings suggest that diet quality alone does not account for nativity-related cardiometabolic disparities, particularly in US-native Black Americans, thus necessitating interventions targeting the social determinants of health.

Multilevel Mediators on the Associations of Neighborhood Social Environmental Factors and Severity of Metabolic Syndrome: The Jackson Heart Study

BACKGROUND

Neighborhood characteristics serve as risk factors for metabolic syndrome (MetS). However, the intermediary factors linking this relationship remain understudied. Thus, we investigated the sex-specific mediating role of C-reactive protein, physical activity (PA), and perceived stress in the associations of perceived neighborhood social environment (PNSE) with MetS severity among Black adults.

METHODS AND RESULTS

This cross-sectional study included 3185 adults (64% women) from exam 1 (2000-2004) of the Jackson Heart Study. MetS severity Z scores were calculated based on the Adult Treatment Panel III criteria formula. PNSE included neighborhood violence, problems, and social cohesion. Men and women were analyzed separately. A bootstrap resampling technique with 95% bias-corrected CI (95% BC CI) was used to evaluate whether C-reactive protein, PA, and perceived stress mediated the association between each PNSE and MetS severity, adjusting for covariates. All PNSE factors were directly related to MetS severity in women but not in men. In women, neighborhood problems were indirectly associated with MetS severity mediated through PA (β=0.02 [95% BC CI, 0.00-0.05]). In men, neighborhood violence, problems, and social cohesion were indirectly associated with MetS severity mediated through PA (β=0.05 [95% BC CI, 0.01-0.10]; β=0.03 [95% BC CI, 0.00-0.06]; and β=-0.04 [95% BC CI, -0.09 to -0.01], respectively). Neither C-reactive protein nor perceived stress mediated such associations in either women or men.

CONCLUSIONS

All PNSEs (violence, problems, and social cohesion) were directly related to MetS severity in women only. PA mediated the relationship between each PNSE and MetS in a sex-specific manner. Efforts focusing on local conditions are needed to better understand why such disparities exist for at-risk minoritized groups.

The Influence of Racial Discrimination as a Chronic Stressor on Type 2 Diabetes Risk and Self-Management Behaviors among Black Adults: A Scoping Review

PURPOSE OF REVIEW

This literature review highlights the behavioral and biological mechanisms that link racial discrimination to type 2 diabetes (T2D) risk, self-management, and related complications in the Black population in the United States. Next steps are discussed and include recommendations for disease mitigation.

RECENT FINDINGS

Black Americans are exposed to high levels of stress, with many stressors rooted in racial discrimination, a psychosocial factor that inhibits positive behavior change and disrupts bodily systems and functioning. T2D is a largely preventable disease, yet Black Americans experience known structural and systemic barriers (i.e., structural racism) that profoundly impact diabetes onset and progression. While causal mechanisms that link racial discrimination and T2D have become a more recent focus of study, a dearth of research on racial discrimination-related stress, and the role it plays in the onset and self-management of T2D, remains. Identifying the structural and contextual factors, specifically racial discrimination, that influence diabetes risk and self-management among Black adults is important in closing the gap in health disparities. Findings on coping strategies adopted across the African diaspora are also warranted as policy makers, researchers, and clinicians work together to create an actionable path forward.

The Relationship of Pain Intensity, Perceived Injustice, and Pain Catastrophizing to Heart Rate Variability In Naturally Occurring Acute Pain

OBJECTIVES

Behavioral factors of pain catastrophizing and perceived injustice are associated with pain intensity in chronic pain. Diminished heart rate variability (HRV) is also strongly associated with chronic pain. These factors have been less explored earlier in the pain experience and it is unclear whether they play a role in the transition from acute to chronic pain. The aim of this study was to determine the relationship between pain catastrophizing, perceived injustice, pain intensity, and HRV in naturally occurring acute pain.

MATERIALS AND METHODS

Ninety-seven patients were recruited from local outpatient physical therapy clinics. Seated HRV was captured on 94 patients via Polar chest strap while patients were taking a survey via iPad. In addition to sociodemographic data, the survey included the Pain Catastrophizing Scale (PCS), Injustice Experience Questionnaire (IEQ), and Numeric Pain Rating Scale (NPRS). The natural log of high-frequency power (lnHFP) HRV was used in the statistical analysis.

RESULTS

Multiple linear regression modeling revealed that lower pain catastrophizing, higher perceived injustice, and lower pain intensity were associated with lower HRV, and accounted for 11.4% of the variance in HRV.

DISCUSSION

While greater chronic pain intensity is associated with lower HRV, the relationship is reversed in the setting of acute pain. These findings highlight the need to better understand the unique factors that contribute to lower HRV in the acute phase.

Increased plasminogen activator inhibitor-1 (PAI-1) and its associations with metabolic risk in healthy young adults with early life stress

OBJECTIVES

We aimed to characterize the interplay between early life stress (ELS), metabolic syndrome (MetS), and plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of the fibrinolytic system implicated in cardiometabolic diseases. We also examined the understudied intersection of ELS, physical activity and PAI-1.

METHODS

Healthy young adults ages 18-40 (N=200; 68% female) were recruited from the community. Participants with ELS (N=118) experienced childhood maltreatment, and the majority (n=92) also experienced childhood parental loss. Control participants (N=82) had no history of childhood maltreatment or parental loss. Participants had no current cardiometabolic or thrombotic conditions. Fasting plasma samples were assessed for markers of metabolic risk and total PAI-1 using the Bio-Plex Pro Human Diabetes Panel (Bio-Rad Laboratories). A composite metabolic risk z-score (MetS risk) was computed from the mean standardized z-scores of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, total cholesterol, LDL and HLD cholesterol, fasting plasma glucose, and hemoglobin A1c.

RESULTS

We found that a history of ELS was linked to both higher PAI-1 levels and a higher MetS risk score. ELS was associated with a higher MetS Z-score in adulthood via increased circulating PAI-1 levels (Average Causal Mediation Effect [ACME]= 0.07, p = 0.036). ELS was also linked to increased PAI-1 levels via greater MetS z-scores (ACME = 0.02, p < 0.001). There was a significant interaction effect of ELS and exercise on PAI-1 levels (p = 0.03), such that engaging in higher levels of daily exercise was linked to lower PAI-1 levels in individuals with ELS.

CONCLUSION

Healthy young adults with ELS have elevated PAI-1 levels and metabolic risk scores. Among individuals with ELS, exercise is linked to lower PAI-1 levels, suggesting a potential direction for early intervention.

Racial/Ethnic Discrimination and Cardiometabolic Diseases: A Systematic Review

INTRODUCTION

Racial discrimination has been identified as a risk factor for cardiometabolic diseases, the leading cause of morbidity and mortality among racial/ethnic minority groups; however, there is no synthesis of current knowledge on the association between discrimination and cardiometabolic diseases. The objective of this systematic review was to summarize evidence linking racial/ethnic discrimination and cardiometabolic diseases.

METHODS

The review was conducted based on studies identified via electronic searches of 5 databases (PubMed, Google Scholar, WorldWideScience.org, ResearchGate and Microsoft Academic) using terms related to discrimination and cardiometabolic disease.

RESULTS

Of the 123 eligible studies included in the review, 87 were cross-sectional, 25 longitudinal, 8 quasi-experimental, 2 randomized controlled trials and 1 case-control. Cardiometabolic disease outcomes discussed were hypertension (n = 46), cardiovascular disease (n = 40), obesity (n = 12), diabetes (n = 11), metabolic syndrome (n = 9), and chronic kidney disease (n = 5). Although a variety of discrimination measures was employed across the studies, the Everyday Discrimination Scale was used most often (32.5%). African Americans/Blacks were the most frequently studied racial/ethnic group (53.1%), and American Indians the least (0.02%). Significant associations between racial/ethnic discrimination and cardiometabolic disease were found in 73.2% of the studies.

DISCUSSION

Racial/ethnic discrimination is positively associated with increased risk of cardiometabolic disease and higher levels of cardiometabolic biomarkers. Identifying racial/ethnic discrimination as a potential key contributor to the health inequities associated with cardiometabolic diseases is important for addressing the significant burden borne by racial/ethnic minorities.

Increased Cardiometabolic Risk in Healthy Young Adults With Early Life Stress

OBJECTIVE

This study aimed to evaluate the relationship between early life stress (ELS) and metabolic risk in healthy young adults and assess the role of health behaviors.

METHODS

Young adults aged 18 to 40 years ( N = 190) with no medical conditions or medication usage were recruited from the community. Participants with ELS ( N = 113) had a history of childhood maltreatment, and most also experienced parental loss ( n = 88). Controls ( N = 77) had no history of maltreatment or parental loss. Standardized interviews and self-reports assessed demographics, adversity, medical/psychiatric history, and health behaviors. Blood pressure and anthropometrics were measured, and fasting plasma assayed for lipid profiles, glucose, insulin level, and hemoglobin A 1c . We calculated both a clinical cut-point and continuous composite metabolic risk score based on clinical risk factors and the mean of z scores of each measure, respectively.

RESULTS

ELS was significantly associated with increased clinical cut-point ( β = 0.68, 95% confidence interval [CI] = 0.20-1.17, p = .006) and continuous ( β = 0.23, 95% CI = 0.08-0.038, p = .003) composite metabolic risk scores. On sensitivity analysis, the association of ELS with the continuous composite metabolic risk score was reduced to a trend after adjusting for a range of psychosocial and health predictors ( β = 0.18, 95% CI = 0.00-0.36, p = .053), with both diet and college graduate status significant in the model.

CONCLUSIONS

Healthy young adults with a history of ELS have increased metabolic risk scores as compared with controls. This relationship may be partially due to health behaviors and socioeconomic factors. These findings underline that ELS is an early contributor to metabolic risk.

Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans

OBJECTIVES

This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS

Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N = 1,934) and IADL limitations (N = 2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS

One-unit increase in everyday discrimination was associated with a 25% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION

Everyday discrimination represents a significant stressor that negatively affects older African Americans' performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

Changes in HDL cholesterol, particles, and function associate with pediatric COVID-19 severity

Background

Myriad roles for high-density lipoprotein (HDL) beyond atheroprotection include immunologic functions implicated in the severity of coronavirus disease-2019 (COVID-19) in adults. We explored whether there is an association between HDL and COVID-19 severity in youth.

Methods

A pediatric cohort (N = 102), who tested positive for COVID-19 across a range of disease manifestations from mild or no symptoms, to acute severe symptoms, to the multisystem inflammatory syndrome of children (MIS-C) was identified. Clinical data were collected from the medical record and reserve plasma aliquots were assessed for lipoproteins by NMR spectroscopy and assayed for HDL functional cholesterol efflux capacity (CEC). Findings were compared by COVID-19 status and symptom severity. Lipoprotein, NMR spectroscopy and CEC data were compared with 30 outpatient COVID negative children.

Results

Decreasing HDL cholesterol (HDL-c), apolipoprotein AI (ApoA-I), total, large and small HDL particles and HDL CEC showed a strong and direct linear dose-response relationship with increasing severity of COVID-19 symptoms. Youth with mild or no symptoms closely resembled the uninfected. An atypical lipoprotein that arises in the presence of severe hepatic inflammation, lipoprotein Z (LP-Z), was absent in COVID-19 negative controls but identified more often in youth with the most severe infections and the lowest HDL parameters. The relationship between HDL CEC and symptom severity and ApoA-I remained significant in a multiply adjusted model that also incorporated age, race/ethnicity, the presence of LP-Z and of GlycA, a composite biomarker reflecting multiple acute phase proteins.

Conclusion

HDL parameters, especially HDL function, may help identify youth at risk of more severe consequences of COVID-19 and other novel infectious pathogens.

Associations between perceived discrimination and immune cell composition in the Jackson Heart Study

African American adults suffer disproportionately from several non-communicable and infectious diseases. Among numerous contributing factors, perceived discrimination is considered a stressor for members of historically marginalized groups that contributes to health risk, although biological pathways are incompletely understood. Previous studies have reported associations between stress and both an up-regulation of non-specific (innate) inflammation and down-regulation of specific (adaptive) immunity. While associations between perceived discrimination and markers of inflammation have been explored, it is unclear if this is part of an overall shift that also includes down-regulated adaptive immunity. Relying on a large cross-section of African American adults (n = 3,319) from the Jackson Heart Study (JHS) in Jackson, Mississippi, we tested whether perceived everyday and lifetime discrimination as well as perceived burden from lifetime discrimination were associated with counts of neutrophils (innate), monocytes (innate), lymphocytes (adaptive), and the neutrophil-to-lymphocyte ratio (NLR), derived from complete white blood cell counts with differential. In addition, DNA methylation (DNAm) was measured on the EPIC array in a sub-sample (n = 1,023) of participants, allowing estimation of CD4T, CD8T and B lymphocyte proportions. Unexpectedly, high lifetime discrimination compared to low was significantly associated with lower neutrophils (b : -0.14, [95% CI: -0.24, -0.04]) and a lower NLR (b : -0.15, [95% CI: -0.25, -0.05]) after controlling for confounders. However, high perceived burden from lifetime discrimination was significantly associated with higher neutrophils (b : 0.17, [95% CI: 0.05, 0.30]) and a higher NLR (b : 0.16, [95% CI: 0.03, 0.29]). High perceived burden was also associated with lower lymphocytes among older men, which our analysis suggested might have been attributable to differences in CD4T cells. These findings highlight immune function as a potentially important pathway linking perceived discrimination to health outcomes.

"Something Tells Me I Can't Do That No More": Experiences With Real-Time Glucose and Activity Monitoring Among Underserved Black Women With Type 2 Diabetes

PURPOSE

The purpose of the study was to explore self-regulation skills with real-time activity and glucose monitoring among Black women with type 2 diabetes (T2DM).

METHODS

A small acceptability trial was conducted using technology (continuous glucose monitors and Fitbit) to facilitate core behaviors associated with self-regulation (self-monitoring/assessment, learning, mental contrasting [comparing current values with goal values], and goal setting/review). Participants were given continuous glucose monitors and Fitbit activity trackers for self-monitoring of blood glucose and activity. Two sessions of group diabetes education were also offered. Following the intervention, semistructured interviews and subsequent content analyses were conducted to explore how the women's experiences reflected certain self-regulation behaviors.

RESULTS

Eight underserved Black women with non-insulin-requiring T2DM were included (age = 68 ± 5.2 years; A1C = 6.6% ± 1.1%; 15.3 ± 7.2 years since diagnosis). Content analysis revealed themes that were consistent with core self-regulation behaviors: experiential learning through self-monitoring, mental contrasting, and impact on behavior (actual behavior change and motivation to change behavior).

CONCLUSIONS

With use of real-time glucose and activity monitoring, underserved Black women with T2DM described how they used the data from the devices to make choices about eating and activity behaviors.

The Cardiovascular Conundrum in Ethnic and Sexual Minorities: A Potential Biomarker of Constant Coping With Discrimination

Background: A paradoxical profile of greater elevated sympathetic vasoconstriction (increased total peripheral resistance, TPR) and increased vagally-mediated heart rate variability (HRV) -the so-called Cardiovascular Conundrum- has been reported in African Americans (AAs) both at rest and in response to orthostasis. Whereas some authors have attributed this pattern to genetic factors, others have pointed to the potential role of coping with repeated racial discrimination.

Objective: To disentangle between these alternative explanations, we have examined the hemodynamic profile of another population that is likely to be exposed to episodes of discrimination, i.e., sexual minorities.

Methods: The first study was conducted on a sample of AAs and European Americans (EAs) with the aim of replicating previous results on the Cardiovascular Conundrum. In the second study, lesbian, gay, and bisexual (LGB) people, matched by age and sex with heterosexual participants, underwent a hemodynamic and autonomic assessment at rest and during an emotional (in the experimental group, both LGB-related and non LGB related), and a cognitive stressor.

Results: The first study confirmed a pattern of higher resting HRV, paired with higher TPR, in AAs compared to EAs. In the second study, compared to heterosexuals, the LGB group showed the Cardiovascular Conundrum pattern, characterized by greater HRV and higher TPR at baseline and a more vascular hemodynamic profile and prominent compensation deficit in response to both tasks, and particularly during the LGB-related emotional task. However, in LGB only, the vascular response was negatively correlated with perceived discrimination.

Conclusion: Present preliminary results are discussed in terms of maladaptive physiological consequences of exposure to chronic stress and the chronic use of dysfunctional emotion regulation strategies such as suppression.