Glycemic Control, Cognitive Aging, and Impairment Among Diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging (Hispanic Community Health Study/Study of Latinos)

OBJECTIVE

Hispanics/Latinos in the United States have the highest prevalence of undiagnosed and untreated diabetes and are at increased risk for cognitive impairment. In this study, we examine glycemic control in relation to cognitive aging and impairment in a large prospective cohort of middle-aged and older Hispanics/Latinos of diverse heritages.

RESEARCH DESIGN AND METHODS

Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) is a Hispanic Community Health Study/Study of Latinos (HCHS/SOL) ancillary study. HCHS/SOL is a multisite (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA), probability sampled prospective cohort study. SOL-INCA enrolled 6,377 diverse Hispanics/Latinos age 50 years and older (2016-2018). The primary outcomes were cognitive function, 7-year cognitive decline and mild cognitive impairment (MCI). The primary glycemia exposure variables were measured from fasting blood samples collected at HCHS/SOL visit 1 (2008-2011).

RESULTS

Visit 1 mean age was 56.5 years ± 8.2 SD, and the average glycosylated hemoglobin A1C (HbA1c) was 6.12% (43.5 ± 14.6 mmol/mol). After covariates adjustment, higher HbA1c was associated with accelerated 7-year global (b = -0.045; 95% CI = -0.070; -0.021; in z-score units) and executive cognitive decline, and a higher prevalence of MCI (odds ratio = 1.20; 95% CI = 1.11;1.29).

CONCLUSIONS

Elevated HbA1c levels were associated with 7-year executive cognitive decline and increased MCI risk among diverse middle-aged and older Hispanics/Latinos. Our findings indicate that poor glycemic control in midlife may pose significant risks for cognitive decline and MCI later in life among Hispanics/Latinos of diverse heritages.

Association of nirmatrelvir for acute SARS-CoV-2 infection with subsequent Long COVID symptoms in an observational cohort study

Oral nirmatrelvir/ritonavir is approved as treatment for acute COVID-19, but the effect of treatment during acute infection on risk of Long COVID is unknown. We hypothesized that nirmatrelvir treatment during acute SARS-CoV-2 infection reduces risk of developing Long COVID and rebound after treatment is associated with Long COVID. We conducted an observational cohort study within the Covid Citizen Science (CCS) study, an online cohort study with over 100 000 participants. We included vaccinated, nonhospitalized, nonpregnant individuals who reported their first SARS-CoV-2 positive test March-August 2022. Oral nirmatrelvir/ritonavir treatment was ascertained during acute SARS-CoV-2 infection. Patient-reported Long COVID symptoms, symptom rebound and test-positivity rebound were asked on subsequent surveys at least 3 months after SARS-CoV-2 infection. A total of 4684 individuals met the eligibility criteria, of whom 988 (21.1%) were treated and 3696 (78.9%) were untreated; 353/988 (35.7%) treated and 1258/3696 (34.0%) untreated responded to the Long COVID survey (n = 1611). Among 1611 participants, median age was 55 years and 66% were female. At 5.4 ± 1.3 months after infection, nirmatrelvir treatment was not associated with subsequent Long COVID symptoms (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.80-1.64; p = 0.45). Among 666 treated who answered rebound questions, rebound symptoms or test positivity were not associated with Long COVID symptoms (OR: 1.34; 95% CI: 0.74-2.41; p = 0.33). Within this cohort of vaccinated, nonhospitalized individuals, oral nirmatrelvir treatment during acute SARS-CoV-2 infection and rebound after nirmatrelvir treatment were not associated with Long COVID symptoms more than 90 days after infection.

Factors Associated With Long COVID Symptoms in an Online Cohort Study

Background

Few prospective studies of Long COVID risk factors have been conducted. The purpose of this study was to determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are associated with Long COVID.

Methods

In March 26, 2020, the COVID-19 Citizen Science study, an online cohort study, began enrolling participants with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection. Adult participants who reported a positive SARS-CoV-2 test result before April 4, 2022 were surveyed for Long COVID symptoms. The primary outcome was at least 1 prevalent Long COVID symptom greater than 1 month after acute infection. Exposures of interest included age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, variant wave, number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, and exercise.

Results

Of 13 305 participants who reported a SARS-CoV-2 positive test, 1480 (11.1%) responded. Respondents' mean age was 53 and 1017 (69%) were female. Four hundred seventy-six (32.2%) participants reported Long COVID symptoms at a median 360 days after infection. In multivariable models, number of acute symptoms (odds ratio [OR], 1.30 per symptom; 95% confidence interval [CI], 1.20-1.40), lower socioeconomic status/financial insecurity (OR, 1.62; 95% CI, 1.02-2.63), preinfection depression (OR, 1.08; 95% CI, 1.01-1.16), and earlier variants (OR = 0.37 for Omicron compared with ancestral strain; 95% CI, 0.15-0.90) were associated with Long COVID symptoms.

Conclusions

Variant wave, severity of acute infection, lower socioeconomic status, and pre-existing depression are associated with Long COVID symptoms.

Correlations between complex human phenotypes vary by genetic background, gender, and environment

We develop a closed-form Haseman-Elston estimator for genetic and environmental correlation coefficients between complex phenotypes, which we term HEc, that is as precise as GCTA yet ∼20× faster. We estimate genetic and environmental correlations between over 7,000 phenotype pairs in subgroups from the Trans-Omics in Precision Medicine (TOPMed) program. We demonstrate substantial differences in both heritabilities and genetic correlations for multiple phenotypes and phenotype pairs between individuals of self-reported Black, Hispanic/Latino, and White backgrounds. We similarly observe differences in many of the genetic and environmental correlations between genders. To estimate the contribution of genetics to the observed phenotypic correlation, we introduce "fractional genetic correlation" as the fraction of phenotypic correlation explained by genetics. Finally, we quantify the enrichment of correlations between phenotypic domains, each of which is comprised of multiple phenotypes. Altogether, we demonstrate that the observed correlations between complex human phenotypes depend on the genetic background of the individuals, their gender, and their environment.

Factors Associated with Long Covid Symptoms in an Online Cohort Study

Importance

Prolonged symptoms following SARS-CoV-2 infection, or Long COVID, is common, but few prospective studies of Long COVID risk factors have been conducted.

Objective

To determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute SARS-CoV-2 infection are associated with Long COVID.

Design

Cohort study with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection, and cross-sectional assessment of Long COVID symptoms using data from the COVID-19 Citizen Science (CCS) study.

Setting

CCS is an online cohort study that began enrolling March 26, 2020. We included data collected between March 26, 2020, and May 18, 2022.

Participants

Adult CCS participants who reported a positive SARS-CoV-2 test result (PCR, Antigen, or Antibody) more than 30 days prior to May 4, 2022, were surveyed.

Exposures

Age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, time of infection (variant wave), number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, exercise.

Main Outcome

Presence of at least 1 Long COVID symptom greater than 1 month after acute infection. Sensitivity analyses were performed considering only symptoms beyond 3 months and only severe symptoms.

Results

13,305 participants reported a SARS-CoV-2 positive test more than 30 days prior, 1480 (11.1% of eligible) responded to a survey about Long COVID symptoms, and 476 (32.2% of respondents) reported Long COVID symptoms (median 360 days after infection).Respondents' mean age was 53 and 1017 (69%) were female. Common Long COVID symptoms included fatigue, reported by 230/476 (48.3%), shortness of breath (109, 22.9%), confusion/brain fog (108, 22.7%), headache (103, 21.6%), and altered taste or smell (98, 20.6%). In multivariable models, number of acute COVID-19 symptoms (OR 1.30 per symptom, 95%CI 1.20-1.40), lower socioeconomic status/financial insecurity (OR 1.62, 95%CI 1.02-2.63), pre-infection depression (OR 1.08, 95%CI 1.01-1.16), and earlier variants (OR 0.37 for Omicron compared to ancestral strain, 95%CI 0.15-0.90) were associated with Long COVID symptoms.

Conclusions and Relevance

Variant wave, severity of acute infection, lower socioeconomic status and pre-existing depression are associated with Long COVID symptoms.

Key Points

Question: What are the patterns of symptoms and risk factors for Long COVID among SARS-CoV-2 infected individuals?Findings: Persistent symptoms were highly prevalent, especially fatigue, shortness of breath, headache, brain fog/confusion, and altered taste/smell, which persisted beyond 1 year among 56% of participants with symptoms; a minority of participants reported severe Long COVID symptoms. Number of acute symptoms during acute SARS-CoV-2 infection, financial insecurity, pre-existing depression, and infection with earlier variants are associated with prevalent Long COVID symptoms independent of vaccination, medical history, and other factors.Meaning: Severity of acute infection, SARS-CoV-2 variant, and financial insecurity and depression are associated with Long COVID symptoms.

Association between gestational diabetes and 6-year incident diabetes: results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVE

Type 2 diabetes and gestational diabetes (GDM) disproportionately affect those of Hispanic/Latino heritage. This study examined the association between GDM and prevalent and incident diabetes in a community-based study of Hispanic/Latina women living in the USA.

METHODS

Participants were women aged 18-74 years in the Hispanic Community Health Study/Study of Latinos who had at least one pregnancy and had information on self-reported history of GDM at baseline (n=6389). Logistic regression was used to determine the association between GDM and prevalent (2008-2011) and incident (2014-2017) diabetes and interactions between GDM and risk factors for incident diabetes.

RESULTS

At baseline, 8.7% of participants reported a history of GDM and 18.6% had prevalent diabetes. Women with Mexican heritage had the highest prevalence of GDM history (11.3%) vs women of Cuban (5.0%), Central American (4.9%), and South American (3.8%) heritage (p<0.001 for each comparison to Mexican heritage). Women with self-reported GDM were four times more likely to have prevalent diabetes compared with women without GDM, after adjusting for sociodemographic characteristics and cardiometabolic risk factors (adjusted OR (aOR)=3.94, 95% CI 2.75 to 5.64). Overall incidence of diabetes was 14.3/100 women. Women with GDM at baseline increased their odds of incident diabetes by threefold compared with women without GDM (aOR=3.25, 95% CI 2.09 to 5.05). Women with Cuban or Puerto Rican heritage and GDM had significantly higher odds of incident diabetes compared with women with Mexican heritage (aOR=2.15, 95% CI 1.17 to 3.95; aOR=1.95, 95% CI 1.07 to 3.55, respectively).

CONCLUSION

Self-reported GDM was significantly associated with a threefold higher risk of incident diabetes among Hispanic/Latino women in the USA even after adjusting for several significant predictors of diabetes.

0322 sleep disordered breathing and MRI makers of brain aging in the Hispanic Community Health Study/Study of Latinos

Introduction

We aim to determine if white matter hyperintensities and decreased brain volumes are associated with sleep-disordered breathing (SDB), in a diverse sample of middle-aged and older Hispanic/Latino adults.

Methods

Our sample of 1,119 Hispanics/Latinos (ages older than 50-years; 70% female) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) underwent brain magnetic resonance imaging (MRI) as part of the Study of Latinos - Investigation of Neurocognitive Aging MRI (SOL-INCA MRI) ancillary study. MRI outcomes of interest included global (gray matter, total brain) and regional (lobar cortices, hippocampus) brain volumes, lateral ventricle volume, and total white matter hyperintensity (WMH) volume. All MRI measures were residualized for total cranial volume. Our main exposure was visit-1 sleep data (2008-2011), which includes information about SDB defined with the respiratory event index 3% (REI), ≥5 and ≥15 (moderate-severe SDB) identified by home-sleep apnea test. Survey linear regression models to assess the association between sleep measures and MRI outcomes adjusted for age, sex, education, Hispanic/Latino background, body mass index, tobacco use, alcohol consumption, and physical activity factors and accounted for HCHS/SOL complex study design. We tested for effect modifications by age, sex and Hispanic/Latino background.

Results

Mean age was 63.9±7.0 years. Adjusting for age, sex, and education, individuals with a REI ≥15 (vs. <5) had decrements in total brain volume (Btotal=-6.115[-10.19 ; -2.04]; p<0.01), total gray matter volume(B= -3.702 [-6.7 ; -0.7]; p<0.05), and frontal cortical gray matter volume (B= -1.844[-3.48; -0.21]; p<0.05), and increments in hippocampal volume β= 0.138[0.04; 0.23]; p<0.01). The associations persisted after adjustment for Hispanic/Latino background and behavioral risk factors. Older age modified associations between the REI and age and total brain volumes (Bage*REI=-0.019[-0.04 ;~0.00]; p<0.05). There was no consistent evidence for effect moderation by sex or Hispanic/Latino background.

Conclusion

In a diverse sample of Hispanic/Latinos, moderate-severe SDB was associated with decreased total brain volumes and increments in hippocampal volumes. Our findings suggest that SDB related neuroimaging markers of brain health could serve to identify Hispanic/Latino participants with sleep related Alzheimer’s disease and related dementia risk.

Support (If Any)

This work is supported by National Institute on Aging (R01AG048642, RF1AG054548, and R01AG063868) and by the National Heart Lung Blood Institute (R01HL098297). Dr. González also receives additional support from P30AG59299. The Hispanic Community Health Study/Study of Latinos was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01-philip glass beck HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236), and San Diego State University (N01-HC65237). The following Institutes/Centers/Offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, NIH Institution-Office of Dietary Supplements.

Dietary Patterns and Years Living in the US by Hispanic/Latino Heritage in HCHS/SOL

Objectives

We aimed to identify and compare a posteriori heritage-specific dietary patterns (DPs), and evaluate their associations with “healthfulness” (using Alternative Healthy Eating Index, AHEI-2010) and years living in the US.

Methods

We used baseline data from a population-based cohort of 14,099 Hispanics/Latinos aged 18–74 years in the Hispanic Community Health Study/Study of Latinos. We performed principal factor analysis using two 24-hr recalls to derive DPs, separately, in each heritage group (Cuban, Dominican, Mexican, Puerto Rican, Central American, South American); and identified overarching DPs based on high-loading foods shared by two or more groups. We used multivariable linear regression to test associations of DPs with AHEI-2010 and years living in the US. This trial was registered at clinicaltrials.gov as NCT02060344.

Results

We identified 5 overarching DPs (“Burgers, Fries, & Soft Drinks”; “White Rice, Beans, & Red Meats”; “Fish”; “Egg & Cheese”; and “Alcohol”). While all “Burgers, Fries, & Soft Drinks” DPs were inversely associated with AHEI-2010, all Fish DPs (except Dominican) were positively associated with this index (all Ptrend < 0.001). Meanwhile, “White Rice, Beans, & Red Meats” DPs showed inverse associations in Cuban and Central American groups and positive associations in Mexican-origin individuals (all Ptrend < 0.001). Fewer years living in the US was associated with higher scores for “White Rice, Beans, & Red Meats” DPs in Cuban and Mexican heritage groups and lower scores on “Burgers, Fries, & Soft Drinks” DPs in Cuban, Mexican, and Puerto Rican groups (all Ptrend < 0.01).

Conclusions

Our findings show substantial variation in DPs across Hispanics/Latinos and adherence in DPs by time in the US, which could inform dietary interventions targeting this diverse US population.

Funding Sources

This research received support from the National Heart, Lung, and Blood Institute Global Cardiometabolic Disease Training Grant (1T32HL129969–01A1), the National Institute of Diabetes and Digestive and Kidney Diseases (K01DK107791), and from the Population Research Infrastructure Program (R24 HD050924) awarded to the Carolina Population Center at The University of North Carolina at Chapel Hill by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Multi-Ancestry Genome-wide Association Study Accounting for Gene-Psychosocial Factor Interactions Identifies Novel Loci for Blood Pressure Traits

Psychological and social factors are known to influence blood pressure (BP) and risk of hypertension and associated cardiovascular diseases. To identify novel BP loci, we carried out genome-wide association meta-analyses of systolic, diastolic, pulse, and mean arterial BP taking into account the interaction effects of genetic variants with three psychosocial factors: depressive symptoms, anxiety symptoms, and social support. Analyses were performed using a two-stage design in a sample of up to 128,894 adults from 5 ancestry groups. In the combined meta-analyses of Stages 1 and 2, we identified 59 loci (p value <5e-8), including nine novel BP loci. The novel associations were observed mostly with pulse pressure, with fewer observed with mean arterial pressure. Five novel loci were identified in African ancestry, and all but one showed patterns of interaction with at least one psychosocial factor. Functional annotation of the novel loci supports a major role for genes implicated in the immune response (PLCL2), synaptic function and neurotransmission (LIN7A, PFIA2), as well as genes previously implicated in neuropsychiatric or stress-related disorders (FSTL5, CHODL). These findings underscore the importance of considering psychological and social factors in gene discovery for BP, especially in non-European populations.

Abstract P223: Changes In Cardiometabolic Risk Factors Following Complications Of Pregnancy Among Hispanic/latina Women Of The Hispanic Community Health Study/study Of Latinos, 2008-2017

Background: Pregnancy-related complications (PC), such as preeclampsia (PE), gestational hypertension (GH) and gestational diabetes (GD), are associated with an elevation of cardiometabolic risk and subsequent cardiovascular disease (CVD) following pregnancy among European Caucasian mothers. Our study goal was to determine whether PC is associated with greater change in blood pressure (BP), fasting glucose (FPG), and/or glycosylated hemoglobin (HbA1c) among US Hispanic/Latina women.

Methods: The Hispanic Community Health Study/Study of Latinos is a population-based study of 16,415 Hispanics/Latinos aged 18-74 years (at visit one: 2008-11) from four US sites. At visit two (2014-17), PC information was collected in 550 women who reported a live birth between visits. PC was defined as: no PC (PE, eclampsia, GH, or GD), PC without (w/o) pre-existing conditions (hypertension or diabetes), or PC with pre-existing conditions. At both visits (before and after birth), BP was measured (average of three seated readings) along with FPG and HbA1c (from blood). The association of PC with visit-to-visit change in BP, FPG, and HbA1c was estimated using linear regression models accounting for the complex survey design and adjusted for follow-up time, and visit one sociodemographic, clinical, and behavioral characteristics.

Results: Baseline age was 26.2 years (SE: 0.3), with 77.4% without PC, 17.2% with PC w/o pre-existing conditions, and 5.4% with PC with pre-existing conditions. From fully adjusted models, PC w/o pre-existing conditions compared to no PC, was associated with a greater increase in systolic BP (+4.58mmHg; 95% CI: 1.08, 8.08), diastolic BP (+4.20mmHg; 95% CI: 1.19, 7.20), and FPG (+3.03mg/dL; 95% CI: 0.37, 5.69). PC with pre-existing conditions compared to no PC, was associated with a greater increase in systolic BP (+19.17mmHg; 95% CI: 7.10, 31.23), diastolic BP (+10.10mmHg; 95% CI: 2.67, 17.53), HbA1c (+0.82; 95% CI: 0.19, 1.45), and FPG (+27.12mg/dL; 95% CI: 7.70, 46.55).

Conclusions: BP and blood glucose levels increased among US Hispanic/Latina women following PC with the greatest increase among women with pre-existing conditions. These findings suggest close monitoring of US Hispanic/Latina women with PC is warranted to prevent future CVD.

Omega-3 Fatty Acids and Depressive Symptomology and the Influence of Psychosocial Stress: The Hispanic Community Health Study/Study of Latinos

Objectives

The literature on n-3 fatty acid (FA) intake and depressive symptoms is inconsistent, potentially due in part to the influence of psychosocial stress. Some evidence supports that n-3 intake may have greater benefit on depressive symptoms among those with high oxidative stress. We quantified the associations between dietary and plasma n-3 FA and 6-y depressive symptoms and measured the modifying effect of psychosocial stress.

Methods

Data are from the Hispanic Community Health Study/Study of Latinos (age 48 y, 63% female). At baseline (2008–11), EPA, DHA and n-3 very-long-chain FAs (n-3VLCFAs) were estimated using two 24-hr recalls and the NCI method. Plasma n-3 FAs were measured by mass spectrometry. Depressive symptoms were measured at baseline and 6-y follow-up with the 10-item Center for Epidemiological Studies Depression Scale (CESD). Approximately 9 months from baseline, the 10-item Perceived Stress (PSS) and Chronic Burden of Stress scales were obtained. Unstratified and psychosocial stress-stratified associations were analyzed using survey linear regression among those with dietary (n = 3537) and plasma (n = 718) FA data. Model covariates included, but were not limited to, baseline CESD score, ethnicity, study site, antidepressant use, total energy intake, and dietary or plasma n-6 FA.

Results

Baseline DHA and n-3VLCFA intake were inversely associated with 6-y CESD (P &lt; 0.05). All examined dietary n-3 FA exposures were inversely associated with CESD among those in the highest PSS quartile (Q4) (P &lt; 0.05), but this was attenuated after considering n-6 FA intake. DHA and n-3VLCFA intakes were associated with lower CESD among those with 2 chronic stressors, but not &lt;1 or &gt;2 stressors. Plasma n-3 FAs were not associated with CESD in PSS stratified and unstratified analyses. However, plasma n-3 FA were associated with lower CESD score among those with only 2 chronic stressors.

Conclusions

Dietary n-3VLCFAs, but not plasma, were inversely associated with 6-y CESD. Psychosocial stress did not clearly modify these associations. These results provide some evidence that greater n-3VLCFA intake may reduce depressive symptoms among Hispanic/Latino adults. However, considering the limitations of self-reported intake, further research is needed using biomarkers of long-term n-3 consumption and psychosocial stress to confirm our findings.

Funding Sources

None.

Trans-ethnic fine-mapping of genetic loci for body mass index in the diverse ancestral populations of the Population Architecture using Genomics and Epidemiology (PAGE) Study reveals evidence for multiple signals at established loci

Most body mass index (BMI) genetic loci have been identified in studies of primarily European ancestries. The effect of these loci in other racial/ethnic groups is less clear. Thus, we aimed to characterize the generalizability of 170 established BMI variants, or their proxies, to diverse US populations and trans-ethnically fine-map 36 BMI loci using a sample of >102,000 adults of African, Hispanic/Latino, Asian, European and American Indian/Alaskan Native descent from the Population Architecture using Genomics and Epidemiology Study. We performed linear regression of the natural log of BMI (18.5-70 kg/m²) on the additive single nucleotide polymorphisms (SNPs) at BMI loci on the MetaboChip (Illumina, Inc.), adjusting for age, sex, population stratification, study site, or relatedness. We then performed fixed-effect meta-analyses and a Bayesian trans-ethnic meta-analysis to empirically cluster by allele frequency differences. Finally, we approximated conditional and joint associations to test for the presence of secondary signals. We noted directional consistency with the previously reported risk alleles beyond what would have been expected by chance (binomial p < 0.05). Nearly, a quarter of the previously described BMI index SNPs and 29 of 36 densely-genotyped BMI loci on the MetaboChip replicated/generalized in trans-ethnic analyses. We observed multiple signals at nine loci, including the description of seven loci with novel multiple signals. This study supports the generalization of most common genetic loci to diverse ancestral populations and emphasizes the importance of dense multiethnic genomic data in refining the functional variation at genetic loci of interest and describing several loci with multiple underlying genetic variants.

Behaviors and Knowledge of HealthCorps New York City High School Students: Nutrition, Mental Health, and Physical Activity

BACKGROUND

HealthCorps provides school wellness programming using curricula to promote changes in nutrition, mental health, and physical activity behaviors. The research objective was to evaluate effects of implementing its curricula on nutrition, mental health, and physical activity knowledge and behavior.

METHODS

Pre- and postsurvey data were collected (N = 2255) during the 2012-2013 academic year from 14 New York City public high schools. An 18-item knowledge questionnaire addressed 3 domains; 26 behavioral items were analyzed by factor analysis to identify 6 behavior domains, breakfast being a seventh 1-item domain. We examined the effects stratified by sex, applying mixed-effects models to take into account clustering effects of schools and participants adjusted for age.

RESULTS

The HealthCorps program significantly increased all 3 knowledge domains (p < .05), and significantly changed several key behavioral domains. Boys significantly increased fruits/vegetables intake (p = .03). Girls increased acceptance of new fruits/vegetables (p = .03) and breakfast consumption (p = .04), and decreased sugar-sweetened beverages and energy dense food intake (p = .03). The associations between knowledge and behavior were stronger in boys than girls.

CONCLUSION

The HealthCorps program significantly increased participants' knowledge on nutrition, mental health, and physical activity. It also improved several key behavioral domains, which are targets of the 2010 Dietary Guidelines to address obesity in youth.

The Role of Parenting Practices in the Home Environment among Underserved Youth

BACKGROUND

The home environment, which includes parenting practices, is an important setting in which children develop their health behaviors. We examined the role of parenting practices in the home environment among underserved youth.

METHODS

We examined baseline data of a family-focused pediatric obesity intervention. Parenting practices (monitoring, discipline, limit setting of soda/snacks [SS] and screen media [SM], pressure to eat, and reinforcement) and availability of fruits/vegetables (FV) and sugar-sweetened beverages (SSBs), family meals, television (TV) watching during meals, TVs in the home, owning active video games/sports equipment, and household food security were assessed in 301 parent/caregivers of overweight/obese children (ages 7-12 years; BMI≥85th percentile). Associations were evaluated using Spearman's rank correlation coefficients and logistic regression models adjusted for potential confounders.

RESULTS

Parents/caregivers (ages 22-67 years) were largely Hispanic/Latino (74.1%), female (92.4%), and reported high levels of limit setting SS and low levels of pressure to eat. Parent age, gender, country of birth, and years living in the United States accounted for differences among several parenting practices. Adjusted logistic regression models identified several statistically significant associations, including: Monitoring was positively associated with availability FV (odds ratio [OR]=2.19; 95% confidence interval [CI], 1.25, 3.82); limit setting SS was inversely associated with availability of SSBs (OR=0.40; 95% CI, 0.21, 0.75); and limit setting SM was inversely associated with TV viewing during family meals (OR=0.51; 95% CI, 0.31, 0.85). Nearly 40% of our population was food insecure, and food insecurity was positively associated with pressure to eat (OR=1.77; 95% CI, 1.01, 3.15).

CONCLUSIONS

Parenting practices play an important role in the home environment, and longitudinal studies are needed to examine these associations in the context of family-focused pediatric obesity interventions.

Evolución y Características de las Publicaciones Biomédicas Peruanas, 1985 – 1993

Se realizó un estudio de la evolución y principales características de los artículos científicos de investigaciones realizadas en el Perú, publicadas en revistas nacionales y extranjeras en el período 1985 – 1993. Durante este período se logró identificar 2412 artículos científicos publicados en 32 revistas biomédicas nacionales, y 297 artículos aparecidos en 134 revistas extranjeras. Se observó que la mayoría de revistas médicas nacionales tiene una periodicidad irregular, siendo las revistas de sociedades científicas las más constantes. También se observó que en 8 años el volumen de artículos científicos en revistas nacionales sólo se incrementó en 12%. Además, se describen las características de las autores nacionales y extranjeros, los tipos de artículo que se publican y las áreas temáticas. Finalmente, se hacen alcances acerca de los factores relacionados a las características y tendencias observadas.

Associations of insulin-like growth factor (IGF)-I and IGF-binding protein-3 with HIV disease progression in women

BACKGROUND

The insulin-like growth factor (IGF) axis has been hypothesized to influence the rate of human immunodeficiency virus (HIV) disease progression. This premise is based largely on laboratory models showing that IGF-I stimulates thymic growth and increases lymphocyte numbers and that IGF-binding protein (IGFBP)-3 has an opposing effect, inhibiting hematopoietic stem cell development.

METHODS

We studied 1422 HIV-infected women enrolled in a large cohort that entailed semiannual follow-up (initiated in 1994). Baseline serum samples were tested for IGF-I and IGFBP-3 to determine their associations with incident clinical acquired immunodeficiency syndrome (AIDS) and CD4+ T cell count decline prior to April 1996 (before the era of highly active antiretroviral therapy [HAART]).

RESULTS

Low IGF-I levels (Ptrend= .02) and high IGFBP-3 levels (Ptrend= .02) were associated with rapid CD4+ T cell count decline. Only IGFBP-3, however, was significantly associated with AIDS incidence (hazard ratio for highest vs. lowest quartile, 2.65 [95% confidence interval, 1.30-5.42]; Ptrend= .02) in multivariable models.

CONCLUSIONS

These findings suggest that serum levels of IGFBP-3 (and possibly IGF-I) are associated with the rate of HIV disease progression in women and, more broadly, that interindividual heterogeneity in the IGF axis may influence HIV pathogenesis. If correct, the IGF axis could be a target for interventions to slow HIV disease progression and extend the time before use of HAART becomes necessary.

Adjusting for confounding due to population admixture when estimating the effect of candidate genes on quantitative traits

When analyzing the relationship between allelic variability and traits, a potential source of confounding is population admixture. An approach to adjusting for potential confounding due to population admixture when estimating the influence of allelic variability at a candidate gene is presented. The approach involves augmenting linear regression models with additional regressors. Family genotype data are used to define the regressors, and inclusion of the regressors ensures that, even in the presence of population admixture, the estimates of the regression coefficients that parameterize the influence of allelic variability on the trait are unbiased. The approach is illustrated through an analysis of the influence of apolipoprotein E genotype on plasma low density lipoprotein cholesterol concentrations.

Candida arthritis in adult patients who are not intravenous drug addicts: report of three cases and review of the literature

Candida species are an uncommon cause of infectious arthritis, although the frequency has increased during recent years. Three cases of septic arthritis caused by Candida species are reported, and the literature is reviewed. The first patient developed a popliteal cyst infected by Candida albicans after multiple intravenous antibiotic treatments. The second patient had acute myelogenous leukemia and experienced knee arthritis after chemotherapy, and the third suffered oligoarthritis after a second heart transplantation. All patients received treatment with a standard dose of intravenous amphotericin B. Responses were achieved only in the first two cases; the third patient died despite therapy. Thirty-six previously reported Candida arthritis cases are reviewed, and epidemiologic, diagnostic, therapeutic, and prognostic features are analyzed. Cases are divided into two categories: direct inoculation of fungus and hematogenously disseminated disease; these two categories are compared in terms of sex, age, pathogen species, treatment, and survival. Arthritis induced through direct inoculation of fungus is seen in older individuals, is more frequently produced by species other than C albicans (Candida parapsilosis especially), and has a better prognosis than arthritis caused by disseminated candidiasis. Arthritis can be resolved even in the persistence of the systemic disease. It is believed that the first case of Baker's cyst infected by C albicans and the first case of Candida arthritis in a heart transplant patient are reported here.

Interleukin 2 and interferon alpha modulation of the lymphocyte non-major histocompatibility-restricted lytic activity in glioblastoma patients

We studied the non-major histocompatibility-restricted cytotoxic activity induced by interleukin 2 (IL-2) and interferon alpha (IFN-alpha) in mononuclear cells of peripheral blood (PBMNC) from glioblastoma patients. We observed a depressed cytotoxic activity against natural killer (NK)-sensitive target cells in PBMNC from all the patients studied. Culture of these PBMNC with IFN-alpha for 5 days augmented the cytotoxic activity against NK-sensitive target cells in a small group of patients. Incubation with IL-2 for 5 days normalizes the decreased cytotoxic activity against NK-sensitive target cells of PBMNC from all the glioblastoma patients studied. When PBMNC from these patients were incubated with IL-2 for 5 days and IFN-alpha was added to the culture medium in the last 2 h of culture, an enhancement of non-major histocompatibility-restricted cytotoxic activity was observed compared with that obtained with either IL-2 or IFN-alpha alone. This improvement of the cytotoxic activity was more relevant when it was tested against NK-resistant target cells. The potential utility of the sequential use of the two cytokines in generating non-major histocompatibility cytotoxic activity in glioblastoma patients is discussed.

Modulation by interferon alpha of the decreased natural killer activity in patients with glioblastoma

It is known that natural killer (NK) cells are involved in immunosurveillance against tumours. This study examines the NK activity of mononuclear cells (MNC) from the peripheral blood of patients with glioblastoma. The cytotoxic inducer effect of interferon-alpha (IFN-alpha) upon these MNC has also been studied. A marked decrease in NK activity mediated by MNC from these patients was found. This functional defected in MNC is not due to a decrease in phenotypically defined NK cells. After long-term (5-day) incubation with IFN-alpha, MNC from 5 out of 14 patients showed strong lytic activity against NK-sensitive target cells. In this system, IFN-alpha failed to induce cytotoxic activity against NK-resistant target cells in MNC from all the patients studied. This in vitro induction of cytotoxic activity in MNC from some patients with glioblastoma by IFN-alpha suggests a potential immunotherapeutic use of the lymphokine in these subjects.

Felty's syndrome: response to low dose oral methotrexate

We describe a case of Felty's syndrome with persistent severe neutropenia below 200 granulocytes/mm3, splenomegaly and repeated infections. The patient did not respond to treatment with intramuscular gold salts and lithium carbonate. After 2 months of oral methotrexate administration, 7.5 mg weekly, clinical improvement was notable: she remained afebrile, neutropenia disappeared and splenomegaly regressed. This clinical and laboratory improvement persisted 5 months later. Moreover, accidental discontinuance of the drug and later readministration supported the evidence that the improvement was due to methotrexate.