Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study

PURPOSE

It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.

DESIGN

Multicenter prospective international cohort study.

SETTING

Fourteen university hospitals in Spain and the United Kingdom.

PARTICIPANTS

We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37).

CONCLUSIONS

Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Dietary pattern and diversity analysis using DietDiveR in R: a cross-sectional evaluation in the National Health and Nutrition Examination Survey

BACKGROUND

There are few resources available for researchers aiming to conduct 24-h dietary record and recall analysis using R.

OBJECTIVES

We aimed to develop DietDiveR, which is a toolkit of functions written in R for the analysis of recall or record data collected with the Automated Self-Administered 24-h Dietary Assessment Tool or 2-d 24-h dietary recall data from the National Health and Nutrition Examination Survey (NHANES). The R functions are intended for food and nutrition researchers who are not computational experts.

METHODS

DietDiveR provides users with functions to 1) clean dietary data, 2) analyze 24-h dietary intakes in relation to other study-specific metadata variables, 3) visualize percentages of energy intake from macronutrients, 4) perform principal component analysis or k-means clustering to group participants by similar data-driven dietary patterns, 5) generate foodtrees based on the hierarchical food group information for food items consumed, 6) perform principal coordinate analysis taking food grouping information into account, and 7) calculate diversity metrics for overall diet and specific food groups. DietDiveR includes a self-paced tutorial on a website (https://computational-nutrition-lab.github.io/DietDiveR/). As a demonstration, we applied DietDiveR to a demonstration data set and data from NHANES 2015-2016 to derive a dietary diversity measure of nuts, seeds, and legumes consumption.

RESULTS

Adult participants in the NHANES 2015-2016 cycle were grouped depending on the diversity in their mean consumption of nuts, seeds, and legumes. The group with the highest diversity in nuts, seeds, and legumes consumption had 3.8 cm lower waist circumference (95% confidence interval: 1.0, 6.5) than those who did not consume nuts, seeds, and legumes.

CONCLUSIONS

DietDiveR enables users to visualize dietary data and conduct data-driven dietary pattern analyses using R to answer research questions regarding diet. As a demonstration of this toolkit, we explored the diversity of nuts, seeds, and legumes consumption to highlight some of the ways DietDiveR can be used for analyses of dietary diversity.

Physiologic Adaptation to Macronutrient Change Distorts Findings from Short Dietary Trials: Reanalysis of a Metabolic Ward Study

An influential 2-wk cross-over feeding trial without a washout period purported to show advantages of a low-fat diet (LFD) compared with a low-carbohydrate diet (LCD) for weight control. In contrast to several other macronutrient trials, the diet order effect was originally reported as not significant. In light of a new analysis by the original investigative group identifying an order effect, we aimed to examine, in a reanalysis of publicly available data (16 of 20 original participants; 7 female; mean BMI, 27.8 kg/m2), the validity of the original results and the claims that trial data oppose the carbohydrate-insulin model of obesity (CIM). We found that energy intake on the LCD was much lower when this diet was consumed first compared with second (a difference of -1164 kcal/d, P = 3.6 × 10-13); the opposite pattern was observed for the LFD (924 kcal/d, P = 2.0 × 10-16). This carry-over effect was significant (P interaction = 0.0004) whereas the net dietary effect was not (P = 0.4). Likewise, the between-arm difference (LCD - LFD) was -320 kcal/d in the first period and +1771 kcal/d in the second. Body fat decreased with consumption of the LCD first and increased with consumption of this diet second (-0.69 ± 0.33 compared with 0.57 ± 0.32 kg, P = 0.007). LCD-first participants had higher β-hydroxybutyrate levels while consuming the LCD and lower respiratory quotients while consuming LFD when compared with LFD-first participants on their respective diets. Change in insulin secretion as assessed by C-peptide in the first diet period predicted higher energy intake and less fat loss in the second period. These findings, which tend to support rather than oppose the CIM, suggest that differential (unequal) carry-over effects and short duration, with no washout period, preclude causal inferences regarding chronic macronutrient effects from this trial.

Non-alcoholic fatty liver modifies associations of body mass index and waist circumference with cardiometabolic risk: The CARDIA study

Background

Non-alcoholic fatty liver disease (NAFLD) is recognized as a prevalent determinant of cardiometabolic diseases. The association between NAFLD and obesity warrants further research on how NAFLD modifies associations between body mass index (BMI) and Waist circumference (WC) with cardiometabolic risk (CMR).

Objective

This study assessed whether NAFLD modifies associations between BMI and WC with 5-year changes in CMR in 2366 CARDIA study participants.

Methods

Non-contrast CT was used to quantify liver attenuation, with ≤51 Hounsfield Units (HU) used to define NAFLD in the absence of secondary causes of excess liver fat. The dependent variable was the average Z score of fasting glucose, insulin, triglycerides [log], (-) high-density lipoprotein cholesterol (HDL-C), and systolic blood pressure(SBP). Multivariable linear regression was used to estimate the associations between BMI and WC with CMR. Effect modification by NAFLD was assessed by an interaction term between NAFLD and BMI or WC.

Results

The final sample had 539 (23%) NAFLD cases. NAFLD modified the association of BMI and WC with CMR (interaction p < 0.0001 for both). BMI and WC were associated with CMR in participants without NAFLD (p < 0.001), but not among those with NAFLD. Participants with NAFLD and normal BMI and WC had CMR estimates that were higher than those without NAFLD in the obese categories. Among those without NAFLD the 5 years CMR change estimate was 0.09 (95% CI: 0.062, 0.125) for BMI ≥30 kg/m2 compared to -0.06 (-0.092, -0.018) for BMI < 25 kg/m2, and among those with NAFLD, these estimates were 0.15 (0.108, 0.193) and 0.16 (-0.035, 0.363).

Conclusions

NAFLD modifies associations of BMI and WC with CMR. Compared with BMI and WC, NAFLD was more strongly associated with CMR. In the presence of NAFLD, BMI and WC were not associated with CMR. These findings have implications for clinical screening guidelines.

Increased low-density lipoprotein cholesterol on a low-carbohydrate diet in adults with normal but not high body weight: A meta-analysis

BACKGROUND

Low-density lipoprotein (LDL) cholesterol change with consumption of a low-carbohydrate diet (LCD) is highly variable. Identifying the source of this heterogeneity could guide clinical decision-making.

OBJECTIVES

To evaluate LDL cholesterol change in randomized controlled trials involving LCDs, with a focus on body mass index (BMI) in kg/m2.

METHODS

Three electronic indexes (Pubmed, EBSCO, and Scielo) were searched for studies between 1 January, 2003 and 20 December, 2022. Two independent reviewers identified randomized controlled trials involving adults consuming <130 g/d carbohydrate and reporting BMI and LDL cholesterol change or equivalent data. Two investigators extracted relevant data, which were validated by other investigators. Data were analyzed using a random-effects model and contrasted with results of pooled individual participant data.

RESULTS

Forty-one trials with 1379 participants and a mean intervention duration of 19.4 wk were included. In a meta-regression accounting for 51.4% of the observed variability on LCDs, mean baseline BMI had a strong inverse association with LDL cholesterol change [β = -2.5 mg/dL/BMI unit, 95% confidence interval (CI): -3.7, -1.4], whereas saturated fat amount was not significantly associated with LDL cholesterol change. For trials with mean baseline BMI <25, LDL cholesterol increased by 41 mg/dL (95% CI: 19.6, 63.3) on the LCD. By contrast, for trials with a mean of BMI 25-<35, LDL cholesterol did not change, and for trials with a mean BMI ≥35, LDL cholesterol decreased by 7 mg/dL (95% CI: -12.1, -1.3). Using individual participant data, the relationship between BMI and LDL cholesterol change was not observed on higher-carbohydrate diets.

CONCLUSIONS

A substantial increase in LDL cholesterol is likely for individuals with low but not high BMI with consumption of an LCD, findings that may help guide individualized nutritional management of cardiovascular disease risk. As carbohydrate restriction tends to improve other lipid and nonlipid risk factors, the clinical significance of isolated LDL cholesterol elevation in this context warrants investigation. This trial was registered at PROSPERO as CRD42022299278.

Genetic drivers of heterogeneity in type 2 diabetes pathophysiology

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P < 5 × 10-8) that map to 611 loci, of which 145 loci are, to our knowledge, previously unreported. We define eight non-overlapping clusters of T2D signals that are characterized by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type-specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial cells and enteroendocrine cells. We build cluster-specific partitioned polygenic scores5 in a further 279,552 individuals of diverse ancestry, including 30,288 cases of T2D, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned polygenic scores are associated with coronary artery disease, peripheral artery disease and end-stage diabetic nephropathy across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings show the value of integrating multi-ancestry genome-wide association study data with single-cell epigenomics to disentangle the aetiological heterogeneity that drives the development and progression of T2D. This might offer a route to optimize global access to genetically informed diabetes care.

Plasma Neuronal Growth Regulator 1 May Link Physical Activity to Reduced Risk of Type 2 Diabetes: A Proteome-Wide Study of ARIC Participants

Habitual physical activity (PA) impacts the plasma proteome and reduces the risk of developing type 2 diabetes (T2D). Using a large-scale proteome-wide approach in Atherosclerosis Risk in Communities study participants, we aimed to identify plasma proteins associated with PA and determine which of these may be causally related to lower T2D risk. PA was associated with 92 plasma proteins in discovery (P < 1.01 × 10-5), and 40 remained significant in replication (P < 5.43 × 10-4). Eighteen of these proteins were independently associated with incident T2D (P < 1.25 × 10-3), including neuronal growth regulator 1 (NeGR1; hazard ratio per SD 0.85; P = 7.5 × 10-11). Two-sample Mendelian randomization (MR) inverse variance weighted analysis indicated that higher NeGR1 reduces T2D risk (odds ratio [OR] per SD 0.92; P = 0.03) and was consistent with MR-Egger, weighted median, and weighted mode sensitivity analyses. A stronger association was observed for the single cis-acting NeGR1 genetic variant (OR per SD 0.80; P = 6.3 × 10-5). Coupled with previous evidence that low circulating NeGR1 levels promote adiposity, its association with PA and potential causal role in T2D shown here suggest that NeGR1 may link PA exposure with metabolic outcomes. Further research is warranted to confirm our findings and examine the interplay of PA, NeGR1, adiposity, and metabolic health.

ARTICLE HIGHLIGHTS

Association between dairy products consumption and the prevalences of combined prediabetes and type 2 diabetes mellitus in Brazilian adolescents: a cross-sectional study

The association between dairy products consumption in adults and the likelihood of type 2 diabetes mellitus (T2DM) has been described, but more information on the adolescent population is needed. This nationally representative, cross-sectional school-based study aimed to describe the consumption of dairy products and their subtypes and to evaluate their association with prediabetes and T2DM in adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) includes adolescents aged 12-17 years. Dairy products consumption was evaluated by 24-h food recall. Associations with fasting glucose, glycated hemoglobin (HbA1c) and insulin resistance, as measured by homeostatic model assessment-insulin resistance (HOMA-IR), were evaluated by multivariate linear regression. Poisson regression was also used to assess the association between dairy products consumption and the combined prevalence of prediabetes and T2DM. Models were adjusted for sociodemographic, nutritional, behavioural and anthropometrics. The final sample analysed consisted of 35 614 adolescents. Total intake of dairy products was inversely associated with fasting blood glucose levels after adjusting for all covariates (β = -0·452, 95 % CI -0·899, -0·005). The associations were stronger for overweight and obese adolescents. Findings were similar for full-fat dairy products and yogurt. Higher consumption of low-fat dairy products and cheese were associated with a 46 % (prevalence ratio, PR 1·46, 95 % CI 1·18, 1·80) and 33 % (PR 1·33, 95 % CI 1·14, 1·57) higher combined prevalence of prediabetes and T2DM, respectively. The total consumption of dairy products and full-fat dairy products was associated with a lower combined prevalence of prediabetes and T2DM, while the consumption of cheese and low-fat dairy products was associated with higher combined prevalence of prediabetes and T2DM in Brazilian adolescents.

Young Adult Physical Activity Trajectories and Midlife Nonalcoholic Fatty Liver Disease

Importance

Physical activity (PA) is recommended for preventing and treating nonalcoholic fatty liver disease (NAFLD). Yet, how long-term patterns of intensity-based physical activity, including moderate-intensity PA (MPA) and vigorous-intensity PA (VPA), might affect the prevalence of NAFLD in middle age remains unclear.

Objective

To identify distinct intensity-based PA trajectories from young to middle adulthood and examine the associations between PA trajectories and NAFLD prevalence in midlife.

Design, Setting, and Participants

This population-based cohort of 2833 participants used the Coronary Artery Risk Development in Young Adults study data. The setting included field clinics in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. Data analysis was completed in March 2023.

Exposures

PA was self-reported at 8 examinations over 25 years (1985-1986 to 2010-2011) and separately scored for MPA and VPA.

Main Outcomes and Measures

NAFLD was defined as liver attenuation values less than 51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010-2011).

Results

Among a total of 2833 participants included in the sample, 1379 (48.7%) self-identified as Black, 1454 (51.3%) as White, 1206 (42.6%) as male, and 1627 (57.4%) as female from baseline (1985-1986) (mean [SD] age, 25.0 [3.6] years) to year 25 (2010-2011) (mean [SD] age, 50.1 [3.6] years). Three MPA trajectories were identified: very low stable (1514 participants [53.4%]), low increasing (1096 [38.7%]), and moderate increasing (223 [7.9%]); and 3 VPA trajectories: low stable (1649 [58.2%]), moderate decreasing (1015 [35.8%]), and high decreasing (169 [6.0%]). After adjustment for covariates (sex, age, race, study center, education, smoking status, and alcohol consumption), participants in the moderate decreasing (risk ratio [RR], 0.74; 95% CI, 0.54-0.85) and the high decreasing (RR, 0.59; 95% CI, 0.44-0.80) VPA trajectories had a lower risk of NAFLD in middle age, relative to participants in the low stable VPA trajectory. Adjustments for baseline body mass index and waist circumference attenuated these estimates, but the results remained statistically significant. The adjusted RRs across the MPA trajectories were close to null and not statistically significant.

Conclusions and Relevance

This cohort study of Black and White participants found a reduced risk of NAFLD in middle age for individuals with higher levels of VPA throughout young to middle adulthood compared with those with lower VPA levels. These results suggest the need for promoting sustainable and equitable prevention programs focused on VPA over the life course to aid in lowering NAFLD risk.

Aerobic and Muscle-Strengthening Physical Activity, Television Viewing, and Nonalcoholic Fatty Liver Disease: The CARDIA Study

BACKGROUND

The prevalence of non-alcoholic fatty liver disease (NAFLD) in U.S. adults is over 30%, yet the role of lifestyle factors in the etiology of NAFLD remains understudied. We examined the associations of physical activity, by intensity and type, and television viewing with prevalent NAFLD.

METHODS

Cross-sectional analysis of a population-based sample of 2726 Black (49%) and White (51%) adults (Mean (SD) age, 50 (3.6) years; 57.3% female) from the CARDIA study. Exposures were aerobic activity by intensity (moderate, vigorous; hours/week); activity type (aerobic, muscle-strengthening; hours/week); and television viewing (hours/week), examined concurrently in all models and assessed by validated questionnaires. Our outcome was NAFLD (liver attenuation < 51 Hounsfield Units), measured by non-contrast computed tomography, after exclusions for other causes of liver fat. Covariates were sex, age, race, study center, education, diet quality, smoking status, alcohol consumption, and body mass index or waist circumference.

RESULTS

648 participants had NAFLD. In the fully adjusted modified Poisson regression model, the risk ratios per interquartile range of each exposure were moderate-intensity aerobic activity, 1.10 (95% CI, 0.97-1.26); vigorous-intensity aerobic activity, 0.72 (0.63-0.82); muscle-strengthening activity, 0.89 (0.80-1.01); and television viewing, 1.20 (1.10-1.32). Relative to less active participants with higher levels of television viewing, those who participated in ≥2 h/week of both vigorous-intensity aerobic and muscle-strengthening activity and <7 h/week of television viewing had 65% lower risk of NAFLD (risk ratio = 0.35, 95% CI = 0.23-0.51).

CONCLUSION

Adults who follow public health recommendations for vigorous-aerobic and muscle-strengthening activity, as well as minimize television viewing, are considerably less likely to have NAFLD than those who do not follow the recommendations and who have relatively high levels of television viewing.

Body Mass Index Trajectories and Biomarkers of Cardiometabolic Risk in Children from Low-Income and Racially and Ethnically Diverse Households

Background: This study examined the associations between BMI trajectories and emerging cardiometabolic risk (CMR) in children living in low-income and racially and ethnically diverse households in the United States. Methods: Data were drawn from NET-Works randomized intervention trial and NET-Works 2 prospective follow-up study (N = 338). BMI was measured across 6 follow-up visits and biomarkers of cardiometabolic risk (CMR) at the sixth visit. Group-based trajectory modeling identified child BMI trajectories. Adjusted multivariable linear regressions evaluated the associations between BMI trajectories and CMR. Results: We identified two BMI trajectories: 25% followed a trajectory of steep BMI increase, and 75% followed a moderate decreasing BMI trajectory over time. Relative to children in the moderate decreasing trajectory, children in the increasing trajectory had higher adjusted mean levels of C-reactive protein [CRP; 3.3; 95% confidence interval (CI): 1.6 to 5.0], leptin (63.1; 95% CI: 44.3 to 81.8), triglycerides (35.4; 95% CI: 22.1 to 48.6), triglyceride/high-density lipoprotein (HDL) ratio (1.2; 95% CI: 0.8 to 1.6), hemoglobin A1c (HbA1C; 0.1; 95% CI: 0.03 to 0.2), fasting glucose (1.8; 0.1 to 3.5) and insulin (8.8; 95% CI: 6.5 to 11.0), overall CMR score (0.7; 95% CI: 0.5 to 0.9), and lower adiponectin (-1.3; 95% CI: -2.5 to -0.1) and HDL (-10.8; 95% CI: -14.3 to -7.4). Conclusions: Children with high BMIs early in childhood were more likely to maintain an accelerated BMI trajectory throughout childhood, which was associated with adverse CMR in pre-adolescence. To advance health equity and support children's healthy weight and cardiovascular health trajectories, public health efforts are needed to address persistent disparities in childhood obesity and CMR.

Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 pandemic: a 1-Year longitudinal survey

BACKGROUND

Efforts to limit the spread of COVID-19 have included public space closures, mask usage, and quarantining. Studies regarding the impact of these measures on the psychosocial and behavioral health outcomes of the workforce have focused frequently on healthcare employees. To expand the literature base, we deployed a one-year longitudinal survey among mostly non-healthcare employees assessing changes in select psychosocial outcomes, health behaviors, and COVID-19-related transmission prevention behaviors and perceptions.

METHODS

We deployed the CAPTURE baseline survey across eight companies from November 20, 2020-February 8, 2021. The baseline survey included questions on psychosocial outcomes, health behaviors, and COVID-19 transmission prevention behaviors, with several questions containing a retrospective component to cover the time period prior to the pandemic. Additional questions on vaccination status and social support were subsequently added, and the updated survey deployed to the same baseline participants at three, six, and 12 months after baseline survey deployment. We analyzed data descriptively and performed Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare data within and between time points.

RESULTS

A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees completing all four time points. Employees reported higher stress, anxiety, fatigue, and feelings of being unsafe across all time points compared to pre-pandemic. Time spent sleeping increased initially but returned to pre-pandemic levels at follow-up. Lower rates of physical activity and higher rates of non-work screen time and alcohol consumption relative to pre-pandemic were also reported. Over 90% of employees perceived wearing a mask, physical distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very important' in preventing the spread of COVID-19 across all time points.

CONCLUSIONS

Relative to pre-pandemic, poorer psychosocial outcomes and worsened health behaviors were observed across all time points, with values worse at the baseline and 12-month time points when COVID-19 surges were highest. While COVID-19 prevention behaviors were consistently deemed to be important by employees, the psychosocial outcome and health behavior data suggest the potential for harmful long-term effects of the pandemic on the well-being of non-healthcare employees.

Multi-ancestry genome-wide study in >2.5 million individuals reveals heterogeneity in mechanistic pathways of type 2 diabetes and complications

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes. To characterise the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study (GWAS) data from 2,535,601 individuals (39.7% non-European ancestry), including 428,452 T2D cases. We identify 1,289 independent association signals at genome-wide significance (P<5×10-8) that map to 611 loci, of which 145 loci are previously unreported. We define eight non-overlapping clusters of T2D signals characterised by distinct profiles of cardiometabolic trait associations. These clusters are differentially enriched for cell-type specific regions of open chromatin, including pancreatic islets, adipocytes, endothelial, and enteroendocrine cells. We build cluster-specific partitioned genetic risk scores (GRS) in an additional 137,559 individuals of diverse ancestry, including 10,159 T2D cases, and test their association with T2D-related vascular outcomes. Cluster-specific partitioned GRS are more strongly associated with coronary artery disease and end-stage diabetic nephropathy than an overall T2D GRS across ancestry groups, highlighting the importance of obesity-related processes in the development of vascular outcomes. Our findings demonstrate the value of integrating multi-ancestry GWAS with single-cell epigenomics to disentangle the aetiological heterogeneity driving the development and progression of T2D, which may offer a route to optimise global access to genetically-informed diabetes care.

Evidence for the carbohydrate-insulin model in a reanalysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial

BACKGROUND

The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial demonstrated that meaningful weight loss can be achieved with either a "healthy low-carbohydrate diet" (LCD) or "healthy low-fat diet" (LFD). However, because both diets substantially decreased glycemic load (GL), the dietary factors mediating weight loss remain unclear.

OBJECTIVES

We aimed to explore the contribution of macronutrients and GL to weight loss in DIETFITS and examine a hypothesized relationship between GL and insulin secretion.

DESIGN

This study is a secondary data analysis of the DIETFITS trial, in which participants with overweight or obesity (aged 18-50 y) were randomized to a 12-mo LCD (N = 304) or LFD (N = 305).

RESULTS

Measures related to carbohydrate intake (total amount, glycemic index, added sugar, and fiber) showed strong associations with weight loss at 3-, 6-, and 12-mo time points in the full cohort, whereas those related to total fat intake showed weak to no associations. A biomarker of carbohydrate (triglyceride/HDL cholesterol ratio) predicted weight loss at all time points (3-mo: β [kg/biomarker z-score change] = 1.1, P = 3.5 × 10^-9; 6-mo: β = 1.7, P = 1.1 × 10^-9; and 12-mo: β = 2.6, P = 1.5 × 10^-15), whereas that of fat (low-density lipoprotein cholesterol + HDL cholesterol) did not (all time points: P = NS). In a mediation model, GL explained most of the observed effect of total calorie intake on weight change. Dividing the cohort into quintiles of baseline insulin secretion and GL reduction revealed evidence of effect modification for weight loss, with P = 0.0009 at 3 mo, P = 0.01 at 6 mo, and P = 0.07 at 12 mo.

CONCLUSIONS

As predicted by the carbohydrate-insulin model of obesity, weight loss in both diet groups of DIETFITS seems to have been driven by the reduction of GL more so than dietary fat or calories, an effect that may be most pronounced among those with high insulin secretion. These findings should be interpreted cautiously in view of the exploratory nature of this study.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01826591).

Abstract MP34: Non-Alcoholic Fatty Liver Disease Modifies the Associations of Body Mass Index and Waist Circumference With Changes in Cardiometabolic Risk: The Cardia Study

Introduction: Non-alcoholic fatty liver disease (NAFLD) is often unrecognized and untreated despite its high prevalence (~25% of adults) and implications for cardiometabolic diseases. We examined the potential for NAFLD to modify the associations between BMI and waist circumference (WC) with changes in cardiometabolic risk.

Hypothesis: The associations of BMI and WC with CMR risk are modified by NAFLD.

Methods: We analyzed data from Years 25 (2010/11) and 30 (2015/6) of the CARDIA cohort. NAFLD status was determined by noncontrast CT with a liver attenuation cut-off <51 HU after exclusions for other causes of liver fat. The outcome was 5-yr change in cardiometabolic risk score (CMR) derived by the mean Z-score score of fasting glucose, insulin, triglycerides [log], (-)HDL cholesterol, and systolic blood pressure. BMI and WC were directly assessed, and covariates included age, sex, race, center, education, smoking, alcohol, and medications for diabetes or CVD, and Year 25 CMR. Multivariable linear regression models included NAFLD status, BMI, and WC as the independent variables. Effect modification was assessed by interaction terms between NAFLD and continuous BMI and WC in separate models. Subsequent models were stratified by NAFLD status.

Results: Our final sample size was 2366 (mean age: 50.1 y, males: 42.6%, Black race: 47.2%) with a NAFLD prevalence of 23% (n=539). Year 25 mean (± sd) CMR for those with and without NAFLD was -0.21 ± 0.58 and 0.50 ± 0.60, respectively. NAFLD status considerably modified the association of both BMI (interaction p<0.001) and WC (interaction p=0.002) with CMR change. BMI and WC were more strongly associated with CMR in participants without NAFLD compared to those with NAFLD (see Table). Within each BMI and WC category, CMR change was higher for those with NAFLD relative to those without NAFLD.

Conclusion: NAFLD status modifies the association between BMI and WC with CMR changes. These findings have implications for routine clinical screening guidelines and risk stratification.

Abstract MP71: Associations Between Physical Activity Trajectories and Nonalcoholic Fatty Liver Disease: The Cardia Study

Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the US. Weight loss and lifestyle modifications, including increases in physical activity (PA), are the primary therapeutic recommendations for managing NAFLD. However, little is known about longitudinal physical activity patterns and NAFLD prevalence among a racially diverse population of adults. This study aimed to (1) identify distinct physical activity trajectories from young to middle adulthood and (2) examine the associations between physical activity trajectories and NAFLD prevalence in middle-aged adults.

Methods: The analytic sample included 2833 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Physical activity was self-reported at eight examinations over 25 years (1985/1986 to 2010/2011), and separately scored for moderate- (MPA) and vigorous-intensity (VPA) physical activity. NAFLD was defined as liver attenuation values ≤51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010/2011). Group-based trajectory modeling was used to identify MPA and VPA trajectories over 25 years. Modified Poisson regression models were used to estimate the risk ratios (RR) of NAFLD across the PA trajectories, adjusted for year 25 sex, age, CARDIA study center, race, education, smoking status, dietary pattern, and alcohol consumption.

Results: We identified three distinct MPA and VPA trajectories. MPA: ‘very low stable’ (53%), ‘low stable’ (39%), and ‘moderate increasing’ (8%). VPA: ‘low stable’ (57%), ‘moderate stable’ (36%), and ‘high decreasing’ (7%). Year 25 NAFLD prevalence was 24%. Relative to participants with ‘moderate increasing’ MPA over time, those with lower levels of MPA had adjusted risk ratios of 1.11 (95% CI 0.87-1.43) for ‘low stable’ and 1.11 (95% CI 0.86-1.42) for ‘very low stable.’ Relative to participants with ‘high decreasing’ VPA over time, those with lower levels of VPA had adjusted risk ratios of 1.26 (95% CI 0.95-1.69) for ‘moderate stable’ and 1.62 (95% CI 1.21-2.16) for ‘low stable.’

Conclusions: Our results suggest a higher risk of NAFLD in middle age for those with low levels of VPA from young to middle adulthood relative to those with the highest levels of VPA over time, with evidence of dose-response. Sustaining VPA throughout adulthood may be efficacious in the prevention of NAFLD, highlighting the importance of targeted delivery of prevention and management programs aimed at modifying lifestyle risk factors to reduce NAFLD risk.

Does frequency or duration of standing breaks drive changes in glycemic response? A randomized crossover trial

Intervention strategies to break up sitting have mostly focused on the modality (i.e., comparing different intensities and/or type of activities) and less on how frequency and duration of breaks affect health outcomes. This study compared the efficacy of different strategies to break up sitting time [i.e., high frequency, low duration standing breaks (HFLD) and low frequency, high duration standing breaks (LFHD)] in reducing postprandial glucose. Eleven sedentary and prediabetic adults (mean ± SD age = 46.8 ± 10.6 years; 73% female) participated in a cross-over trial. There were six blocks that represented all potential combinations (ordering) of the study conditions and participants were randomly assigned to a block. Each participant underwent three 7.5-h laboratory visits (1 week apart) where they engaged in either continuous sitting, HFLD, or LFHD condition while performing their usual office-related tasks. Standardized breakfast and lunch meals were provided. Postprandial mean glucose, area under the curve (AUC), and incremental area under the curve (iAUC) were evaluated using mixed models. Compared with LFHD condition, the HFLD standing breaks condition significantly lowered mean glucose by -9.94 (-14.13, -5.74) mg/dL·h after lunch, and by -6.23 (-9.93, -2.52) mg/dL·h, for the total lab visit time. Overall, the results favor frequently interrupting sitting with standing breaks to improve glycemic control in individuals with prediabetes. Further studies are needed with larger sample sizes to confirm the results.

Effect of Weight Goals on Sitting and Moving During a Worksite Sedentary Time Reduction Intervention

Introduction/Purpose

Although many US adults report trying to lose weight, little research has examined weight loss goals as a motivator for reducing workplace sitting and increasing physical activity. This exploratory analysis examined weight goals and the association with changes in workplace sitting, physical activity, and weight.

Methods

Employees (N = 605) were drawn from worksites participating in Stand and Move at Work. Worksites (N = 24) were randomized to a multilevel behavioral intervention with (STAND+) or without (MOVE+) sit-stand workstations for 12 months; MOVE+ worksites received sit-stand workstations from 12 to 24 months. At each assessment (baseline and 3, 12, and 24 months), participants were weighed and wore activPAL monitors. Participants self-reported baseline weight goals and were categorized into the "Lose Weight Goal" (LWG) group if they reported trying to lose weight or into the "Other Weight Goal" (OWG) group if they did not.

Results

Generalized linear mixed models revealed that within STAND+, LWG and OWG had similar sitting time through 12 months. However, LWG sat significantly more than OWG at 24 months. Within MOVE+, sitting time decreased after introduction of sit-stand workstations for LWG and OWG, although LWG sat more than OWG. Change in physical activity was minimal and weight remained stable in all groups.

Conclusions

Patterns of change in workplace sitting were more favorable in OWG relative to LWG, even in the absence of notable weight change. Expectations of weight loss might be detrimental for reductions in workplace sitting. Interventionists may want to emphasize non-weight health benefits of reducing workplace sitting.

Levels of abdominal adipose tissue and metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 years: the CARDIA Study

BACKGROUND

Higher levels of intra-abdominal adipose tissue (IAAT) comprising visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT), and liver fat are posited drivers of obesity-related chronic disease risk. Fast food is hypothesized to contribute to IAAT patterns.

OBJECTIVES

We quantified levels of abdominal subcutaneous adipose tissue (SAT), IAAT, and odds of metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 y.

METHODS

We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent 6 clinical exams and measurements over 25 y with computed tomography-measured VAT, SAT, and IMAT (n = 3156), plus MAFLD defined by liver attenuation (≤40 Hounsfield units) and 1 metabolic abnormality at year 25 (2010, n = 3001, n cases = 302). We estimated means of VAT, SAT, IMAT, and liver attenuation at the year 25 exam according to categories of average fast-food intake over the previous 25 y adjusted for sociodemographic and lifestyle factors and logistic regression to estimate the odds ratio of MAFLD at year 25.

RESULTS

With higher average fast-food intake over 25 y (categorized as follows: never-1×/mo, >1×-3×/mo, 1-<2×/wk, 2-<3×/wk, ≥3×/wk), there were monotonic higher levels of VAT (98.5, 127.6, 134.5, 142.0, 145.5 cm3), P-trend < 0.0001, which were consistent across anthropometrically classified obesity categories. There was a similar pattern with liver fat. There were higher levels of IMAT and SAT with higher fast-food intake (P-trend = 0.003, 0.0002, respectively), with amounts leveling off at ≥2×/wk. In addition, compared with participants who ate fast food never-1×/mo, there were monotonic higher odds of having MAFLD at year 25 with higher average fast-food intake, with participants who ate fast food ≥3×/wk having an OR of MAFLD = 5.18 (95% CI: 2.87, 9.37).

CONCLUSIONS

There were monotonic higher levels of VAT, liver fat, and odds of having MAFLD in middle age according to higher average fast-food intake over the preceding 25 y.

Cost and cost-effectiveness of the 'Stand and Move at Work' multicomponent intervention to reduce workplace sedentary time and cardiometabolic risk

Objective

Few studies have reported the cost and cost-effectiveness of workplace interventions to reduce sedentary time. The purpose of this study was to complete an economic evaluation of a multilevel intervention to reduce sitting time and increase light-intensity physical activity (LPA) among employees.

Methods

We conducted a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a 12-month multilevel intervention with (STAND+) and without (MOVE+) a sit-stand workstation, across 24 worksites (N=630 employee participants) enrolled in a cluster randomized clinical trial. We estimated the intervention costs using activity-based costing strategy. The intervention costs were further expressed as per person and per worksite. CEA was conducted using an incremental cost-effectiveness ratio (ICER) metric, expressed as costs for additional unit of sitting time (minute/day), LPA (minutes/day), cardiometabolic risk score, and quality-adjusted life years (QALY) increased/decreased at 12 months. We assessed the cost analysis and CEA from the organizational (ie, employer) perspective with a one-year time horizon.

Results

Total intervention costs were $134 and $72 per person, and $3939 and $1650 per worksite for the STAND+ (N worksites = 12; N employees = 354) and MOVE+ (N worksites = 12; N employees = 276) interventions, respectively. The ICER was $1 (95% CI $0.8–1.4) for each additional minute reduction of workplace sitting time (standardized to 8-hour workday); and $4656 per QALY gained at 12 months. There was a modest and non-significant change of loss of work productivity improvement (-0.03 hours, 95% CI -4.16–4.09 hours), which was associated with a $0.34 return for every $1 invested.

Conclusions

The multi-level intervention with sit-stand workstations has the potential to be widely implemented to reduce workplace sitting time. Future research into work productivity outcomes in terms of cost-benefits for employers is warranted.

Qualitative comparative analysis of the implementation fidelity of a workplace sedentary reduction intervention

BACKGROUND

Stand and Move at Work was a 12-month, multicomponent, peer-led (intervention delivery personnel) worksite intervention to reduce sedentary time. Although successful, the magnitude of reduced sedentary time varied by intervention worksite. The purpose of this study was to use a qualitative comparative analysis approach to examine potential explanatory factors that could distinguish higher from lower performing worksites based on reduced sedentary time.

METHODS

We assessed 12-month changes in employee sedentary time objectively using accelerometers at 12 worksites. We ranked worksites based on the magnitude of change in sedentary time and categorized sites as higher vs. lower performing. Guided by the integrated-Promoting Action on Research Implementation in Health Services framework, we created an indicator of intervention fidelity related to adherence to the protocol and competence of intervention delivery personnel (i.e., implementer). We then gathered information from employee interviews and surveys as well as delivery personnel surveys. These data were aggregated, entered into a truth table (i.e., a table containing implementation construct presence or absence), and used to examine differences between higher and lower performing worksites.

RESULTS

There were substantive differences in the magnitude of change in sedentary time between higher (-75.2 min/8 h workday, CI₉₅: -93.7, -56.7) and lower (-30.3 min/8 h workday, CI₉₅: -38.3, -22.7) performing worksites. Conditions that were present in all higher performing sites included implementation of indoor/outdoor walking route accessibility, completion of delivery personnel surveys, and worksite culture supporting breaks (i.e., adherence to protocol). A similar pattern was found for implementer willingness to continue role and employees using face-to-face interaction/stair strategies (i.e., delivery personnel competence). However, each of these factors were also present in some of the lower performing sites suggesting we were unable to identify sufficient conditions to predict program success.

CONCLUSIONS

Higher intervention adherence and implementer competence is necessary for greater program success. These findings illustrate the need for future research to identify what factors may influence intervention fidelity, and in turn, effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

Multi-ancestry genetic study of type 2 diabetes highlights the power of diverse populations for discovery and translation

We assembled an ancestrally diverse collection of genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 180,834 affected individuals and 1,159,055 controls (48.9% non-European descent) through the Diabetes Meta-Analysis of Trans-Ethnic association studies (DIAMANTE) Consortium. Multi-ancestry GWAS meta-analysis identified 237 loci attaining stringent genome-wide significance (P < 5 × 10-9), which were delineated to 338 distinct association signals. Fine-mapping of these signals was enhanced by the increased sample size and expanded population diversity of the multi-ancestry meta-analysis, which localized 54.4% of T2D associations to a single variant with >50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying the foundations for functional investigations. Multi-ancestry genetic risk scores enhanced transferability of T2D prediction across diverse populations. Our study provides a step toward more effective clinical translation of T2D GWAS to improve global health for all, irrespective of genetic background.

Psychosocial and Behavioral Outcomes and Transmission Prevention Behaviors: Working During the Coronavirus Disease 2019 Pandemic

Objective

To investigate the impact of coronavirus disease 2019 (COVID-19) on psychosocial and behavioral responses of the non–health care workforce and to evaluate transmission prevention behavior implementation in the workplace.

Participants and Methods

We deployed the baseline questionnaire of a prospective online survey from November 20, 2020, through February 8, 2021 to US-based employees. The survey included questions on psychosocial and behavioral responses in addition to transmission prevention behaviors (e.g., mask wearing). Select questions asked employees to report perceptions and behaviors before and during the COVID-19 pandemic. Data were analyzed descriptively and stratified by work from home (WFH) percentage.

Results

In total, 3607 employees from 8 companies completed the survey. Most participants (70.0%) averaged 90% or more of their time WFH during the pandemic. Employees reported increases in stress (54.0%), anxiety (57.4%), fatigue (51.6%), feeling unsafe (50.4%), lack of companionship (60.5%), and feeling isolated from others (69.3%) from before to during the pandemic. Productivity was perceived to decrease for 42.9% of employees and non–work-related screen time and alcohol consumption to increase for 50.7% and 25.1% of employees, respectively, from before to during the pandemic. Adverse changes were worse among those with lower WFH percentages. Most employees reported wearing a mask (98.2%), washing hands regularly (95.7%), and physically distancing (93.6%) in the workplace.

Conclusion

These results suggest worsened psychosocial and behavioral outcomes from before to during the COVID-19 pandemic and higher transmission prevention behavior implementation among non–health care employees. These observations provide novel insight into how the COVID-19 pandemic has impacted non–health care employees.

Zeolite addition to improve biohydrogen production from dark fermentation of C5/C6-sugars and Sargassum sp. biomass

Thermophilic biohydrogen production by dark fermentation from a mixture (1:1) of C5 (arabinose) and C6 (glucose) sugars, present in lignocellulosic hydrolysates, and from Sargassum sp. biomass, is studied in this work in batch assays and also in a continuous reactor experiment. Pursuing the interest of studying interactions between inorganic materials (adsorbents, conductive and others) and anaerobic bacteria, the biological processes were amended with variable amounts of a zeolite type-13X in the range of zeolite/inoculum (in VS) ratios (Z/I) of 0.065–0.26 g g⁻¹. In the batch assays, the presence of the zeolite was beneficial to increase the hydrogen titer by 15–21% with C5 and C6-sugars as compared to the control, and an increase of 27% was observed in the batch fermentation of Sargassum sp. Hydrogen yields also increased by 10–26% with sugars in the presence of the zeolite. The rate of hydrogen production increased linearly with the Z/I ratios in the experiments with C5 and C6-sugars. In the batch assay with Sargassum sp., there was an optimum value of Z/I of 0.13 g g⁻¹ where the H₂ production rate observed was the highest, although all values were in a narrow range between 3.21 and 4.19 mmol L⁻¹ day⁻¹. The positive effect of the zeolite was also observed in a continuous high-rate reactor fed with C5 and C6-sugars. The increase of the organic loading rate (OLR) from 8.8 to 17.6 kg m⁻³ day⁻¹ of COD led to lower hydrogen production rates but, upon zeolite addition (0.26 g g⁻¹ VS inoculum), the hydrogen production increased significantly from 143 to 413 mL L⁻¹ day⁻¹. Interestingly, the presence of zeolite in the continuous operation had a remarkable impact in the microbial community and in the profile of fermentation products. The effect of zeolite could be related to several properties, including the porous structure and the associated surface area available for bacterial adhesion, potential release of trace elements, ion-exchanger capacity or ability to adsorb different compounds (i.e. protons). The observations opens novel perspectives and will stimulate further research not only in biohydrogen production, but broadly in the field of interactions between bacteria and inorganic materials.

A Suggested Technique to Restore a Stable and Tight Contact Point in Diastema Closure

This article presents a case report on diastema closure in anterior teeth with direct resin composite restoration. This suggested approach has been found to be efficient with regards to esthetics, marginal adaptation, and the quality of proximal contacts in diastema closure. These advantages are presented in this report.

Impact of Atrial Fibrillation type in Acute Coronary Syndrome and the antithrombotic strategy

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Atrial fibrillation (AF) is an adverse prognostic factor during acute coronary syndrome (ACS). Current evidence recommends dual antithrombotic therapy (DAT), 1 antiplatelet drug and 1 anticoagulant drug, as the default strategy after nonST elevation ACS.

AIM

To identify the clinical differences and prognosis of AF type-new onset (nAF) or pre-existing (pFA)- during ACS, to evaluate antithrombotic strategy at hospital discharge (HD) and its impact on haemorrhagic and ischemic events.

METHODS

We performed a retrospective observational cohort study including 3241 patients (pts) with ACS (mean age 64 years, 77.5% male) admitted to a single center over a 6-year period, with 12-months follow-up.

RESULTS

AF rhythm was identified in 11.2% pts, of whom 63.2% presented nAF and 36.8% pAF.

When AF types where compared, pts with pAF had a higher prevalence of cardiovascular (Cv) comorbidities, including hypertension (p &lt; 0.001), previous ACS (p = 0.03), valvular disease (p = 0.01) or stroke (p = 0.05), had greater left atrial diameter (p &lt; 0.001) and were less likely to have significant coronary lesions (p = 0.05). Pts with nAF more frequently presented with STelevation ACS (p &lt; 0.001) and had a lower Hemoglobin nadir (p &lt; 0.001). The independent predictors of nAF in ACS were age (OR 1.1, p&lt; =0.001), LVEF ≤ 40% (OR 2.2, p = 0.001), STelevation ACS (OR 2.6, p&lt; =0.001) and previous valvular disease (OR 3.5, p&lt; =0.01). Compared with the population without AF, nAF was a predictor of in-hospital death (OR 2.9, p = 0.027) and in-hospital composite endpoint (death, stroke, reinfarction and cardiogenic shock) (OR 2.5, p = 0.001) in multivariate analysis, but pAF wasn’t. During 12-months follow-up of pts with ACS and AF, there was no difference regarding death or follow-up composite endpoint (death, stroke and ACS) between the AF types.Regarding antithrombotic therapy, nAF pts were less often anticoagulated (p &lt; 0.001) and pAF pts where more often treated with triple antithrombotic therapy (TAT) at HD (&lt;0.001). Most of the pts with TAT stopped the second antiplatelet at agent 6-months (43.8%) or 12 months (25.5%) after HD. During 12-months follow-up, pts discharged with TAT had trend towards more haemorrhagic events (TAT 6.2% vs DAT2.7%,p = 0.69) and both groups had similar ischaemic events (death, ACS, stroke) (TAT 20.9% vs DAT23.7%,p = 0.714). In multivariate analysis the choice of TAT or DAT wasn’t a predictor of ischaemic events.

CONCLUSIONS

In ACS, pts with nAF had worst in-hospital outcomes than pts with pAF. Regarding antithrombotic strategy at HD pts with nFA were less often anticoagulated and less often treated with TAT. In our study the choice between DAT or TAT had no statistical impact on follow-up outcomes.

Association between Objective Activity Intensity and Heart Rate Variability: Cardiovascular Disease Risk Factor Mediation (CARDIA)

PURPOSE

We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease risk factors.

METHODS

Data were from 1668 participants (X[Combining Overline]age = 45.9 ± 3.5 yr, 58.0% female, 39.9% black) who participated in year 20 (2005-2006) of the Coronary Artery Risk Development in Young Adults Fitness Study. The ActiGraph 7164 estimated participants' mean minutes per day of vigorous-intensity PA (VPA), moderate-intensity PA (MPA), and light-intensity PA (LPA) over 7 d. Three sequential 10-s 12-lead ECG strips were used to derive standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Mediators representing glycemic control indices included fasting glucose, fasting insulin, and 2-h oral glucose tolerance, with other mediators being traditional cardiovascular disease risk factors. Multiple linear regression assessed independent associations of PA intensity with HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV association attributable to physiological mediators.

RESULTS

Participants averaged 2.7 ± 6.2 min·d, 33.0 ± 22.0 min·d, and 360.2 ± 83.8 min·d of VPA, MPA, and LPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. After adjustment for demographic and lifestyle behaviors, VPA was associated with both HRV metrics (SDNN: std beta = 0.06 [0.03, 0.10]; rMSSD: std beta = 0.08 [0.05, 0.12]) and LPA with rMSSD only (std beta = 0.05 [0.01, 0.08]). Fasting insulin and glucose mediated 11.6% to 20.7% of the association of VPA and LPA with HRV, with triglycerides also potentially mediating these associations (range, 9.6%-13.4%).

CONCLUSIONS

Accelerometer-estimated VPA was associated with higher (i.e., improved) HRV. Light-intensity PA also demonstrated a positive association. Mediation analyses suggested these associations may be most attributable to glucose-insulin dynamics.

Efficacy of the 'Stand and Move at Work' multicomponent workplace intervention to reduce sedentary time and improve cardiometabolic risk: a group randomized clinical trial

Background

Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk.

Methods

Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months.

Results

Worksites (N = 24; academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) and employees (N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was − 59.2 (CI: − 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (− 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat.

Conclusions

Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized.

Trial registration

ClinicalTrials.gov Identifier: NCT02566317. Registered 2 October 2015, first participant enrolled 11 January 2016.

Electron Storage in Electroactive Biofilms

Microbial electrochemical technologies (METs) are promising for sustainable applications. Recently, electron storage during intermittent operation of electroactive biofilms (EABs) has been shown to play an important role in power output and electron efficiencies. Insights into electron storage mechanisms, and the conditions under which these occur, are essential to improve microbial electrochemical conversions and to optimize biotechnological processes. Here, we discuss the two main mechanisms for electron storage in EABs: storage in the form of reduced redox active components in the electron transport chain and in the form of polymers. We review electron storage in EABs and in other microorganisms and will discuss how the mechanisms of electron storage can be influenced.

Identification of type 2 diabetes loci in 433,540 East Asian individuals

Meta-analyses of genome-wide association studies (GWAS) have identified more than 240 loci that are associated with type 2 diabetes (T2D)1,2; however, most of these loci have been identified in analyses of individuals with European ancestry. Here, to examine T2D risk in East Asian individuals, we carried out a meta-analysis of GWAS data from 77,418 individuals with T2D and 356,122 healthy control individuals. In the main analysis, we identified 301 distinct association signals at 183 loci, and across T2D association models with and without consideration of body mass index and sex, we identified 61 loci that are newly implicated in predisposition to T2D. Common variants associated with T2D in both East Asian and European populations exhibited strongly correlated effect sizes. Previously undescribed associations include signals in or near GDAP1, PTF1A, SIX3, ALDH2, a microRNA cluster, and genes that affect the differentiation of muscle and adipose cells3. At another locus, expression quantitative trait loci at two overlapping T2D signals affect two genes-NKX6-3 and ANK1-in different tissues4-6. Association studies in diverse populations identify additional loci and elucidate disease-associated genes, biology, and pathways.

The effect of green walking on heart rate variability: A pilot crossover study

We investigated the effects of regular walking in green and suburban environments on heart rate variability (HRV) and blood pressure (BP) in middle-aged adults. Twenty-three adults participated in a non-randomized crossover experiment comprised of once-weekly 50-min moderate-intensity walking sessions. Separated by a two-week washout period, participants walked for three weeks in each of two treatment conditions (green and suburban) in a local arboretum and suburban sidewalks of Chaska, MN. Eleven participants completed green walking first and 12 suburban walking first. Walks were split into 15-min intra-walk phases, with phases representing each walk's beginning, middle, and final 15-min. Repeated measures linear mixed models evaluated (1) HRV phase differences between treatments and HRV change within treatments, and (2) pre- and post-walk BP differences between treatments and pre-to post-walk BP changes. Intra-walk phase analyses revealed higher HRV during green walking vs. suburban walking during phase 2 (p < 0.0001) and phase 3 (p = 0.02). Less HRV reduction was seen between intra-walk phases 1 and 2 during green vs. suburban walking (p = 0.02). Pre-to post-walk changes revealed decreased mean systolic BP for both green (p = 0.0002) and suburban (p = 0.003) walking conditions, but not for diastolic BP. Post-walk BP results were similar after both green walking and suburban walking. In summary, walking sessions in a green environment elicited greater beneficial HRV responses compared to a suburban environment. Additionally, walking in either environment, green or suburban, promoted reductions in systolic BP.

Associations of Accelerometer-Measured Sedentary Time and Physical Activity With Prospectively Assessed Cardiometabolic Risk Factors: The CARDIA Study

Background

Isotemporal substitution examines the effect on health outcomes of replacing sedentary time with light‐intensity physical activity or moderate‐to‐vigorous intensity physical activity; however, existing studies are limited by cross‐sectional study designs.

Methods and Results

Participants were 1922 adults from the CARDIA (Coronary Artery Risk Development in Young Adults) study. Linear regression examined the associations of sedentary, light‐intensity physical activity, and moderate‐to‐vigorous intensity physical activity at year 20 (2005–2006) with waist circumference, blood pressure, glucose, insulin, triglycerides, high‐density lipoprotein cholesterol, and a composite risk score at year 30 (2015–2016). Models then examined change in activity with change in cardiometabolic risk over the same 10‐year period. Replacing 30 min/day of sedentary time with 30 min/day of light‐intensity physical activity at year 20 was associated with a lower composite risk score (−0.01 SD [95% CI, −0.02, −0.00]) at year 30, characterized by lower waist circumference (0.15 cm [95% CI, −0.27, 0.02]), insulin (0.20 μU/mL [95% CI, −0.35, −0.04]), and higher high‐density lipoprotein cholesterol (0.20 mg/dL [95% CI, 0.00, 0.40]; all P<0.05). An increase of 30 min/day in MVPA from year 20 to year 30, when replacing an equivalent increase in sedentary time, was associated with a decrease in the composite risk score (−0.08 [95% CI, −0.13, −0.04]) over the same 10 years, characterized by a decrease in waist circumference (1.52 cm [95% CI, −2.21, −0.84]), insulin (−1.13 μU/mL [95% CI, −1.95, −0.31]), triglycerides (−6.92 mg/dL [95% CI, −11.69, −2.15]), and an increase in high‐density lipoprotein cholesterol (1.59 mg/dL [95% CI, 0.45, 2.73]; all P<0.05).

Conclusions

Replacement of sedentary time with light‐intensity physical activity or moderate‐to‐vigorous intensity physical activity is associated with improved cardiometabolic health 10 years later.

Effect of ultra-fine friction grinding on the physical and chemical properties of curcuma (Curcuma longa L.) suspensions

Curcuma longa is a rhizome used for the extraction of curcumin, a yellow colorant that only represents 3 wt% of the dried rhizome. To increase the possibility of using the entire rhizome as a food colorant, in the present investigation, the effect of ultra-fine friction grinding (supermasscolloider) to obtain turmeric suspensions was evaluated. To achieve this goal, two distances between the grinding stones or Gap were evaluated (G of -1 and -1.5), and the obtained suspensions were characterized by infrared spectroscopy and through the determination of curcumin content, color, particle size, sedimentation index, serum cloudiness, and microstructure. The results establish that a lower G contributes to an increase in the release of curcumin in the suspension up to 21%, which is related to a greater tendency for yellow coloration, observed in the increase of the ^* b coordinate of color (from 61.588 to 66.497). Additionally, it was found that a lower G generates smaller particle sizes, which is related to a lower turbidity. PRACTICAL APPLICATION: This research shows that ultra-fine friction grinding (UFFG) has great potential for the development of turmeric suspensions. The results have applications in the food industry sector, because UFFG could be used to produce different types of vegetable suspensions.

Are Correlates of Physical Activity in Adolescents Similar Across Ethnicity/Race and Sex: Implications for Interventions

BACKGROUND

This study tested for differences in personal, social, and environmental correlates of moderate to vigorous physical activity (MVPA) across ethnicity/race in male and female adolescents.

METHODS

Self-reported MVPA and 47 potential correlates of MVPA were measured in an ethnically/racially diverse cross-sectional sample of adolescents, in Minnesota, who participated in EAT-2010 (Eating and Activity in Teens). Interactions of potential correlates with ethnicity/race on MVPA were tested in linear hierarchical regression models in boys and girls.

RESULTS

Boys reported 1.7 more weekly hours of MVPA than girls. White adolescents reported 1.1 to 2.1 more weekly hours of MVPA than nonwhite adolescents. Among girls, neighborhood road connectivity was negatively correlated with MVPA among Hispanic and Asian participants. Among boys, sports participation was positively correlated with MVPA among all ethnicities/races, except Asians. Home media equipment was positively correlated with MVPA among Hispanic boys, but negatively correlated among white boys.

CONCLUSIONS

A few correlates of physical activity among adolescents differed intersectionally by ethnicity/race and sex. Sports participation and home media equipment may have differing impacts on physical activity across ethnicities and races in boys, whereas neighborhood features like road connectivity may have differing impacts on physical activity across ethnicities and races in girls.

Use of Wearable Technology and Social Media to Improve Physical Activity and Dietary Behaviors among College Students: A 12-Week Randomized Pilot Study

College students demonstrate poor physical activity (PA) and dietary behaviors. We evaluated the feasibility of a combined smartwatch and theoretically based, social media-delivered health education intervention versus a comparison on improving college students' health behaviors/outcomes. Thirty-eight students (28 female; Xage = 21.5 ± 3.4 years) participated in this two-arm, randomized 12-week pilot trial (2017-2018). Participants were randomized into: (a) experimental: Polar M400 use and twice-weekly social cognitive theory- and self-determination theory-based Facebook-delivered health education intervention; or (b) comparison: enrollment only in separate, but content-identical, Facebook intervention. Primary outcomes pertained to intervention feasibility. Secondary outcomes included accelerometer-estimated PA, physiological/psychosocial outcomes, and dietary behaviors. Intervention adherence was high (~86%), with a retention of 92.1%. Participants implemented health education tips 1-3 times per week. We observed experimental and comparison groups to have 4.2- and 1.6-min/day increases in moderate-to-vigorous PA (MVPA), respectively, at six weeks-partially maintained at 12 weeks. In both groups, similarly decreased body weight (experimental = -0.6 kg; comparison = -0.5 kg) and increased self-efficacy, social support, and intrinsic motivation were observed pre- and post-intervention. Finally, we observed small decreases in daily caloric consumption over time (experimental = -41.0 calories; comparison = -143.3). Both interventions were feasible/of interest to college students and demonstrated initial effectiveness at improving health behaviors/outcomes. However, smartwatch provision may not result in an additional benefit.

Changes in Psychological and Cognitive Outcomes after Green versus Suburban Walking: A Pilot Crossover Study

This study investigated the acute effects of repeated walking sessions within green and suburban environments on participants’ psychological (anxiety and mood) and cognitive (directed-attention) outcomes. Twenty-three middle-aged adults (19 female) participated in a non-randomized crossover study comprised of once-weekly 50-min moderate-intensity walking sessions. Participants walked for three weeks in each of two treatment conditions: green and suburban, separated by a two-week washout period. Eleven participants completed green walking first and 12 suburban walking first. For each walk, we used validated psychological questionnaires to measure pre- and post-walk scores for: (1) mood, evaluated via the Positive and Negative Affect Schedule (PANAS); (2) anxiety, assessed by the State-Trait Anxiety Inventory (STAI-S); and (3) directed-attention, measured using the visual Backwards Digit Span test (BDS). Repeated measures linear mixed models assessed pre- to post-walk changes within-treatment conditions and post-walk contrasts between-treatment conditions. Results indicated that anxiety decreased after green walking and increased after suburban walking (−1.8 vs. +1.1 units, respectively; p = 0.001). For mood, positive affect improved after green walking and decreased after suburban walking (+2.3 vs. −0.3 units, respectively; p = 0.004), and negative affect decreased after green walking and remained similar after suburban walking (−0.5 vs. 0 units, respectively; p = 0.06). Directed-attention did not improve from pre- to post-walk for either condition. Our results suggested that green walking may be more effective at reducing state anxiety and increasing positive affect compared to suburban walking.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Garden and food waste co-fermentation for biohydrogen and biomethane production in a two-step hyperthermophilic-mesophilic process

Co-fermentation of garden waste (GW) and food waste (FW) was assessed in a two-stage process coupling hyperthermophilic dark-fermentation and mesophilic anaerobic digestion (AD). In the first stage, biohydrogen production from individual substrates was tested at different volatile solids (VS) concentrations, using a pure culture of Caldicellulosiruptor saccharolyticus as inoculum. FW concentrations (in VS) above 2.9 g L^-1 caused a lag phase of 5 days on biohydrogen production. No lag phase was observed for GW concentrations up to 25.6 g L^-1. In the co-fermentation experiments, the highest hydrogen yield (46 ± 1 L kg^-1) was achieved for GW:FW 90:10% (w/w). In the second stage, a biomethane yield of 682 ± 14 L kg^-1 was obtained using the end-products of GW:FW 90:10% co-fermentation. The energy generation predictable from co-fermentation and AD of GW:FW 90:10% is 0.5 MJ kg^-1 and 24.4 MJ kg^-1, respectively, which represents an interesting alternative for valorisation of wastes produced locally in communities.

Stand and Move at Work sedentary behavior questionnaire: validity and sensitivity to change

PURPOSE

We evaluated the validity and sensitivity to change of a workplace questionnaire to assess sedentary behavior (SB) during and outside work.

METHODS

Participants wore an activPAL and completed an SB questionnaire at two time points (baseline and 3-month follow-up). Ecological momentary assessments were used to assess workplace location (at desk vs. away from desk). Intraclass correlation coefficients, mean difference, root of mean square error, kappa agreement, and Bland-Altman plots assessed validity. Sensitivity to change after 3 months of intervention was assessed using the standardized effect size.

RESULTS

Data from 546 participants (age = 45.1 ± 16.4 years, 24.9% males, 72.7% white) were analyzed. Intraclass correlation coefficients ranged from 0.08 to 0.23. SB was overestimated d¯(95%CI)[] by 47.9 (39.2, 56.6) min during work hours but underestimated for both non-work hours and nonworkdays by -38.3 (-47.4, 29.1) and -106.7 (124.0, -89.5) min, respectively. Participants slightly underestimated SB by -3.4 (-12.6, 5.7)% when at their desk but overestimated SB by 2.8 (-2.4, 8.0)% when not at their desk. The questionnaire demonstrated similar standardized effect size (>0.6) to the activPAL for sedentary and standing time.

CONCLUSIONS

Agreement between the questionnaire and activPAL was on par with other self-report measures. The questionnaire yielded valid estimates of at/away from desk SB and was sensitive to change.

Enrollment Strategies, Barriers to Participation, and Reach of a Workplace Intervention Targeting Sedentary Behavior

PURPOSE

To review enrollment strategies, participation barriers, and program reach of a large, 2-year workplace intervention targeting sedentary behavior.

APPROACH

Cross-sectional, retrospective review.

SETTING

Twenty-four worksites balanced across academic, industry, and government sectors in Minneapolis/Saint Paul (Minnesota) and Phoenix (Arizona) regions.

PARTICIPANTS

Full-time (≥30+ h/wk), sedentary office workers.

METHODS

Reach was calculated as the proportion of eligible employees who enrolled in the intervention ([N enrolled/(proportion of eligible employees × N total employees)] × 100). Mean (1 standard deviation) and median worksite sizes were calculated at each enrollment step. Participation barriers and modifications were recorded by the research team. A survey was sent to a subset of nonparticipants (N = 57), and thematic analyses were conducted to examine reasons for nonparticipation, positive impacts, and negative experiences.

RESULTS

Employer reach was 65% (56 worksites invited to participate; 66% eligible of 56 responses; 24 enrolled). Employee reach was 58% (1317 invited to participate, 83% eligible of 906 responses; 632 enrolled). Postrandomization, on average, 59% (15%) of the worksites participated. Eighteen modifications were developed to overcome participant-, context-, and research-related participation barriers.

CONCLUSION

A high proportion of worksites and employees approached to participate in a sedentary behavior reduction intervention engaged in the study. Interventions that provide flexible enrollment, graded participant engagement options, and adopt a participant-centered approach may facilitate workplace intervention success.