Backward Stepwise Regression Analysis Research Articles

Impending Low Intake Dehydration at Admission to A Geriatric Ward- Prevalence and Correlates in a Cross-Sectional Study

Dehydration risk increases with frailty and functional dependency, but a limited number of studies have evaluated this association in hospitalized geriatric patients. This cross-sectional study aimed to assess the prevalence and determinants of dehydration in patients admitted to the geriatric ward. Dehydration was diagnosed when calculated osmolarity was above 295 mMol/L. Logistic regression analyses (direct and stepwise backward) were used to assess determinants of impending dehydration. 358 of 416 hospitalized patients (86.1%) were included: 274 (76.5%) women, and 309 (86.4%) 75+ year-old. Dehydration was diagnosed in 209 (58.4%) cases. Significantly higher odds for impending dehydration were observed only for chronic kidney disease with trends for diabetes and procognitive medication when controlling for several health, biochemical, and nutritional parameters and medications. After adjusting for “dementia” the negative effect of “taking procognitive medications” became a significant one. Chronic kidney disease, diabetes, taking procognitive medications and hypertension were the main variables for the outcome prediction according to the stepwise backward regression analysis. This may indicate an additional benefit of reducing the risk of dehydration when using procognitive drugs in older patients with dementia.

Gross nitrogen transformation rates in semiarid tropical soils under different salinity and vegetation conditions

AbstractExacerbated inundations and saltwater intrusions due to sea‐level rise can significantly alter the ecology of low‐lying coastal drylands by affecting their nutrient cycling and productivity. During the present study, controls on production and consumption of nitrogen in soils of semiarid tropical climate with different levels of vegetation–salinity–moisture condition were investigated using 15N isotope dilution experiments. For this purpose, soils were collected from five land types including two in salt flat and one each in grassland (GL), wetland (WL), and an agricultural field. Soils with no vegetation, high salinity, and high moisture (salt flats) showed significant decline in gross production of nitrogen (mineralization rate: 0.21 ± 0.10 mg N·kg−1·d−1; nitrification rate: 0.27 ± 0.17 mg N·kg−1·d−1) compared to soils with vegetation, low salinity, and low moisture (GL, WL, and agricultural) (mineralization rate: 2.47 ± 1.74 mg N·kg−1·d−1; nitrification rate: 1.43 ± 1.30 mg N·kg−1·d−1). Backward stepwise regression analysis of the results indicated salinity to be the most important factor controlling nitrogen transformation rates. It is likely that soils undergoing frequent seawater exposure or excessive evaporation may experience slowdown in nitrogen cycling due to salinization leading to reduced nutrient production and consumption. Due to climate change, the areal extent of coastal drylands undergoing such decline in nutrient production is likely to increase, eventually leading to loss of productivity and desertification.

Distribution of Cardioembolic Stroke: A Cohort Study

Background: A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology. Methods: We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In this initiative, the so-called Parelsnoer Institute-Cerebrovascular Accident Study Group, clinical data, imaging, and biomaterials of patients with stroke are prospectively and uniformly collected. We compared the proportions of posterior stroke location in patients with a cardiac stroke source with those with another stroke etiology and calculated risk ratios (RR) with corresponding 95% CI with Poisson regression analyses. To assess which patient or disease characteristics were most strongly associated with a cardiac etiology in patients with ischemic stroke, we performed a stepwise backward regression analysis. Results: For the primary aim, 1,428 patients were eligible for analyses. The proportion of patients with a posterior stroke location among patients with a cardiac origin of their stroke (28%) did not differ statistically significant to those with another origin (25%), age and sex adjusted RR 1.16; 95% CI 0.96–1.41. For the secondary aim, 1,955 patients were eligible for analyses. No recent history of smoking, no hyperlipidemia, coronary artery disease, a higher age, and a higher National Institutes of Health Stroke Scale (NIHSS) score were associated with a cardiac etiology of ischemic stroke. Conclusions: We could not confirm our hypothesis that thromboembolic stroke localized in the posterior circulation is associated with a cardioembolic source of ischemic stroke, and therefore posterior stroke localization on itself does not necessitate additional cardiac examination. The lack of determinants of atherosclerosis, for example, no recent history of smoking and no hyperlipidemia, coronary artery disease, a higher age, and a higher NIHSS score are stronger risk factors for a cardiac source of ischemic stroke.

Development and validation of body fat prediction models in American adults.

SummaryIntroductionCommonly used statistical models to predict body fat percentage currently rely on skinfold measures, anthropometric measures, or some combination of the two but do not account for the wide ranges of age and body mass index (BMI) present in the American adult population. The objective of this study was to develop a statistical regression model to predict in vivo body fat percentage (dual energy X‐ray) in men and women across significant age and obesity ranges.MethodsThis study included 228 adults between the ages of 21 and 70, with BMI between 18.5 and 40.0 kg m−2. The study population was split into training (n = 163) and validation (n = 65) groups, which were used to develop and validate the prediction models. The models were developed on the training group using a backwards stepwise regression analysis, with the initial predictors including age, BMI, and several anthropometric and skinfold measurements.ResultsThe final statistical regression models included age, BMI, anthropometric measures, and skinfold measures with significant effects following the stepwise process. The models predicted body fat percentage in the testing group with average errors of less than 0.10% body fat in males and females, while the four previously existing methods (Durnin, Hodgdon, Jackson, and Woolcott) significantly underestimated or overestimated body fat in both genders, with errors ranging between 2% and 10%.ConclusionsThe final models included hand thickness, and the female model was dependent on waist circumference and two of the skinfold measures, while the male model used hip and thigh circumferences, along with three skinfold measures. By including the skinfold measurements separately, instead of only as sums like previous models have done, these models can account for the different relative contributions of each site to total body fat.

The use of neutrophil lymphocyte ratio to predict complications post cardiac surgery.

Cardiac surgery remains the gold standard treatment for select cohorts of patients with coronary artery and valvular heart diseases. It induces an acute systemic inflammatory response due to cardiopulmonary bypass (CPB), myocardial arrest, and surgical trauma. There is growing evidence that increased inflammation leads to greater complications and poorer outcomes for patients post cardiac surgery. Neutrophil/lymphocyte ratio (NLR) is a promising marker of inflammation. This study assessed if NLR could predict postoperative atrial fibrillation and acute kidney injury after cardiac surgery. A retrospective review of patients undergoing first-time on-pump cardiac surgery was performed. Postoperative atrial fibrillation and acute kidney injury within 7 days of surgery was recorded. Preoperative, day 1, and day 2 NLR were recorded. Potential confounders such as age, sex, comorbidities, and operative factors were included in univariate analysis. Backwards stepwise multivariate regression analysis was performed to identify independent predictors of these complications. Nine hundred and six patients were included for analysis. Higher preoperative NLR was significantly associated with postoperative atrial fibrillation. Day 1 and day 2 NLR were associated with postoperative atrial fibrillation in analyses including all patients. Older age, male gender, preexisting atrial arrhythmias, and higher EuroSCORE II also had a significant association. Diabetes mellitus was protective for postoperative arrhythmias. Preoperative NLR was not significantly associated with acute kidney injury. Day 2 NLR, older age, higher EuroSCORE II, and longer CPB time were independently associated with acute kidney injury post cardiac surgery. Higher preoperative and postoperative NLRs are associated with higher rates of complications post cardiac surgery.

Optimizing Quality of Life With Cognitive Impairment: A Study of End-of-Life Care in Assisted Living

ObjectivesAssisted living (AL) is an expanding site of end-of-life (EOL) care in the United States. Understanding determinants of quality of life (QoL) for AL residents near EOL is vital to optimize care for this growing population, most of whom have some degree of cognitive impairment (CI). This analysis aimed to identify factors associated with QoL in a diverse sample of AL residents with CI approaching EOL. DesignObservational cross-section design. Setting and participantsData are from a 5-year study funded by the National Institute on Aging examining EOL care of residents in 7 diverse AL communities in metropolitan Atlanta (n = 67). MethodsCI was assessed with the Montreal Cognitive Assessment (scores ≤ 26) and QoL was determined with the self-reported QoL in Alzheimer's disease survey adapted for use in AL. Psychological distress was assessed using the Patient Health Questionnaire–4 and fatigue was assessed using the 13-item Functional Assessment of Chronic Illness Therapy Fatigue Scale. Initial descriptive analyses were followed by backward stepwise regression analyses to select a best-fitting model of QoL. ResultsThe final model predicted 27% of the variance in QoL. CI was not significantly correlated with QoL and was not retained in the final model. Pain and functional limitation also did not meet inclusion criteria (P ≤ .10) and were sequentially removed, producing a final model of QoL in terms of psychological distress (β = −0.28, P = .032), fatigue (β = −0.26, P = .048), and race (β = 0.21, P = .063). Conclusions and ImplicationsThe lack of a significant correlation between degree of CI and self-reported QoL suggests that AL residents have the potential to experience high QoL, despite CI. Interventions to reduce psychological distress and manage fatigue could be implemented during EOL care to attempt to improve QoL for AL residents with CI. The correlation between race and QoL warrants investigation into possible racial disparities in AL and EOL care.

Creating a prediction model of passenger preference between low cost and legacy airlines

The airline industry is highly competitive, and in order to increase profits, airlines are always looking to better target key customers. Increased understanding of customers also helps improve the product from the customer's perspective. This study aims to determine which factors predict airline passengers' preference between legacy and low-cost carriers. The correlational design used creates a prediction model for passengers from the United States. Through two stages of this study, 936 participants (379 females) from the US were utilized for the linear multiple regression analyses to build the model. In the first stage, the regression analysis was used to generate a regression model of passenger preference, which was then tested in the second stage, thereby validating the prediction model. Samples for each stage were independent and subjected to a backward stepwise regression analysis. To determine the influencers of passenger preference, nine potential predictors were surveyed. The predictors were age of the participant, gender of the participant, yearly income of the participant, education level of the participant, seat type, purpose of travel, frequency of travel in a year, category of frequent flier program, and risk-taking tendencies of the participant. The results of the data analysis showed frequency of travel in a year, yearly income of the participant, seat type, and education level of the participant as significant predictors of passengers' preference between legacy and low-cost carriers. This research has practical implications for the airline industry in better understanding the consumer base, which could lead to increased profitability for the carriers.

Precipitation as the Primary Driver of Variability in River Nitrogen Loads in the Midwest United States

AbstractNitrogen (N) losses from agricultural lands in the Midwest United States are contributing to the expansion of the hypoxic zone in the Gulf of Mexico. This study evaluated the importance of inter‐annual variability in precipitation, land cover, and N fertilizer use on NO3 + NO2‐N loads in seven United States Midwestern Rivers using the backward stepwise regression analysis. At the annual scale, fluctuations in the current and previous years’ precipitations explained much of the variation in streamflow, baseflow, and N‐load. Previous years precipitation effects were associated with fillable soil porosity. In some years, higher residual soil N from previous dry years also contributed to an increase in N‐load. Area under soybean production (SOY), a surrogate for replacement of prairies and small grains was generally not a significant explanatory variable. Fertilizer use from 1987 to 2012 was also not a significant explanatory variable in the annual analysis. Precipitation in both the current and previous months and previous year were important in explaining variation in monthly streamflow, baseflow, and N‐load. SOY was significant in one or two months from June to August, but had a higher p‐value than precipitation. We conclude recent increases in river N‐loads are primarily due to wet climate and minimally due to the changes in land cover or N fertilizer use. Under current cropping systems and agronomic N application rates, tile water remediation will be necessary to reduce river N‐loads.

Becoming business-like: the determinants of NGOs? marketization turning into social enterprises in Poland

Research background: NGOs face an increasing expectation to be more business-like. They are becoming involved in selling services by performing a commercial activity, which, in turn, is a basic condition for creating social enterprises. The changes related to this approach are an essential condition for their survival and a significant reason for developing their new form as social enterprises. On the other hand, there is no lack of critical opinions related primarily to mission volatility. Currently, a discussion is taking place in the literature on factors that may affect NGOs? marketization; these, however, have not been empirically verified yet. The identified research gap constituted a major challenge for the author.
 Purpose of the article: The purpose of this paper is to verify whether conducting a business activity influences the entrepreneurial way of NGOs? operation, and to indicate the factors that have a significant impact on their marketization.
 Methods: On the basis of a representative national survey of 3,800 NGOs, including 412 social enterprises in Poland. a one-factor analysis of variance (ANOVA) and a stepwise backward regression analysis were carried out.
 Findings & Value added: The analysis of the results confirms that there are significant differences between NGOs operating as social enterprises and NGOs not performing a business activity. In contrast with the existing literature, this study indicates that social enterprises have less diversified revenue sources and use a more or less democratic governance model. Moreover, Polish social enterprises less frequently adjust their policy direction to donors? interests. The factors significantly affecting NGOs? marketization include action strategies for several years, activity in favor of external benefit takers, close business cooperation, lack of permanent financing sources, and regular activity combined with flexible working time.

Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone.

BackgroundIt is well established that Ebola Survivors experience a myriad of physical and psychological sequelae. However, little is known about how they seek care to address their health needs. Our study determines the current healthcare seeking behaviour among Ebola survivors and determines the prevalence, pattern of use and correlates of traditional and complementary medicine (T&CM) use among Ebola survivors in Sierra Leone.MethodsWe conducted a nationwide questionnaire survey among a cross-sectional sample of Ebola Survivors in Sierra Leone between January and August 2018. We employed descriptive statistics, chi-square test, Fisher exact two-tailed test and backward stepwise binary regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant.ResultsEbola Survivors who participated in our study (n = 358), visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n = 255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). Survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of (n = 163, 45.5%) Ebola survivors reported using T&CM treatments for post ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. Ebola survivors who considered their health to be fair or poor (AOR = 4.08; 95%CI: 2.22–7.50; p<0.01), presented with arthralgia (AOR = 2.52; 95%CI: 1.11–5.69, p = 0.026) and were discharged three years or less (AOR = 3.14; 95%CI: 1.13–8.73, p = 0.028) were more likely to use T&CM. Family (n = 101,62.0%) and friends (n = 38,23.3%) were the common sources of T&CM information. Abdominal pain (n = 49, 30.1%) followed by joint pain (n = 46, 28.2%) and back pain (n = 43, 26.4%) were the most cited post–Ebola indications for T&CM use. More than three-quarters of T&CM users (n = 135, 82.8%) failed to disclose their use of T&CM to their healthcare providers.ConclusionEbola survivors in Sierra Leone employ a myriad of healthcare options including T&CM in addressing their healthcare needs. Researchers, health policy makers and healthcare providers should be aware of the substantial role of T&CM in the health seeking of survivors, and this topic that should be factored into future research, policy formulation and implementation as well as routine practice regarding Ebola survivors.

Nailfold microvascular changes in patients with systemic lupus erythematosus and their associative factors

ObjectivesThe aim of this study was to determine capillaroscopic changes in patients with systemic lupus erythematosus (SLE) and their predictors. MethodsFifty-nine SLE patients and 31 controls were enrolled in a cross-sectional study. Nailfold capillaroscopy examinations were performed, and qualitative semi-quantitative and quantitative parameters were evaluated in all fingers. Demographic features and lupus characteristics, such as renal involvement, medications, laboratory data, disease activity (SLEDAI) and damage, were recorded. The predictors of capillaroscopic abnormalities were obtained by backward stepwise regression analysis. ResultsCapillary numbers of right hands were significantly lower in patients than in controls [8.74 (1.66) vs. 9.63 (1.80), P = 0.0001]. Capillaries were wider in patients than in controls in right [56.32 μm (16.76) vs. 50.43 μm (10.16), P = 0.002] and left hands [54.40 (15.02) vs. 49.71 (9.77), P = 0.005]. Capillaries were shorter in SLE patients than in controls. Multivariate analysis revealed that the main associative factors of microvascular abnormalities were gender, drinking tea and hydroxychloroquine use for giant capillaries, SLEDAI and low C3 for avascularity and age, lupus nephritis and corticosteroid use for ramification. ConclusionMost nailfold capillaroscopic abnormalities were more common in SLE patients than in controls. Hydroxychloroquine, corticosteroids, SLEDAI, low complement and lupus nephritis may be the major prognostic factors for microvascular changes in SLE patients.

Extent and drivers of CSR disclosure: evidence from Russia

The present study aims to assess the status of CSR disclosure and its various determinants in the context of Russia. This study employs Content Analysis to examine the extent of CSR disclosure of 48 Russian companies selected from Broad Market Index for the year 2014–2015. CSR disclosure is measured through CSR disclosure index. Descriptives are used to calculate company wise and industry wise scores. Backward Step-Wise Regression Analysis is applied to investigate the impact of factors that affect the extent of CSR disclosure. The results reveal that Russia has low disclosure score of 41%. The findings of the study show that there is significant positive impact of international listing, industry, board size and board independence on CSR disclosure. The results strongly implicate Russian Government to undertake strong initiatives to inculcate CSR disclosure practices among companies, so that all firms even when they do not have international listing follow CSR practices.

Measurement of serum vitamin B12-related metabolites in newborns: implications for new cutoff values to detect B12 deficiency

Objective Our aim was to determine the prevalence of maternal and neonatal vitamin B12 (vit-B12) and folate deficiencies, a new cutoff value of serum vit-B12 in newborns using vit-B12-related metabolites and also cutoff values of homocysteine (Hcy), propionyl (C3) carnitine, and methyl malonic acid (MMA) in newborns using a vit-B12 cutoff value of 200 pg/mL. Methods Healthy pregnant women (without iron deficiency) and 98 healthy, term, singleton babies were included. Blood samples were obtained from women 0–8 h before birth and from cord blood during birth for hemogram and to measure serum vit-B12, folate, and Hcy levels. Maternal and cord blood serum vit-B12 levels were classified as low < 200 pg/mL, marginal 200–300 pg/mL, and normal ≥ 300 pg/mL. Neonatal urine MMA levels were analyzed in mothers with a vit-B12 concentration < 300 pg/mL. C3 carnitine levels of newborns were acquired from extended newborn screening. Receiver operating characteristics curve (ROC) analysis was used for serum vit-B12, urine MMA, C3 carnitine, and Hcy. Results Of total, 98 pregnant women (28.6 ± 5.5-year-old) and 98 newborn were included. Vit-B12 level was lower than 300 pg/mL in 93% of the pregnant women and 61% of cord blood samples. Folate deficiency was not found in either group. There was statistically significant negative correlation between baby C3 carnitine, cord blood folate (r = −0.265, p = .008) and cord blood vit-B12 (r = −0.220, p = .029). In backward stepwise linear regression analysis, maternal vit-B12 level exerted the most marked effect on cord blood vit-B12 level (adjusted R 2 = 0.457). In ROC analysis, the Hcy cutoff value was 4.77 µmol/L (68.4% sensitivity, 58.3% specificity, p = .012) for the detection of vit-B12 deficiency. Conclusion Vit-B12 deficiency remains an important health issue for pregnant women and newborns. Our study revealed a cutoff value for Hcy for the detection of nutritional vit-B12 deficiency that could be used in practice for newborns.

Prevalence of dementia diagnoses not otherwise specified in eight European countries: a cross-sectional cohort study

BackgroundDementia is a syndrome, with a wide range of symptoms. It is important to have a timely diagnosis during the disease course to reduce the risk of medication errors, enable future care planning for the patient and their relatives thereby optimizing quality of life (QoL). For this reason, it is important to avoid a diagnosis of dementia not otherwise specified (DNOS) and instead obtain a diagnosis that reflects the underlying pathology. The aim of this study was to investigate the prevalence and associated factors of DNOS in persons with dementia living at home or in a nursing home.MethodsThis is a cross-sectional cohort study performed in eight European countries. Persons with dementia aged ≥65 years living at home (n = 1223) or in a nursing home (n = 790) were included. Data were collected through personal interviews with questionnaires based on standardised instruments. Specific factors investigated were sociodemographic factors, cognitive function, and mental health, physical health, QoL, resource utilization and medication. Bivariate and backward stepwise multivariate regression analyses were performed.ResultsThe prevalence of DNOS in the eight participating European countries was 16% (range 1–30%) in persons living at home and 21% (range 1–43%) in persons living in a nursing home. These people are more often older compared to those with a specific dementia diagnosis. In both persons living at home and persons living in a nursing home, DNOS was associated with more severe neuropsychiatric symptoms and less use of anti-dementia medication. In addition, persons with DNOS living at home had more symptoms of depression and less use of antidepressant medication.ConclusionsThe prevalence of DNOS diagnosis is common and seems to vary between European countries. People with DNOS are more often older with more severe neuropsychiatric symptoms and receive fewer anti-dementia medication, anxiolytics and antidepressants. This would support the suggestion that a proper and specific diagnosis of dementia could help the management of their disease.

Nutrition transition, overweight and obesity among rural-to-urban migrant women in Kenya.

To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya. Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women's BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward multiple ordinal regression analysis was applied. Kenya Demographic and Health Survey 2014. Rural non-migrant, rural-to-urban migrant and urban non-migrant women aged 15-49 years (n 6171). Crude data analysis showed rural-to-urban migration to be associated with overweight/obesity risk and nutrition transition. After adjustment for household wealth, no significant differences between rural non-migrants and rural-to-urban migrants for overweight/obesity risk and household consumption of several food groups characteristic of nutrition transition (animal-source, fats and sweets) were observed. Regardless of wealth, migrants were less likely to consume main staples and legumes, and more likely to consume fruits and vegetables. Identified predictive factors of overweight/obesity among migrant women were age, duration of residence in urban area, marital status and household wealth. Our analysis showed that nutrition transition and overweight/obesity risk among rural-to-urban migrants is apparent with increasing wealth in urban areas. Several predictive factors were identified characterising migrant women being at risk for overweight/obesity. Future research is needed which investigates in depth the association between rural-to-urban migration and wealth to address inequalities in diet and overweight/obesity in Kenya.

Plasma Linoleic Acid Is Associated with Less Adiposity and Lower Risk of Metabolic Syndrome: An NHANES Analysis (P08-121-19)

ObjectivesTo examine relationships between plasma fatty acids, dietary intake of fatty acids, adiposity and risk of metabolic syndrome (MetSyn) in the National Health and Nutrition Examination Survey (NHANES) dataset. MethodsPlasma fatty acids levels (n = 24) measured in NHANES 2001–2003 (n = 1674) and dietary intake of fatty acids (n = 19) from NHANES 2001–2014 (n = 9108) were used for these analyses. The association between plasma fatty acid levels, intake of fatty acids and body weight, BMI, waist circumference, and number of criteria for MetSyn was assessed. Backwards stepwise multiple regression analyses adjusted for age, sex, ethnicity, prescription of anti-hypertensive, lipid-lowering of anti-diabetic medication, modified Health Eating Index-2015 score, physical activity, poverty to income ratio, smoking, and calorie intake were conducted to identify fatty acids that were predictive of the outcomes of interest. Logistic regression analysis, adjusted for the aforementioned covariates, was used to assess the odds of MetSyn, and overweight/obesity associated with each fatty acid. ResultsHigher levels of the plasma saturated fatty acids myristic acid (14:0), stearic acid (18:0), and docosanoic acid (22:0) were associated with greater BMI, waist circumference, and number of MetSyn criteria (P < 0.01). Arachidic acid (20:0) and lignoceric acid (24:0) were inversely associated with BMI, waist circumference, and number of MetSyn criteria. Plasma linoleic acid (18:2) was the only PUFA inversely associated with BMI (β = −0.002), waist circumference (β = −0.005), and number of MetSyn criteria (β −0.0003) (all P < 0.01). Plasma linoleic acid was also correlated with lower risk of being overweight or obese (odds ratio (OR) 0.9995; P < 0.03) and having an elevated waist circumference (OR 0.9992; P < 0.01). These results were not supported by the dietary fatty acid intake data. ConclusionsThese data from a representative U.S. cohort indicate that plasma medium and longer chain saturated fats were generally associated with greater adiposity and more criteria for MetSyn, whereas these relationships were not detected for MUFA. Linoleic acid was the only PUFA associated with less adiposity and lower risk of MetSyn and, thus also lower risk of cardiometabolic disease. Funding SourcesACH Food Companies, Inc.

209-LB: Is the Abdominal Aorta Diameter a Novel Marker of Diabetes Risk in Elderly Women?

Diabetes mellitus (DM) prevalence increases worldwide. Elevated BMI, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG) and triglycerides (TGs), as well as low HDL cholesterol level are known risk factors of DM incidence. We analyzed the association of these parameters, with the addition of abdominal aorta diameter (AAD) and estimated glomerular filtration rate (eGFR) using CKD-EPI equation, with DM incidence among 200 women aged 65-74, nondiabetic at baseline assessment in 2012. After 6.5 years of follow-up 36 new DM cases occurred. Women with incident DM had significantly higher baseline FPG, 108.6±18.0 vs. 97.2±10,9 mg/dL, P&amp;lt;0.001 and TGs, 142.2±54,6 vs. 115,6±49,7 mg/dL, P=0.002, while they had lower AAD, 18.1±4,7 vs. 18.4±2,5 mm, P=0.019; HDL cholesterol 58.7±12.7 vs. 68.9±17.3 mg/dL, P&amp;lt;0.001 and eGFR, 77.4±14.5 vs. 83.1±17.2 mL/min/1.73 m2, P=0.045. WC, BP and BMI were not significantly different between groups. Relative risk (RR) of DM incidence was significantly higher for AAD &amp;lt;18 mm, RR (95% CI) 2.66 (1.41-5.01), P=0.003; FPG ≥100 mg/dL, RR 2.89 (1.51-5.55), P&amp;lt;0.001; TGs ≥150 mg/dL, RR 2.26 (1.26-4.03), P=0.013 and eGFR &amp;lt;75,0 ml/min/1,73 m2, RR 2.11 (1.18-3.77), P=0.020. Other variables did not attain statistical significance limit. In the multiple logistic regression analysis including all variables, only AAD &amp;lt;18 mm, FPG ≥100 mg/dL, and eGFR &amp;lt;75,0 ml/min/1,73 m2 were independently associated with DM risk (P=0.005, P=0.010 and P=0.018 respectively). In the backward stepwise regression analysis DM incidence could be predicted from a linear combination of the independent variables: AAD &amp;lt;18 mm (P=0.005), FPG ≥100 mg/dL (P=0.009), eGFR &amp;lt;75,0 ml/min/1,73 m2 (P=0.017) and TGs ≥150 mg/dL (P=0.034). Thus, AAD &amp;lt;18 mm seem to be a novel, independent marker of DM risk in elderly women, and AAD assessment during routine abdomen ultrasound may be helpful, together with other DM risk factors, in identifying elderly females at very high risk of DM incidence. Disclosure M. D?browski: Other Relationship; Self; Ascensia Diabetes Care, AstraZeneca, Eli Lilly and Company, Mundipharma, Novo Nordisk Inc., Sanofi-Aventis, Servier, WöRWAG Pharma. T. Derezinski: None. A. Uruska: None. D. Zozulinska-Ziolkiewicz: Advisory Panel; Self; Roche Diabetes Care. Other Relationship; Self; Ascensia Diabetes Care, AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, Servier, WöRWAG Pharma.

The impact of technical and clinical factors on fecal microbiota transfer outcomes for the treatment of recurrent Clostridioides difficile infections in Germany.

Fecal microbiota transfer (FMT) is highly effective in the treatment and prevention of recurrent Clostridioides difficile infection (rCDI) with cure rates of about 80% after a single treatment. Nevertheless, the reasons for failure in the remaining 20% remain largely elusive. The aim of the present study was to investigate different potential clinical predictors of response to FMT in Germany. Information was extracted from the MicroTrans Registry (NCT02681068), a retrospective observational multicenter study, collecting data from patients undergoing FMT for recurrent or refractory CDI in Germany. We performed binary logistic regression with the following covariates: age, gender, ribotype 027, Eastern Co-operative Oncology Group score, immunosuppression, preparation for FMT by use of proton pump inhibitor, antimotility agents and bowel lavage, previous recurrences, severity of CDI, antibiotic induction treatment, fresh or frozen FMT preparation, and route of application. Treatment response was achieved in 191/240 evaluable cases (79.6%) at day 30 (D30) post FMT and 78.1% at day 90 (D90) post FMT. Assessment of clinical predictors for FMT failure by forward and confirmatory backward-stepwise regression analysis yielded higher age as an independent predictor of FMT failure (p = 0.001; OR 1.060; 95%CI 1.025-1.097). FMT in Germany is associated with high cure rates at D30 and D90. No specific pre-treatment, preparation or application strategy had an impact on FMT success. Only higher age was identified as an independent risk factor for treatment failure. Based on these and external findings, future studies should focus on the assessment of microbiota and microbiota-associated metabolites as factors determining FMT success.

Prediction model for detecting circulating tumor DNA (ctDNA) in metastatic colorectal cancer (mCRC).

3590 Background: While tissue-based assays have yields above 90% in solid tumors, there is less known about factors that influence the sensitivity of ctDNA for detecting mutations. Methods:We retrospectively evaluated mCRC patients (pts) who had plasma-derived NGS utilizing a highly-sensitive targeted 68-73-gene ctDNA assay. In a case-control design, pts with a known mutation on tissue and radiologic evidence of metastatic disease but no detectable ctDNA mutation were matched 1:3 with randomly selected pts with detectable mutations and compared according to clinical, laboratory, and radiologic characteristics. A prediction score for ctDNA detection was built using a binary logistic backward stepwise regression analysis and tested in two independent data sets from different institutions. Area under the curve (AUC) from receiver operating characteristics curves (ROC) were used for internal and external validation. Results: From 416 pts who met inclusion criteria, plasma-derived NGS did not find tumor mutations in 66 cases (15.9%); 198 pts with detectable alterations were selected as controls. After multivariate analysis, the detection of ctDNA was associated with increasing age (OR 1.05; 95%CI 1.02-1.09; p = .001), presence of liver (OR 5.82; 95%CI 2.55-12.49; p &lt; .001) and lymph node metastases (OR 3.28; 95%CI 1.51-7.60; p = .004), archival TP53 mutations (OR = 2.88; 95%CI 1.37-6.17; p = .006). A key determinant was timing of collection relative to disease status: plasma collected in newly diagnosed metastatic disease or after evidence of progression was substantially more likely to have detectable alterations (OR 9.24; 95%CI 4.11-22.40; p &lt; .001); The simplified prediction model performed well in internal (AUC = 0.88) and external validation (AUC = 0.95; 163 pts). Conclusions: Our validated prediction model provides clinicians and researchers with a tool to screen for patients in whom ctDNA testing can outperform tissue-based testing in detecting genomic alterations.

Applying the Conservation of Resources Theory to the Psychological Stress Experienced by a Random Sample of Americans With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, unpredictable neurological disorder whose wide ranging symptoms and capricious disease course are known to produce considerable psychological stress. This study applied the Conservation of Research theory in building a prediction model to explain variability in perceived stress and coping within a sample of Americans with MS. The study sample consisted of 1,114 people with MS, 219 men (20%) and 895 women (80%), who participated in a national survey of the employment and psychosocial concerns of Americans with MS. Primarily Caucasian (75%), participants ranged in age from 20 to 87 years (M= 50.57,SD= 10.31). A backward stepwise multiple regression analysis revealed that women; non-Caucasians; younger people; those who had more difficulties meeting their financial obligations and who were less satisfied with their housing situations; people who reported lower levels of community and social life engagement; and those whose MS resulted in higher numbers of reported symptoms, lower levels of residual cognitive functioning, and lower levels of mobility impairment reported higher levels of perceived stress than did other participants. The aggregated predictors explained 41% of the variability in participants' stress ratings. The findings demonstrate the complexity in predicting how the onset and progression of MS affects an individual's psychological functioning.