Cardiometabolic Markers Research Articles

Effect of Extra Virgin Olive Oil on Anthropometric Indices, Inflammatory and Cardiometabolic Markers: a Systematic Review and Meta-Analysis of Randomized Clinical Trials

BackgroundA large body of literature associated extra virgin olive oil (EVOO) consumption with low risk of cardiovascular disease and mortality. However, findings from clinical trials related to EVOO consumption on blood pressure, lipid profile, and anthropometric and inflammation parameters are not univocal. ObjectivesThe aim of this systematic review and meta-analysis was to evaluate the effect of EVOO consumption on cardiometabolic risk factors and inflammatory mediators. MethodsWe searched PubMed/MEDLINE, Scopus, and Cochrane up through 31 March, 2023, without any particular language limitations, in order to identify randomized controlled trials (RCTs) that examined the effects of EVOO consumption on cardiometabolic risk factors, inflammatory mediators, and anthropometric indices. Outcomes were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) estimated from Hedge’s g and random-effects modeling. Heterogeneity was assessed by Cochran Q-statistic and quantified (I2). ResultsThirty-three trials involving 2020 participants were included. EVOO consumption was associated with a significant decrease in insulin (n = 10; SMD: −0.28; 95% CI: −0.51, −0.05; I2 = 48.57%) and homeostasis model assessment of insulin resistance levels (HOMA-IR) (n = 9; SMD: −0.19; 95% CI: −0.35, −0.03; I2 = 00.00%). This meta-analysis indicated no significant effect of consuming EVOO on fasting blood glucose, triglycerides, total cholesterol, low density lipoproteins, very low density lipoproteins, high density lipoproteins, Apolipoprotein (Apo) A-I and B, lipoprotein a, blood pressure, body mass index, waist circumference, waist to hip ratio, C-reactive protein, interleukin-6, interleukin-10, and tumor necrosis factor α levels (P > 0.05). ConclusionsThe present evidence supports a beneficial effect of EVOO consumption on serum insulin levels and HOMA-IR. However, larger well-designed RCTs are still required to evaluate the effect of EVOO on cardiometabolic risk biomarkers.This study was registered in PROSPERO as CRD42023409125.

Interrupting sitting acutely attenuates cardiometabolic risk markers in South Asian adults living with overweight and obesity.

This study examined the acute effects of interrupting sitting with light-intensity walking on postprandial cardiometabolic risk markers in South Asian adults. South Asians with overweight/obesity (n = 19; body mass index [BMI] > 23kg·m-2) and normal-weight (n = 8; BMI 18.0-22.9kg·m-2) aged 48.8 ± 5.6years completed two, 5-h conditions: (1) prolonged sitting (SIT), and (2) interrupted sitting with 5-min bouts of light-intensity walking every 30-min (INT-SIT). Blood samples and resting expired air samples were collected throughout each condition. Statistical analyses were completed using linear mixed models. In participants with overweight/obesity, postprandial glucose, triglycerides (TAG) and metabolic load index (MLI) over time were lower, whereas resting substrate utilisation and resting energy expenditure (REE) were higher, in INT-SIT than SIT (all p ≤ 0.05). Compared with SIT (0.18 [95% CI 0.13, 0.22] kcal.min-1), INT-SIT (0.23 [95% CI 0.18, 0.27] kcal.min-1) increased postprandial REE iAUC in participants with overweight/obesity (p = 0.04, d = 0.51). Postprandial TAG concentrations over time were lower in INT-SIT versus SIT (p = 0.01, d = 30) in normal-weight participants, with no differences in any other outcomes for this sample group. These findings suggest that interrupting sitting with 5-min bouts of light walking every 30-min acutely attenuates cardiometabolic risk markers among South Asians living with overweight/obesity, whereas limited effects may be seen in individuals with normal-weight.

The association of copeptin with metabolic risk markers is modified by region of origin

Iraqi born immigrants in Sweden have higher prevalence of metabolic diseases compared to native Swedes. Copeptin, a marker for vasopressin, is associated with increased risk of metabolic disease. In this cross-sectional population study based on the MEDIM cohort we investigated differences in copeptin levels between Iraqi and Swedish born individuals and if the association between copeptin and cardiometabolic risk markers differed by region of origin. We included 1109 Iraqi and 613 Swedish born participants (58% men, mean age 47 years). The Swedish participants had a higher concentration of copeptin compared to the Iraqi born group after age and sex adjustment (p < 0.001). This difference existed only among male individuals with the highest copeptin concentrations, i.e. belonging to copeptin quartile 4 (median (25th; 75th percentile) 20.07 (15.27;33.28) pmol/L for the Swedish born versus 15.57 (13.91;19.00) pmol/L for the Iraqi born, p < 0.001). We found a significant interaction between copeptin (continuous ln-transformed) and being born in Iraq regarding the association with plasma triglycerides (Pinteraction = 0.006). The association between copeptin and BMI was stronger amongst the Iraqi born individuals compared to the Swedish born. Together, this could indicate that copeptin is a more potent marker of metabolic disease among individuals born in Iraq compared to Sweden.

Abstract 12661: Area Deprivation Index, Symptoms, and Biomarkers Among Black and African Americans Living With Heart Failure

Introduction: Heart failure (HF) is a complex chronic condition that disproportionally affects Black adults. Social determinants of health, such as the lived environment and socioeconomic status, contribute to higher incidence and poorer outcomes, including higher stress and poorer sleep in this population. This study aims to examine the relationship between neighborhood socioeconomic disadvantage with symptoms, and inflammatory and cardiometabolic markers in Black adults living with HF. Methods: A secondary analysis of a pilot study that enrolled self-identified Black adults living with HF was performed (N=41, 57 ± 11 years of age, 66% women). Neighborhood socioeconomic disadvantage was measured by Area Deprivation Index (ADI) national and state rankings generated from the Neighborhood Atlas; higher scores reflect higher neighborhood disadvantage. Questionnaires included Perceived Stress Scale (PSS) and PROMIS Sleep Disturbance. Inflammatory and cardiometabolic biomarkers were measured via immunoassay. Spearman correlation analyses were performed. Results: Mean ADI scores were 61.23 ± 21.1 (national) and 5.7 ± 2.4 (state). National and State ADI scores were positively associated with both PSS (ρ=.584, p&lt;.001; ρ=.551, p&lt;.001) and PROMIS Sleep Disturbance (ρ=.486, p=.04; ρ =.551, p=&lt;.001), respectively. Additionally, National and State ADI scores were positively associated with inflammatory cytokines IL-4 (ρ=.345, p=.031; ρ=.371, p=.020) and IL-18 (ρ=.408, p=.009; ρ=.392, p=.012). National and State ADI scores were also related to cardiometabolic biomarkers VCAM-1 (ρ=.360, p=.022; ρ=.363, p=.021) and C1QNTF1 (ρ=.483, p=.002; ρ=.447, p=.004). No significant association was found between ADI scores and demographics. Discussion: These findings suggest higher ADI scores are associated with higher perceived stress, sleep disturbance, and inflammatory and cardiometabolic biomarkers among Black adults living with HF. These results highlight the potential role neighborhood socioeconomic status contributes to adverse health outcomes in this population.Further research is warranted to identify mechanisms contributing to these relationships and to develop approaches to reduce the impact of health disparities in HF.

Abstract 15294: Preliminary Results of the Sit Less Program for Patients With Coronary Artery Disease: A Pilot Randomized Controlled Trial

Introduction: Coronary artery disease (CAD) patients spend on average 10-14 hours per day sitting, which is higher than the recommended 8 hours of sitting. Independent of physical activity levels, higher levels of daily sitting are associated with adverse cardiometabolic outcomes. This study evaluated the feasibility and preliminary efficacy of a multi-technology-based Sit Less program in reducing sitting time (ST) and increasing breaks in ST in CAD patients. Methods: CAD patients were randomized to a control (n=8) or a 12-week Sit Less program (n=11). Sit Less included one in-person counseling session, a Fitbit, a smart water bottle (used to break prolonged ST via frequent restroom visits), and tailored weekly text messages. Feasibility was assessed via text message response rate and program satisfaction. Primary outcomes included changes in total daily ST, prolonged ST (total time spent in sitting bouts of &gt;30 mins and &gt;60 mins), and sit-to-stand transitions (all measured using activPAL). Cardiometabolic biomarkers included BMI, blood pressure, insulin, HbA1c, and lipids. Pre-post group differences were examined using independent t-tests. Results: All participants completed the study (15 male, 66±10yrs, mean ST = 10.4 hours/day). Out of the 11 Sit Less participants, 82% responded to all text messages and expressed satisfaction with the program. Significant pre-post group differences were found for total daily ST and prolonged ST (Figure 1). The Sit Less group had 36 minutes reduction in total ST and 3.4 more sit-to-stand transitions, while the control group had 47 minutes increase in total ST and 1 fewer sit-to-stand transitions. No significant differences in cardiometabolic markers were found within or between groups. Conclusion: The Sit Less program was feasible in CAD patients and the intervention reduced total and prolonged ST. Large-scale trials are needed to assess the program's effectiveness in reducing sitting and improving cardiometabolic outcomes.

Abstract 15452: Using a Commercial Virtual Health Platform to Effectively Treat Obesity and Improve Cardiometabolic Risk Factors at Scale

Introduction: Obesity is a critical risk factor for cardiometabolic disease, yet effective treatment has not been available at scale for the &amp;gt;200 million Americans who meet criteria for obesity treatment. To improve access to evidence-based treatment, we established a virtual metabolic health company to provide medically supervised obesity treatment at scale. Research Questions: This real-world evaluation examines the impact of a virtual health program on weight and related cardiometabolic markers as well as self-reported assessment of key health behaviors in food, exercise, sleep, and emotional health. Methods: Data were analyzed for individuals who completed at least 12 months in the core program. Obesity treatment involved GLP-1 receptor agonist medications combined with a proprietary intensive lifestyle intervention delivered with virtual coaching. Weights were submitted via cellular connected scale. Waist circumference, metabolic labs, and patient questionnaires were also analyzed at baseline and 12 months. Results: The cohort includes 2,643 patients who completed at least 12 months. Average weight loss at 12, 15, and 18 months was 15.58% (n=2,397), 15.97% (n=1,319), and 15.82% (n=569). Improvement was observed for all collected metabolic markers: waist circumference, AST/ALT, lipids, HbA1c, insulin, hs-CRP. Specifically for cardiovascular labs, 12 month endpoints showed improvement in HDL in 51% (n= 1180), in LDL for 61% (n=1174), in hs-CRP for 81% (n=956). Of n=303 with abnormal A1c at baseline, 72.9% achieve A1c &amp;lt;5.7%. Average reduction in waist circumference was 5.95 inches (n=1,507). Positive changes were also seen for patient-reported outcomes. Discussion: Given limited access to effective obesity treatment as a pathway to better cardiometabolic disease management, novel approaches must be developed. Results from 2,643 enrollees in a virtual metabolic health program demonstrate clinically significant and sustained weight loss through 18 months, with improvement in associated key cardiometabolic risk markers, health behaviors, and patient-reported outcomes. This commercial program demonstrates promising results in cardiometabolic risk improvement through medically managed weight loss delivered virtually.

Abstract 15044: The Relationship of Pericardial Fat With Metabolic Change and Myocardial Remodelling Following Bariatric Surgery

Introduction: Pericardial fat is a cardiometabolic risk factor that can be quantified from routine cardiovascular magnetic resonance (CMR) studies. However the extent to which this is modifiable, and its relationship with cardiometabolic markers remains unclear. Aims: Determine the effect of bariatric surgery on pericardial fat and associate with cardiometabolic improvements post-surgery. Methods: Thirty-eight people referred for bariatric surgery were assessed pre-operatively using CMR, blood biomarkers and anthropometry. Six months post-operatively, twenty-seven participants underwent paired follow-up assessments. Pericardial fat was quantified manually from routine short axis cine stacks by a single blinded clinical observer. Linear regression was used to assess the association of pericardial fat volume and cardiometabolic parameters, at baseline and changes pre- vs post-surgery. Results: At baseline, pericardial fat volume was associated with multiple cardiometabolic parameters including weight (r=0.46 p=0.004), fasting insulin (r=-0.46, p=0.007) hepatic fat concentration (Hepafat) (r=0.37 p=0.029) and LV mass (r=0.38, p=0.019). Pericardial fat remained independently associated with waist circumference after adjusting for the above (β=0.68, 95% CI: 1.24,9.23, p=0.012). At 6 months post-bariatric surgery pericardial adipose tissue reduced by an average of 29% (95% CI: -21-36%, p&lt;0.001). This change was associated with improvements in fasting insulin levels even after adjusting for changes in weight, Hepafat and LV mass (β=0.72, 95% CI: 0.15, 0.70, p=0.005). Conclusion: Pericardial fat in obesity associates with multiple adverse cardiometabolic parameters, including waist circumference. Bariatric surgery causes a significant reduction in pericardial fat which associates with reduced insulin resistance, providing a potential modifiable mechanism to reduce cardiovascular risk in patients living with obesity.

Clonal Hematopoiesis, Inflammation, Hemostasis, and Cardiometabolic Biomarkers: The Reasons for Geographic and Racial Differences in Stroke Study

CONCLUSIONS Clonal hematopoiesis (CH) is implicated in the pathogenesis of multiple age-associated disorders including malignancy, cardiovascular disease (CVD), chronic kidney disease, and mortality. Some of these adverse outcomes may be mediated by CH-driven inflammatory dysregulation, but the association of CH with biomarkers in other pathways related to these outcomes has not been studied. We studied the association between CH and biomarkers of inflammation, hemostasis and cardiometabolic risk in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a prospective study that enrolled 30,239 Black and White individuals ≥45 years across United States between 2003 and 2007, and collected extensive health data by telephone and in-person exams. Biomarkers listed in Table 2, and CH were measured in baseline blood samples in an age-, sex-, and race-stratified cohort random sample (CRS). We excluded participants with prior history of CVD. Sequencing was performed at &amp;gt;500x depth to identify somatic mutations in 24 of the most common CH genes, capturing &amp;gt;95% of CH observed in the general population. CH was categorized based on variant allele frequency (VAF) of the dominant mutation as 0%, &amp;gt;0-&amp;lt;2%, 2-10% and &amp;gt;10%. Linear regression was used to calculate the age-, sex-, and race-adjusted difference in mean biomarker level for those with versus those without CH. The study included 781 participants (mean age at enrollment: 66 years [SD 12.1], 46% male, 50% Black individuals). The prevalence of CH at varying VAF was: VAF 0% - 43.3%; VAF &amp;gt;0 to &amp;lt;2% - 32.5%; 2 to 10% - 18.4%; &amp;gt;10% - 5.8%. Mutations were most prevalent in DNMT3A (60.3%), then TET2 (13.8%) and ASXL1 (10.1%). The mean age was higher in participants with CH (73 years, SD 10) than in those without CH (61 years, SD 11). Distributions of the most common CH mutations at VAF ≥2% by age, sex and race are shown in Table 1. Mutations in DNMT3A were overrepresented in Black participants and women, whereas mutations in TET2 and ASXL1 were more common in White participants. Associations of CH with inflammation, hemostasis and cardiometabolic biomarkers were presented in Table 2. Mean Log IL-8 was 0.23 (95% CI 0.05-0.41) units higher in those with high VAF CH (&amp;gt;10%) versus those without CH, with no association among other inflammation biomarkers.Among hemostasis biomarkers, mean log D-dimer was 0.26 (95% CI 0.01-0.52) units higher in those with high VAF CH versus those without CH. There was a non-significant trend towards an association between CH and lower Factor VIII and higher fibrinogen (Table 2). Among cardiometabolic biomarkers, mean log Adiponectin was 0.32 (95% CI 0.04-0.61) units higher in those with high VAF CH versus no CH. We did not identify a statistically significant association between CH and other cardiometabolic markers. CH is prevalent in the general population, especially at low VAF. In addition to inflammatory dysregulation, findings here suggest possible other pathways for deleterious effects of CH on health via hemostasis and cardiometabolic pathways. Since our study was cross-sectional, we could not ascertain if CH leads to abnormal biomarker levels or if pathways represented by the above biomarkers predispose to CH. Studying associations of CH with serial biomarkers in a larger population, by specific mutations, and by sex and race will provide mechanistic insights on CH associated adverse outcomes.

Interaction Between Meal-timing and Dietary Inflammatory Potential: Association with Cardiometabolic End Points in a 3-Month Prospective Analysis

BackgroundDiet quality is a moderator of cardiometabolic markers. The timing of dietary intake may be an important determinant; however, previous results have been mixed. Complex mechanisms may result in an interaction between diet timing and quality. ObjectivesThis study aimed to examine the association between fasting duration and first and last mealtime and inflammatory and lipid biomarkers. We also explored the interactions between Energy-density Dietary Inflammatory Index (E-DII) scores and meal-timing on inflammatory and lipid biomarkers. MethodsThis study was a secondary data analysis of a dietary intervention. Assessments occurred at baseline and 3 mo. Three unannounced 24-h dietary recalls estimated diet for calculation of E-DII scores, nighttime fasting duration, and first and last mealtime. Cardiometabolic markers were obtained from a fasting blood sample. Multiple linear regression of baseline data was used for aim 1. For aim 2, the interaction between E-DII change over 3 mo and the meal-timing metrics were used to estimate changes in cardiometabolic markers. ResultsMost participants (n = 95) were female (81%) and White (62%) and their average age was 46.9 ± 13.4 y and body mass index of 31.4 ± 7.1 kg/m2. Every 1-h longer fasting duration was associated with increased total cholesterol (β = 5.79, P = 0.01), low-density lipoprotein (LDL) cholesterol (β = 4.47, P = 0.03), and LDL:high-density lipoprotein (HDL) ratio (β = 0.08, P = 0.04). For every 30-min later first mealtime, increases in total cholesterol, LDL cholesterol, and LDL:HDL ratios also were observed. Anti-inflammatory E-DII changes were associated with reduced total cholesterol and LDL cholesterol (among participants with shorter fasting durations, later last mealtime, or earlier first mealtime) and C-reactive protein (among earlier first mealtime and shorter fasting duration). ConclusionsThis study provides evidence for interaction between dietary timing and quality on cardiometabolic biomarkers. Worsening lipid profiles seen with longer fasting durations may be an artifact of skipped or delayed breakfast, underlining the potential importance of food consumption early in the morning.This trial was registered at clinicaltrials.gov as NCT02382458.

The Associations of Breastfeeding Status at 6 Months with Anthropometry, Body Composition, and Cardiometabolic Markers at 5 Years in the Ethiopian Infant Anthropometry and Body Composition Birth Cohort

(1) Background: Breastfeeding (BF) has been shown to lower the risk of overweight and cardiometabolic disease later in life. However, evidence from low-income settings remains sparse. We examined the associations of BF status at 6 months with anthropometry, body composition (BC), and cardiometabolic markers at 5 years in Ethiopian children. (2) Methods: Mother–child pairs from the iABC birth cohort were categorised into four BF groups at 6 months: 1. “Exclusive”, 2. “Almost exclusive”, 3. “Predominantly” and 4. “Partial or none”. The associations of BF status with anthropometry, BC, and cardiometabolic markers at 5 years were examined using multiple linear regression analyses in three adjustment models. (3) Results: A total of 306 mother–child pairs were included. Compared with “Exclusive”, the nonexclusive BF practices were associated with a lower BMI, blood pressure, and HDL-cholesterol at 5 years. Compared with “Exclusive”, “Predominantly” and “Almost exclusive” had shorter stature of −1.7 cm (−3.3, −0.2) and −1.2 cm (−2.9, 0.5) and a lower fat-free mass index of −0.36 kg/m2 (−0.71, −0.005) and −0.38 kg/m2 (−0.76, 0.007), respectively, but a similar fat mass index. Compared with “Exclusive”, “Predominantly” had higher insulin of 53% (2.01, 130.49), “Almost exclusive” had lower total and LDL-cholesterol, and “Partial or none” had a lower fat mass index. (5) Conclusions: Our data suggest that children exclusively breastfed at 6 months of age are overall larger at 5 years, with greater stature, higher fat-free mass but similar fat mass, higher HDL-cholesterol and blood pressure, and lower insulin concentrations compared with predominantly breastfed children. Long-term studies of the associations between BF and metabolic health are needed to inform policies.

Effects of wholegrain compared to refined grain Intake on cardiometabolic risk markers, gut microbiota and gastrointestinal symptoms in children: A randomized crossover trial

BackgroundWholegrain intake is associated with lower risk of cardiometabolic diseases in adults, potentially via changes in the gut microbiota. Although cardiometabolic prevention should start early, we lack evidence on the effects in children. ObjectivesThis study investigated the effects of wholegrain oats and rye intake on serum low-density lipoprotein (LDL) cholesterol and plasma insulin (coprimary outcomes), other cardiometabolic markers, body composition, gut microbiota composition and metabolites, and gastrointestinal symptoms in children with high body mass index (BMI). MethodsIn a randomized crossover trial, 55 healthy Danish 8- to 13-y-olds received wholegrain oats and rye (“WG”) or refined grain (“RG”) products ad libitum for 8 wk in random order. At 0, 8, and 16 wk, we measured anthropometry, body composition by dual-energy absorptiometry, and blood pressure. Fasting blood and fecal samples were collected for analysis of blood lipids, glucose homeostasis markers, gut microbiota, and short-chain fatty acids. Gut symptoms and stool characteristics were determined by questionnaires. Diet was assessed by 4-d dietary records and compliance by plasma alkylresorcinols (ARs). ResultsFifty-two children (95%) with a BMI z-score of 1.5 ± 0.6 (mean ± standard deviation) completed the study. They consumed 108 ± 38 and 3 ± 2 g/d wholegrain in the WG and RG period, which was verified by a profound difference in ARs (P < 0.001). Compared with RG, WG reduced LDL cholesterol by 0.14 (95% confidence interval: −0.24, −0.04) mmol/L (P = 0.009) and reduced total:high-density lipoprotein cholesterol (P < 0.001) and triacylglycerol (P = 0.048) without altering body composition or other cardiometabolic markers. WG also modulated the abundance of specific bacterial taxa, increased plasma acetate, propionate, and butyrate and fecal butyrate and reduced fatigue with no other effects on gut symptoms. ConclusionHigh intake of wholegrain oats and rye reduced LDL cholesterol and triacylglycerol, modulated bacterial taxa, and increased beneficial metabolites in children. This supports recommendations of exchanging refined grain with wholegrain oats and rye among children.This trial was registered at clinicaltrials.gov as NCT04430465.

Effect of depot medroxyprogesterone acetate on cardiometabolic risk factors among women of reproductive age in Rwanda: A prospective cohort study

Objectives: Depot medroxyprogesterone acetate (DMPA) injectable contraceptive is a widely used hormonal method that offers reversible and effective birth control for women worldwide. However, various studies have raised concerns regarding its potential association with increased cardiovascular disease risk, attributed to its influence on cardiometabolic risk factors. While previous studies have primarily focused on lipid profile, weight gain, blood pressure, and blood glucose, important aspects such as central obesity, glycated hemoglobin (HbA1C), and systemic inflammation have remained under-investigated. Thus, this study aimed to explore the influence of DMPA injectable contraceptives on lipid panel, HbA1C, visceral fat deposition, blood pressure, and inflammatory markers among women of childbearing age in Rwanda. Materials and Methods: The study was a prospective cohort and recruited an equal number of DMPA users (45) as the study group and users of nonhormonal (NH) contraceptives (45) as the control group. We recruited participants from two selected family planning centers in Kigali and collected data at baseline, 6 months, and 12 months. We measured the waist circumference, blood pressure, lipids profile (high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], total cholesterol [TC], and triglycerides [TG]), HbA1C, and high-sensitivity C-reactive protein (hs-CRP). We run the Mann–Whitney to compare the median (MD) change between DMPA and NH users. Data were presented as MD (interquartile range), with a significance level of 5%. Results: After a follow-up of 12 months, DMPA users experienced a significant increase in waist circumference, TG, LDL, TC, hs-CRP, and HbA1C (P &lt; 0.05), whereas they experienced a significant decrease in HDL than controls (P &lt; 0.05). However, our data did not indicate a significant difference in blood pressure changes between DMPA and NH users (P &gt; 0.05). Conclusion: The effect of DMPA injectable on cardiometabolic parameters was minimal in the first 6 months of use; however, it manifested statistically significant at 12 months of follow-up. It is recommended to initiate a follow-up with users at least 12 months of use and repeat every 6 months to check the status of cardiometabolic markers and intervene where necessary.

Potential determinants of antibody responses after vaccination against SARS-CoV-2 in older persons: the Doetinchem Cohort Study

BackgroundImmune responses to vaccination vary widely between individuals. The aim of this study was to identify health-related variables potentially underlying the antibody responses to SARS-CoV-2 vaccination in older persons. We recruited participants in the long-running Doetinchem Cohort Study (DCS) who underwent vaccination as part of the national COVID-19 program, and measured antibody concentrations to SARS-CoV-2 Spike protein (S1) and Nucleoprotein (N) at baseline (T0), and a month after both the first vaccination (T1), and the second vaccination (T2). Associations between the antibody concentrations and demographic variables, including age, sex, socio-economic status (SES), comorbidities (cardiovascular diseases and immune mediated diseases), various health parameters (cardiometabolic markers, inflammation markers, kidney- and lung function) and a composite measure of frailty (‘frailty index’, ranging from 0 to 1) were tested using multivariate models.ResultsWe included 1457 persons aged 50 to 92 years old. Of these persons 1257 were infection naïve after their primary vaccination series. The majority (N = 954) of these individuals were vaccinated with two doses of BNT162b2 (Pfizer) and their data were used for further analysis. A higher frailty index was associated with lower anti-S1 antibody responses at T1 and T2 for both men (RT1 = -0.095, PT1 = 0.05; RT2 = -0.11, PT2 = 0.02) and women (RT1 = -0.24, PT1 < 0.01; RT2 = -0.15, PT2 < 0.01). After correcting for age and sex the frailty index was also associated with the relative increase in anti-S1 IgG concentrations between the two vaccinations (β = 1.6, P < 0.01). Within the construct of frailty, history of a cardiac catheterization, diabetes, gastrointestinal disease, a cognitive speed in the lowest decile of the population distribution, and impaired lung function were associated with lower antibody responses after both vaccinations.ConclusionsComponents of frailty play a key role in the primary vaccination response to the BNT162b2 vaccine within an ageing population. Older persons with various comorbidities have a lowered immune response after their first vaccination, and while frail and sick older persons see a stronger increase after their second vaccination compared to healthy people, they still have a lower antibody response after their second vaccination.

Operationalization, characterization and validation of a healthy lifestyle index in 35 LMICs

Abstract Background For low- and middle-income countries (LMICs), there is no comprehensive and valid index reflecting overall lifestyle. This study aimed to operationalize, characterize, and validate a healthy lifestyle index (HLI), based on the World Health Organization (WHO) recommendations. Methods We used cross-sectional, complete-case data from individual-level, nationally representative surveys among non-pregnant adults in 35 LMICs, applying the WHO STEPwise approach to NCD risk factor surveillance (2009-2019; N = 125,607). The HLI was constructed based on WHO recommendations for fruit and vegetable intake, physical activity, smoking, and alcohol intake (unhealthiest = 0 points; healthiest = 16 points). We calculated the distributions of the HLI and its subcomponents across socio-demographic and geographic strata, accounting for the survey design and each country's World Bank population estimate. Partial Spearman correlations were calculated for the HLI with its subcomponents and cardio-metabolic risk markers. Results In this study (females: 51%, median age: 35.4 years), median HLI-score was 10.3 (interquartile range: 8.2-12.3), being highest in females (versus males) and low-income countries (versus middle-income countries). Twenty-two percent had at least five servings of fruits and vegetables per day (males: 20%, females: 24%); 82% exercised at least 600 MET-min/week (males: 87%, females: 78%); 69% never smoked (males: 40%, females: 97%); 64% were alcohol abstainers (males: 50%, females: 78%). Correlations of the HLI with its subcomponents were moderate and positive, ranging between r = 0.35 and r = 0.64; correlations with cardio-metabolic risk markers were weak, ranging between r = |0.02| and r =|0.12|. Conclusions The majority of adults in LMICs appear to live a healthy lifestyle, particularly women and individuals in low-income countries. Low fruit and vegetable intakes are a major concern. The HLI shows good content but poor construct validity. Key messages • There is an urgent need for interventions to promote fruit and vegetable consumption in LMICs. • The HLI is suitable to monitor lifestyles in LMICs on individual-, country- and WHO region-level.

Vitamin B and One-Carbon Metabolite Profiles Show Divergent Associations with Cardiometabolic Risk Markers but not Cognitive Function in Older New Zealand Adults: A Secondary Analysis of the REACH Study

BackgroundVitamin B inadequacies and elevated homocysteine status have been associated with impaired cognitive and cardiometabolic health with aging. There is, however, a scarcity of research investigating integrated profiles of one-carbon (1C) metabolites in this context, including metabolites of interconnected folate, methionine, choline oxidation, and transsulfuration pathways. ObjectivesThe study aimed to examine associations between vitamins B and 1C metabolites with cardiometabolic health and cognitive function in healthy older adults, including the interactive effects of Apolipoprotein E-ε4 status. MethodsThree hundred and thirteen healthy participants (65-74 y, 65% female) were analyzed. Vitamins B were estimated according to dietary intake (4-d food records) and biochemical status (serum folate and vitamin B12). Fasting plasma 1C metabolites were quantified by liquid chromatography with tandem mass spectrometry. Measures of cardiometabolic health included biochemical (lipid panel, blood glucose) and anthropometric markers. Cognitive function was assessed by the Computerized Mental Performance Assessment System (COMPASS) and Montreal Cognitive Assessment (MoCA). Associations were analyzed using multivariate linear (COMPASS, cardiometabolic health) and Poisson (MoCA) regression modeling. ResultsOver 90% of participants met dietary recommendations for riboflavin and vitamins B6 and B12, but only 78% of males and 67% of females achieved adequate folate intakes. Higher serum folate and plasma betaine and glycine concentrations were associated with favorable cardiometabolic markers, whereas higher plasma choline and homocysteine concentrations were associated with greater cardiometabolic risk based on body mass index and serum lipids concentration values (P< 0.05). Vitamins B and homocysteine were not associated with cognitive performance in this cohort, though higher glycine concentrations were associated with better global cognitive performance (P = 0.017), episodic memory (P = 0.016), and spatial memory (P = 0.027) scores. Apolipoprotein E-ε4 status did not modify the relationship between vitamins B or 1C metabolites with cognitive function in linear regression analyses. ConclusionsVitamin B and 1C metabolite profiles showed divergent associations with cardiometabolic risk markers and limited associations with cognitive performance in this cohort of healthy older adults.

Visceral adipose index, lipid accumulation product, and selected cardiometabolic risk markers among postmenopausal Sudanese women: A cross-sectional study

BackgroundIn Sub-Saharan African countries, data examining postmenopausal women's cardiometabolic risk (CMR) remains limited. Our study aimed to assess the visceral adiposity index (VAI) and lipid accumulation product (LAP), atherogenic index of plasma (AIP), and physical activity levels of postmenopausal women and determine their CMR. MethodsA cross-sectional study included 224 postmenopausal women aged ≥47 years recruited from Khartoum State, Sudan. Weight, height, waist and hip circumferences were measured. Physical activity levels were determined using the Global Physical Activity Questionnaire version 2. Fasting blood samples (5 mL) were collected to determine the lipid profile. The VAI and LAP were calculated as indicators for visceral adiposity, whereas AIP was calculated as an indicator of CVD risk. ResultsThe postmenopausal women's mean age was 62.4 ± 10.2 years. Women (29.2%; 54/185) were physically inactive, with most inactive women being >64 years and having ≥5 CVD risk factors compared with the active and very active women with 3–4 CVD risk factors. Women had high total cholesterol (24.6%), triglycerides (26.6%), low-density lipoprotein cholesterol (14.3%), and low high-density lipoprotein cholesterol (61.2%) levels. Moreover, women (33.5%) had a high CVD risk. In multiple regression analyses, AIP increased significantly with VAI and BMI. The ROC analysis revealed that the highest and statistically significant AUC was recorded for VAI followed by LAP among postmenopausal women, suggesting their diagnostic significance for CVD risk. ConclusionVAI and LAP were closely associated with an increased risk of CVD in postmenopausal Sudanese women and were considered the best diagnostic performance.

Metabolic Syndrome: An Overview on Its Genetic Associations and Gene-Diet Interactions.

Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors that includes central obesity, hyperglycemia, hypertension, and dyslipidemias and whose inter-related occurrence may increase the odds of developing type 2 diabetes and cardiovascular diseases. MetS has become one of the most studied conditions, nevertheless, due to its complex etiology, this has not been fully elucidated. Recent evidence describes that both genetic and environmental factors play an important role on its development. With the advent of genomic-wide association studies, single nucleotide polymorphisms (SNPs) have gained special importance. In this review, we present an update of the genetics surrounding MetS as a single entity as well as its corresponding risk factors, considering SNPs and gene-diet interactions related to cardiometabolic markers. In this study, we focus on the conceptual aspects, diagnostic criteria, as well as the role of genetics, particularly on SNPs and polygenic risk scores (PRS) for interindividual analysis. In addition, this review highlights future perspectives of personalized nutrition with regard to the approach of MetS and how individualized multiomics approaches could improve the current outlook.

FRI048 Cardiometabolic Risk Markers In Children With Obesity And Variants In MC4R Pathway Related Genes

Abstract Disclosure: M. Salama: None. S. Kumar: None. F. Pinto e Vairo: None. R. Hentz: None. Objective: The association between disrupted melanocortin 4 receptor (MC4R) pathway function and childhood obesity is well established. Several variants in MC4R pathway related genes have been implicated to influence cardiometabolic parameters including lipid metabolism and glucose homeostasis. We compared the cardiometabolic risk markers in children with obesity and MC4R related clinically reported genetic variants relative to children with obesity and no MC4R related genetic variants. Methods: This was a retrospective case-control study conducted by chart review of children (age &amp;lt;18 years) with obesity who underwent a multi-gene panel testing for monogenic obesity between February 2020 and November 2022. Children were divided into two groups according to their genetic test results: The first group was of children with clinically reported variants (pathogenic, likely pathogenic, risk allele or variant of uncertain significance) within the MC4R pathway), and the second group was of children with no reported variants in the MC4R pathway (negative genetic testing or variants in non-MC4R related genes). Data on systolic and diastolic blood pressure percentiles, fasting lipid panel, fasting blood glucose, hemoglobin A1c and ALT were extracted. Tests for group differences were performed using the independent two-sample t-test, Wilcoxon rank-sum test, Chi-Square test, or Fisher’s exact test as appropriate for each variable type and test assumptions. Results: Data on a total of 91 children were reviewed. Mean age at testing was 11 years (SD: 4) and mean peak BMI% of the 95th percentile was 158 (SD: 28). 36 patients had clinically reported variants in the MC4R pathway, and 55 patients had no reported MC4R related variants. The blood pressure percentiles, fasting glucose, hemoglobin A1C, total cholesterol, high density lipoprotein cholesterol and low-density lipoprotein cholesterol were not different between both groups. Conclusion: In this pilot study, among children with obesity, variants in the MC4R pathway related genes were not associated with cardiometabolic risk markers. Larger studies are warranted to assess the correlation between MC4R pathway genes and cardiometabolic risk. Presentation: Friday, June 16, 2023

A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy.

In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium-glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple 'traffic light' style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced. Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.

Protein Intake from Various Foods Sources Is Negatively Associated with Cardiometabolic Risk Markers in Italian Older Adults

ObjectivesTo examine the relationships between protein intake from various food sources and cardiometabolic risk markers in Italian older adults.DesignCross-sectional study. Setting: Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns).ParticipantsPeople 65+ years who provided a written informed consent.MeasurementsBlood pressure (BP), blood glucose, total blood cholesterol, and anthropometric indices were assessed. Daily protein intake was estimated for 12 food items listed in a food frequency questionnaire.ResultsThree-thousand four-hundred twenty-four older adults (mean age: 72.7 ± 5.7 years; 55% women) were included in the study. Results of linear regression analysis indicated that protein intake from several food sources was negatively associated with BP, waist and hip circumferences, and waist-to-hip ratio in both sexes. Blood glucose levels were inversely associated with many protein sources in women. Positive associations were observed between some protein sources and total blood cholesterol in both men and women.ConclusionOur findings suggest that dietary protein is differentially associated with cardiometabolic risk factors depending on sex and food sources.