Cardiometabolic Outcomes Research Articles

Associations of childhood physical activity and screen time with cardiometabolic health in preteens who were born to mothers with previous macrosomic delivery: Findings from the ROLO longitudinal birth cohort study.

Macrosomia (birthweight ≥4 kg) may alter the associations of physical activity (PA) and screen time (ST) throughout childhood with later cardiometabolic risk. To investigate associations of PA and ST over a 4-6-year follow-up period with cardiometabolic outcomes in preteens (9-11-year-olds) who were born to mothers with previous macrosomic delivery. This is an analysis of 402 preteens from the ROLO study, who were born to mothers that previously delivered an infant with macrosomia. Parental-reported measures of PA and ST were obtained in early childhood at 5-years of age. Preteen self-reported PA, parental-reported ST, anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance, and blood biomarkers were obtained at 9-11-years. Crude and adjusted linear regression models explored associations and the interaction of birthweight was investigated in all models. Early childhood PA and ST at the 5-year follow-up were not related to preteen cardiometabolic outcomes. In adjusted models, higher preteen PA was associated with lower sum of skinfolds (B = -3.00, 95% CI -5.98, -0.02, p = 0.048) and higher cardiorespiratory endurance (B = 0.50, 95% CI 0.20, 0.80, p = 0.001) at the same time point. No strong evidence for modification by birthweight was found. Higher preteen PA may have potential benefits for cardiometabolic health, irrespective of birthweight.

The effect of home-based neuromuscular electrical stimulation-resistance training and protein supplementation on lean mass in persons with spinal cord injury: A pilot study.

In persons with a spinal cord injury (SCI), resistance training using neuromuscular electrical stimulation (NMES-RT) increases lean mass in the lower limbs. However, whether protein supplementation in conjunction with NMES-RT further enhances this training effect is unknown. In this randomized controlled pilot trial, 15 individuals with chronic SCI engaged in 3 times/week NMES-RT, with (NMES+PRO, n = 8) or without protein supplementation (NMES, n = 7), for 12 weeks. Before and after the intervention, whole body and regional body composition (DXA) and fasting glucose and insulin concentrations were assessed in plasma. Adherence to the intervention components was ≥96%. Thigh lean mass was increased to a greater extent after NMES+PRO compared to NMES (0.3 (0.2, 0.4) kg; p < 0.001). Furthermore, fasting insulin concentration and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were decreased similarly in both groups (fasting insulin: 1 [-9, 11] pmol∙L-1; HOMA-IR: 0.1 [-0.3, 0.5] AU; both p ≥ 0.617). Twelve weeks of home-based NMES-RT increased thigh lean mass, an effect that was potentiated by protein supplementation. In combination with the excellent adherence and apparent improvement in cardiometabolic health outcomes, these findings support further investigation through a full-scale randomized controlled trial.

An Overlooked Disease: Minimal Autonomous Cortisol Secretion (MACS). A Narrative Review.

A far more common disease than Cushing's syndrome is subclinical hypercortisolism or mild autonomous cortisol secretion (MACS), with an overall prevalence of 0.2-2%. This review aims to shed light on the prevalence, screening and diagnostic criteria, comorbidities, and management of Mild Autonomous Cortisol Secretion (MACS). Studies eligible targeted MACS regarding prevalence, screening, comorbidities, management, and clinical outcome. This is a mini-review. IRB approval was not needed. The 1 mg Dexamethasone suppression test (DST) remains the first screening test. MACS is associated with adverse cardiometabolic and renal outcomes, osteoporosis and osteopenia, immunodeficiency, depression, coagulopathy, and sarcopenia. Surgery is the gold standard treatment. Medical therapy is recommended when surgery is contraindicated or not feasible. Clinically silent hypercortisolism is a frequent entity that necessitates early detection and treatment. The production of cortisol should be looked at as a spectrum where subtle, undetectable levels can still be produced. They know its association with adverse health outcomes. MACS is no longer considered an asymptomatic disorder; repeated hormonal and functional tests are crucial to prevent multiorgan damage.

Eggs, dietary choline, and nonalcoholic fatty liver disease in the Framingham Heart Study

BackgroundEggs are rich in bioactive compounds, including choline and carotenoids, that may benefit cardiometabolic outcomes. However, little is known about their relation with nonalcoholic fatty liver disease (NAFLD). ObjectiveWe investigated the association between intakes of eggs and selected egg-rich nutrients (choline, lutein and zeaxanthin) and NAFLD risk and changes in liver fat over approximately 6 years of follow-up in the Framingham Offspring and Third Generation cohorts. MethodsOn two separate occasions (2002–2005 and 2008–2011), liver fat was assessed using a computed tomography scan to estimate the average liver fat attenuation relative to a control phantom to create the liver phantom ratio (LPR). In 2008-2011, cases of incident NAFLD were identified as an LPR ≤0.33 in the absence of heavy alcohol use, after excluding prevalent NAFLD (LPR ≤0.33) in 2002–2005. Food frequency questionnaires were used to estimate egg intakes (classified as <1, 1, and ≥2 per week) and dietary choline (adjusted for body weight using the residual method), and the combined intakes of lutein and zeaxanthin. Multivariable modified Poisson regression and general linear models were used to compute incident risk ratios (RR) of NAFLD and adjusted mean annualized liver fat change. ResultsNAFLD cumulative incidence was 19% among a total of 1414 participants. We observed no associations between egg intake or the combined intakes of lutein and zeaxanthin with an incident NAFLD risk or liver fat change. Other diet and cardiometabolic risk factors did not modify this association. However, dietary choline intakes were inversely associated with NAFLD risk (RR for tertile 3 vs. 1: 0.69, 95% CI: 0.51–0.94). ConclusionsWhile egg intake was not directly associated with NAFLD risk, eggs are a major source of dietary choline, which was strongly inversely associated with NAFLD risk in this community-based cohort.

7143 Near Term Cardiometabolic Outcomes in Transgender Boys and Men in the First Year of Gender-Affirming Testosterone Therapy

7143 Near Term Cardiometabolic Outcomes in Transgender Boys and Men in the First Year of Gender-Affirming Testosterone Therapy

A randomized feasibility trial of time-restricted eating during pregnancy in people with increased risk of gestational diabetes

Time-restricted eating (TRE) is a nutritional intervention that confines the daily time-window for energy intake. TRE reduces fasting glucose concentrations in non-pregnant individuals, but whether this eating protocol is feasible and effective for glycemic control in pregnancy is unknown. The aim of this randomized controlled trial was to investigate the adherence to and effect of a 5-week TRE intervention (maximum 10 h daily eating window) among pregnant individuals at risk of gestational diabetes mellitus (GDM), compared with a usual-care control group. Participants underwent 2-h oral glucose tolerance tests and estimation of body composition, before and after the intervention. Interstitial glucose levels were continuously measured, and adherence rates and ratings of hunger were recorded daily. Thirty of 32 participants completed the trial. Participants allocated to TRE reduced their daily eating window from 12.3 (SD 1.3) to 9.9 (SD 1.0) h, but TRE did not affect glycemic measures, blood pressure, or body composition, compared with the control group. TRE increased hunger levels in the evening, but not in the morning, and induced only small changes in dietary intake. Adhering to a 5-week TRE intervention was feasible for pregnant individuals with increased risk of GDM but had no effect on cardiometabolic outcomes.

Efficacy of physical activity in polycystic ovary syndrome treatment.

Physical activity (PA) is acknowledged as an important component of lifestyle therapy in the management of polycystic ovary syndrome (PCOS). The purpose of this current systematic review is to analyze recent literature assessing the role of PA and exercise interventions as potential treatment for PCOS. The recent literature published since 2022 has focused on understanding the specific benefits of different PA modalities on PCOS pathophysiology, suggesting that high intensity exercise may relay greater metabolic improvements, although results are still inconclusive; expanding our understanding of the impact PA has on a wider range of outcomes, including sleep, quality of life, inflammation, and DNA methylation; and recognizing barriers and limitations of implementing efficacious PA interventions for individuals with PCOS. Current literature supports a role for PA in improving PCOS-related cardiometabolic and reproductive outcomes; however, there is still a significant evidence gap of high-quality studies assessing optimal exercise regimens as well as strategies for implementing PA interventions in real-world settings for individuals with PCOS.

Echoes of conflict and displacement in maternal health: Life-course violence, timing, and maternal stress after childbirth at the northern Thailand-Myanmar border

Armed conflict, displacement, and related violence is escalating globally, concentrated among civilians and migrants in border areas, and poses grave harms to women and children. The current study investigates how women’s life-course experiences of conflict and displacement are linked to maternal stress and health outcomes after childbirth at the Thailand-Myanmar border, specifically stress, mental health, and cardiometabolic outcomes. Analyses are based on a cross-sectional population-based maternal and child health survey of 701 mothers, collected in 2017–18 in northern Thailand along the Myanmar border, including in camps, worksites, and residential homes. Results suggest that how conflict violence shapes contemporary stress and health depends on the outcome, level and timing of conflict violence exposure, and subsequent contextual threats and deprivation in displacement contexts. Past conflict violence was associated with symptoms of perceived stress (PS) and generalized anxiety disorder (GAD) but not depression. It was also associated with hypothalamic-pituitary-adrenal (HPA) axis activity (hair cortisol concentration) and adiposity (waist circumference and waist-to-hip ratio). Additionally, past conflict violence that began in childhood was particularly salient for PS, GAD, and adiposity; and level and timing of violence were salient jointly for HPA activity. Post-displacement factors also independently predicted higher blood pressure and played a potentially partial mediating role in the association between conflict exposure and both PS and GAD symptoms.

Abstract B014: Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program

Abstract Purpose: Cannabis use has been linked to alleviating symptoms such as sleep issues, mental health, and physical problems resulting from cancer treatment among cancer survivors. However, in the US general population, evidence suggests that an increase in cannabis use increases the risk for cardiovascular disease including high blood pressure, type 2 diabetes, and high cholesterol. This is even more alarming since users who have been diagnosed with cancer have an even greater independent risk of cardiovascular events due to the toxicities of cancer therapeutic drugs. Given the US trend in cannabis legalization and decriminalization and the limited knowledge of the association between cannabis use and cardiometabolic biomarkers among cancer survivors, we aim to assess the independent associations between cannabis use and several cardiometabolic biomarkers and explore racial/ethnic and sex differences among a sample of cancer survivors from the All of Us (AoU) Program. Methods: Cross-sectional cannabis data and cardiometabolic risk factor biomarkers were obtained from adult cancer survivors in the AoU Research Program from 2018-2022. Cannabis use was defined as never use (in a lifetime or past three months), occasional use (twice or monthly in the past three months), and frequent/regular use (weekly or daily). Cardiometabolic outcomes included cardiovascular (e.g., systolic, diastolic blood pressure, hypertension), immune (i.e., White Blood Cell [WBC] counts, C-reactive protein [CRP]), and metabolic systems biomarkers (e.g. waist-to-hip ratio, lipids, HbA1c), were dichotomized from continuous values to elevated vs normal where high values, defined by clinically established cutoffs or &amp;gt;75th percentile, represented elevated biomarkers. Multivariable logistic regression and stratified models if interactions were statistically significant, adjusting for treatment, smoking, hazardous alcohol use, and sociodemographic variables were used. Results: Our cohort (N=6,985) consisted of 7.6% Hispanic, 6.2% Black, and 86.2% White survivors. Overall, 8.2% of survivors reported occasional and frequent/regular cannabis use, with Black survivors (9.7%) reporting a greater proportion of frequent/regular use compared to White (3.2%) and Hispanic (4.7%) survivors. Similarly, female (2.8%) survivors reported a lower frequency of frequent/regular cannabis use compared to male (4.2%) survivors. Compared to never users, frequent/regular users were 3.35(95% CI=1.10-10.53) times as likely to report elevated WBC count. No significant associations were found between cannabis use and CRP, cardiovascular, and metabolic systems biomarkers. Similarly, no race/ethnicity or sex (both pinteraction &amp;gt; 0.05) differences were found in the cannabis and WBC association. Conclusion: Our results underscore that more frequent cannabis use may have a detrimental effect on immune risk factors like WBC counts among survivors. Being that high WBC may be predictive of cardiovascular diseases and mortality, future studies should explore the longitudinal effects of cannabis use on WBC. Citation Format: Angel Arizpe, Claudia M. Toledo-Corral, Carol Y. Ochoa-Dominguez, Stephanie Navarro, Sue E. Kim, Albert J. Farias. Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B014.

Effect of time restricted eating versus current practice in dietetics on glycaemic control and cardio-metabolic outcomes in individuals at risk of developing type 2 diabetes: Protocol for a multi-centre, parallel group, non-inferiority, randomised controlled trial

BackgroundTime restricted eating (TRE) is a dietary strategy that may improve metabolic health. However, no studies have compared TRE with current practice (CP) in dietetics. HypothesisTRE will not be inferior to CP to improve glycaemic control in individuals at risk of type 2 diabetes (T2D). MethodsThis parallel group, randomised, non-inferiority, controlled trial randomised 247 participants by site and glycated haemoglobin (HbA1c) into TRE or CP (1:1) for 12 months. Participants were aged 35–70 years, with a body mass index (BMI) >25 but <45 kg/m2, and score ≥15 on the Australian type 2 diabetes risk (AUSDRISK) assessment, without a diagnosis of T2D. Study visits were balanced between groups and all participants received five consultations at 0, 0.5, 1, 2 and 3 months. TRE followed a self-selected 9 h eating window (≥0600 and ≤1900), whereas CP followed Australian dietary guidelines. OutcomesThe primary endpoint is the estimate of group mean difference (TRE vs CP) of HbA1c at 4 months in a covariate linear regression adjusting for stratification factors and sex. Secondary efficacy outcomes at 4 and 12 months are changes in fasting glucose, fasting insulin, HOMA-IR and nocturnal glucose by continuous glucose monitor incremental area under the curve and change in HbA1c at 12 months. Other endpoints are exploratory and will not be adjusted for multiplicity. ConclusionsWe will determine whether TRE is an alternate strategy to current practice in dietetics to improve glucose control.Trial registration:NCT04762251; 21 Feb 2021.

Effect of different modalities of exercise on Fatty Liver Index in patients with metabolic syndrome: The RESOLVE randomized trial

IntroductionMetabolic associated liver disease (MASLD) is the most common liver disease in the world especially in people with metabolic syndrome. First-line treatments mainly consist in lifestyle modifications for these populations. The main objective of this study is to assess the effect of a short intervention program with different exercise modalities on Fatty Liver Index (FLI) in patients with metabolic syndrome. Methods85 patients (40 men, 45 women) with metabolic syndrome and liver steatosis were randomized in 3 groups for a 3 weeks residential program: Re group—high-resistance-moderate-endurance; rE group—moderate-resistance with high-endurance and re group—moderate-resistance with moderate-endurance. Patients also followed a negative energy balance of 500 kcal/day. Then, a follow-up of 1 year with interviews with dieticians and exercise physicians to maintain lifestyle modification was performed. Anthropometric, cardiometabolic and hepatic outcomes were performed at baseline, at the end of the 3-week residential program, 3 months, 6 months and 12 months after baseline. ResultsThis study demonstrated that all three training programs significantly improve FLI and that this effect was lasting among the follow-up (p < 0.001). More specifically, the Re group exhibited a more pronounced decrease in FLI compared with re (p < 0.05). Finally, the decrease in FLI was associated with improvement in anthropometric and cardiometabolic outcomes at 3-weeks (p < 0.001) and 3-months (p < 0.01). ConclusionShort duration program is effective to improve FLI and cardiometabolic parameters in MASLD patients. Encourage to increase physical activity even for a short duration is relevant in this population.

Long-term nighttime aircraft noise exposure and risk of hypertension in a prospective cohort of female nurses

There is growing interest in cardiometabolic outcomes associated with nighttime noise, given that noise can disturb sleep and sleep disturbance can increase cardiometabolic risk such as hypertension. However, there is little empirical research evaluating the association between nighttime aircraft noise and hypertension risk. In this study, we expand on previous work to evaluate associations between nighttime aircraft noise exposure and self-reported hypertension incidence in the Nurses' Health Studies (NHS/NHSII), two US-wide cohorts of female nurses. Annual nighttime average aircraft sound levels (Lnight) surrounding 90 airports for 1995–2015 (in 5-year intervals) were modeled using the Aviation Environmental Design Tool and assigned to participants’ geocoded addresses over time. Hypertension risk was estimated for each cohort using time-varying Cox proportional-hazards models for Lnight dichotomized at 45 dB (dB), adjusting for individual-level hypertension risk factors, area-level socioeconomic status, region, and air pollution. Random effects meta-analysis was used to combine cohort results. Among 63,229 NHS and 98,880 NHSII participants free of hypertension at study baseline (1994/1995), we observed 33,190 and 28,255 new hypertension cases by 2014/2013, respectively. Although ∼1% of participants were exposed to Lnight ≥45 dB, we observed an adjusted hazard ratio (HR) of 1.10 (95% CI: 0.96, 1.27) in NHS and adjusted HR of 1.12 (95% CI: 0.98, 1.28) in NHSII, comparing exposure to Lnight ≥45 versus <45 dB(A). In meta-analysis, we observed an adjusted HR of 1.11 (95% CI: 1.01, 1.23). These results were attenuated with adjustment for additional variables such as body mass index. Our findings support a modest positive association between nighttime aircraft noise and hypertension risk across NHS/NHSII, which may reinforce the concept that sleep disturbance contributes to noise-related disease burden.

High-intensity interval training for cardiometabolic health in adults with metabolic syndrome: a systematic review and meta-analysis of randomised controlled trials

ObjectiveTo assess the effectiveness of high-intensity interval training (HIIT) compared with traditional moderate-intensity continuous training (MICT) and/or non-exercise control (CON) for modification of metabolic syndrome (MetS) components and other cardiometabolic...

Dental caries and adolescent cardiometabolic health from the National Health and Nutrition Examination Survey (NHANES)

Background and aimsTo assess the association between dental caries and cardiometabolic risk in adolescents. Methods and resultsThe analysis included adolescents aged 13–17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 who completed an Oral Health Examination. Untreated caries was defined as having one or more decayed teeth. Caries experience was assessed by Decayed, Missing, Filled Teeth (DMFT) score. Primary cardiometabolic outcomes included elevated BP (defined as BP 120–129/<80 mmHg) and hypertensive BP (defined as BP ≥ 130/80 mmHg). Secondary cardiometabolic outcomes included obesity, dyslipidemia (defined as any abnormal lipid level), glucose intolerance (measured by HOMA-IR), and microalbuminuria (defined as urine albumin: creatinine ≥30 mg/mg). Adjusted linear and logistic models examined associations using complex survey design procedures.In the sample of 2861 adolescents, 25.6 % (1.3 %) had untreated caries. 55.4 % (1.3 %) had DMFT ≥1. In adjusted regression analyses, untreated caries status was not significantly associated with primary outcomes of elevated BP (OR = 1.04, 95 % CI 0.71, 1.52 p > 0.05), hypertensive BP (OR = 1.72, 95 % CI 0.71, 3.89 p > 0.05), nor secondary cardiometabolic outcomes. No statistically significant associations were found between DMFT score and primary outcomes of elevated BP (OR = 0.01, 95 % CI 0.34, 1.07 p > 0.05), hypertensive BP (OR = 0.91, 95 % CI 0.81, 1.08 p > 0.05), or secondary cardiometabolic outcomes. ConclusionAlthough studies in other countries and in adults show associations between caries and cardiometabolic outcomes, this study did not find an association between caries and cardiometabolic markers.

Associations between dimensions of the social environment and cardiometabolic health outcomes: a systematic review and meta-analysis

ObjectivesThe social environment (SE), that is, the social relationships and social context in which groups of people live and interact, is an understudied element of the broader living environment which...

Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander.

The aim of this review was to discuss cardiometabolic risk factors that affect women. Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women. Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.

Systemic Health Effects of Oleuropein and Hydroxytyrosol Supplementation: A Systematic Review of Randomized Controlled Trials.

Non-communicable diseases (NCDs) cause 41 million deaths annually, accounting for 74% of global fatalities. The so-called Mediterranean diet, with its especially significant consumption of olive oil, has shown promising results in reducing the risk of developing NCDs, such as cardiovascular, liver, or bone diseases. In the context of the nutritional health benefits of foods, phenolic compounds such as olive oil's main components, oleuropein (OLE) and hydroxytyrosol (HT), have been shown to possess different beneficial effects. However, no systematic review has evaluated the health-promoting effects of OLE and HT until now. Consequently, this systematic review analyzed 12 human randomized controlled trials (RCTs), involving 683 participants, to assess the effects of supplements, pure compounds, or enriched foods containing OLE and HT regarding systemic health outcomes, including CVD risk factors, liver parameters, and bone, joint, and cognitive health. The review found contrasting but encouraging results, with some studies reporting significant modulation of body weight, lipid profile, and glucose metabolism, and improvements in bone, joint, and cognitive functions. The studies described different dosages and forms of supplementation, ranging from 5 mg/d HT to 990 mL/d olive leaf infusion (320.8 mg OLE and 11.9 mg HT), highlighting the need for further research to determine the optimal dosing and duration. Despite the mixed outcomes, OLE and HT supplementation show potential for improving some of the cardiometabolic health outcomes and bone, joint, and cognitive health. However, further studies are necessary to understand their benefits better and address existing limitations.

Ancestry-aligned polygenic scores combined with conventional risk factors improve prediction of cardiometabolic outcomes in African populations

BackgroundCardiovascular diseases (CVD) are a major health concern in Africa. Improved identification and treatment of high-risk individuals can reduce adverse health outcomes. Current CVD risk calculators are largely unvalidated in African populations and overlook genetic factors. Polygenic scores (PGS) can enhance risk prediction by measuring genetic susceptibility to CVD, but their effectiveness in genetically diverse populations is limited by a European-ancestry bias. To address this, we developed models integrating genetic data and conventional risk factors to assess the risk of developing cardiometabolic outcomes in African populations.MethodsWe used summary statistics from a genome-wide association meta-analysis (n = 14,126) in African populations to derive novel genome-wide PGS for 14 cardiometabolic traits in an independent African target sample (Africa Wits-INDEPTH Partnership for Genomic Research (AWI-Gen), n = 10,603). Regression analyses assessed relationships between each PGS and corresponding cardiometabolic trait, and seven CVD outcomes (CVD, heart attack, stroke, diabetes mellitus, dyslipidaemia, hypertension, and obesity). The predictive utility of the genetic data was evaluated using elastic net models containing multiple PGS (MultiPGS) and reference-projected principal components of ancestry (PPCs). An integrated risk prediction model incorporating genetic and conventional risk factors was developed. Nested cross-validation was used when deriving elastic net models to enhance generalisability.ResultsOur African-specific PGS displayed significant but variable within- and cross- trait prediction (max.R2 = 6.8%, p = 1.86 × 10−173). Significantly associated PGS with dyslipidaemia included the PGS for total cholesterol (logOR = 0.210, SE = 0.022, p = 2.18 × 10−21) and low-density lipoprotein (logOR = − 0.141, SE = 0.022, p = 1.30 × 10−20); with hypertension, the systolic blood pressure PGS (logOR = 0.150, SE = 0.045, p = 8.34 × 10−4); and multiple PGS associated with obesity: body mass index (max. logOR = 0.131, SE = 0.031, p = 2.22 × 10−5), hip circumference (logOR = 0.122, SE = 0.029, p = 2.28 × 10−5), waist circumference (logOR = 0.013, SE = 0.098, p = 8.13 × 10−4) and weight (logOR = 0.103, SE = 0.029, p = 4.89 × 10−5). Elastic net models incorporating MultiPGS and PPCs significantly improved prediction over MultiPGS alone. Models including genetic data and conventional risk factors were more predictive than conventional risk models alone (dyslipidaemia: R2 increase = 2.6%, p = 4.45 × 10−12; hypertension: R2 increase = 2.6%, p = 2.37 × 10−13; obesity: R2 increase = 5.5%, 1.33 × 10−34).ConclusionsIn African populations, CVD and associated cardiometabolic trait prediction models can be improved by incorporating ancestry-aligned PGS and accounting for ancestry. Combining PGS with conventional risk factors further enhances prediction over traditional models based on conventional factors. Incorporating data from target populations can improve the generalisability of international predictive models for CVD and associated traits in African populations.

Intermittent Energy Restriction for Adolescents With Obesity

Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management. To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity. This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included. Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52). The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed. A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups. These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice. http://anzctr.org.au Identifier: ACTRN12617001630303.

A systematic review and meta-analysis of randomized trials of substituting soymilk for cow’s milk and intermediate cardiometabolic outcomes: understanding the impact of dairy alternatives in the transition to plant-based diets on cardiometabolic health

BackgroundDietary guidelines recommend a shift to plant-based diets. Fortified soymilk, a prototypical plant protein food used in the transition to plant-based diets, usually contains added sugars to match the sweetness of cow’s milk and is classified as an ultra-processed food. Whether soymilk can replace minimally processed cow’s milk without the adverse cardiometabolic effects attributed to added sugars and ultra-processed foods remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials, to assess the effect of substituting soymilk for cow’s milk and its modification by added sugars (sweetened versus unsweetened) on intermediate cardiometabolic outcomes.MethodsMEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched (through June 2024) for randomized controlled trials of ≥ 3 weeks in adults. Outcomes included established markers of blood lipids, glycemic control, blood pressure, inflammation, adiposity, renal disease, uric acid, and non-alcoholic fatty liver disease. Two independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). A sub-study of lactose versus sucrose outside of a dairy-like matrix was conducted to explore the role of sweetened soymilk which followed the same methodology.ResultsEligibility criteria were met by 17 trials (n = 504 adults with a range of health statuses), assessing the effect of a median daily dose of 500 mL of soymilk (22 g soy protein and 17.2 g or 6.9 g/250 mL added sugars) in substitution for 500 mL of cow’s milk (24 g milk protein and 24 g or 12 g/250 mL total sugars as lactose) on 19 intermediate outcomes. The substitution of soymilk for cow’s milk resulted in moderate reductions in non-HDL-C (mean difference, − 0.26 mmol/L [95% confidence interval, − 0.43 to − 0.10]), systolic blood pressure (− 8.00 mmHg [− 14.89 to − 1.11]), and diastolic blood pressure (− 4.74 mmHg [− 9.17 to − 0.31]); small important reductions in LDL-C (− 0.19 mmol/L [− 0.29 to − 0.09]) and c-reactive protein (CRP) (− 0.82 mg/L [− 1.26 to − 0.37]); and trivial increases in HDL-C (0.05 mmol/L [0.00 to 0.09]). No other outcomes showed differences. There was no meaningful effect modification by added sugars across outcomes. The certainty of evidence was high for LDL-C and non-HDL-C; moderate for systolic blood pressure, diastolic blood pressure, CRP, and HDL-C; and generally moderate-to-low for all other outcomes. We could not conduct the sub-study of the effect of lactose versus added sugars, as no eligible trials could be identified.ConclusionsCurrent evidence provides a good indication that replacing cow’s milk with soymilk (including sweetened soymilk) does not adversely affect established cardiometabolic risk factors and may result in advantages for blood lipids, blood pressure, and inflammation in adults with a mix of health statuses. The classification of plant-based dairy alternatives such as soymilk as ultra-processed may be misleading as it relates to their cardiometabolic effects and may need to be reconsidered in the transition to plant-based diets.Trial registrationClinicalTrials.gov identifier, NCT05637866.