Covariate-adjusted Means Research Articles

The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of Chinese population

BackgroundThis study aims to comprehensively explain of glycosylated Hemoglobin (HbA1c) control patterns and help determine the causal relationship between glycemic control patterns and atherosclerosis progression, thereby contributing to the effective management of diabetes complications.MethodAll participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital. The HbA1c pattern was described by HbA1c variability and trajectory groups of HbA1c. Then we examined the associations between the HbA1c pattern and the changes of intima-media thickness (ΔIMT) using covariate-adjusted means (SE) of ΔIMT, which were calculated by multiple linear regression analyses adjusted for the covariates. Finally, a cross-lagged panel model (CLPM) was performed to further verify the bidirectional relationship between IMT and HbA1c.ResultsAfter data cleaning, a total of 1041 type 2 diabetes patients aged 20–80 years were included in this study. Except for average real variability (ARV), the other variation variables of HbA1c were associated with ΔIMT% (P < 0.05). Four discrete trajectories of HbA1c were identified in trajectory analysis. Comparing with the low-stable trajectory group of HbA1c, the covariate-adjusted means (SE) of ΔIMT% were significantly higher in Moderate-increase, U-shape and relative high trajectory groups, the mean (SE) were 7.03 (0.031), 15.49 (0.185), 14.15 (0.029), respectively. Meanwhile, there were significant bidirectional cross-lagged associations between HbA1c and IMT after adjusting for covariates.ConclusionWe found four discrete trajectory groups of HbA1c during the long-term follow-up of diabetes. There was a positive association between HbA1c variability and the progression of atherosclerosis. Our study suggested that patients with diabetes should avoid roller coaster changes in glucose over a long period when controlling blood glucose.

Trajectories of glycated hemoglobin of T2DM and progress of arterial stiffness: a prospective study

AimThis study aimed to describe the different trajectories groups of HbA1c during the long-term treatment of diabetes and explore the effect of glycemic control on the progression of arterial stiffness.MethodThe study participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe hospital. The latent class mixture model (LCMM) was used to identify distinct trajectories of HbA1c. We calculated the change value of baPWV (ΔbaPWV) of each participant between the whole follow-up time as the primary outcome. Then we examined the associations between each HbA1c trajectory pattern and ΔbaPWV using covariate-adjusted means (SE) of ΔbaPWV, which were calculated by multiple linear regression analyses adjusted for the covariates.ResultsAfter data cleaning, a total of 940 type 2 diabetes patients aged 20–80 years were included in this study. According to the BIC, we identified four discrete trajectories of HbA1c: Low-stable, U-shape, Moderate-decrease, High-increase, respectively. Compared with the low-stable group of HbA1c, the adjusted mean values of baPWV were significantly higher in U-shape, Moderate-decrease, and High-increase groups (all P < 0.05, and P for trend < 0.001), the mean values (SE) were 82.73 (0.08), 91.19 (0.96), 116.00 (0.81) and 223.19 (11.54), respectively.ConclusionWe found four different trajectories groups of HbA1c during the long-term treatment of diabetes. In addition, the result proves the causal relationship between long-term glycemic control and arterial stiffness on a time scale.

Association of Diet Quality Measured by Three A Priori-Defined Dietary Patterns With Gut Microbiota and Intestinal Permeability Among Obese Individuals

ObjectivesThe human gastrointestinal tract (GI) may play a critical role in the prevention of obesity and metabolic diseases. Considering the importance of a healthy diet for optimal health, this study examined associations of diet quality assessed by three a priori-defined dietary patterns (Healthy Eating Index 2010 [HEI-2010], Mediterranean Eating Pattern for Americans [MEPA], and Dietary Approaches to Stop Hypertension [DASH] with gut microbiota, short-chain fatty acids (SCFA) and intestinal permeability markers in adult obese participants. MethodsAnalyses utilized baseline data from 103 obese subjects (43.8 ± 11.3 years, body mass index ≥30 kg/m2, 72.8% females, 64.1% blacks) who participated in a probiotic/prebiotic supplement trial. Diet was assessed using a validated food frequency questionnaire. Associations of diet quality with outcome measures were assessed using partial correlation coefficient adjusting for relevant covariates. General linear models (GLM) were applied to compare covariate-adjusted means of outcomes for tertiles of respective dietary patterns scores. ResultsScores of HEI-2010 (r = 0.25, P = 0.02), MEPA (r = 0.24, P = 0.03) and DASH (r = 0.28, PP = 0.008) were positively associated with Blautia abundance. HEI-2010 score was positively associated butyrate and propionate to total SCFA ratio (r = 0.24, P = 0.048). Intestinal permeability marker, urinary 24-hr sucralose levels were inversely associated with HEI-2010 (r= –0.30, P = 0.009) and MEPA (r= –0.26, P = 0.02) score. The results were similar when GLM models were performed. No significant associations were observed between scores of dietary patterns and measures of microbial diversity. ConclusionsBlautia abundance and inversely associated with intestinal permeability markers such as urinary 24-h sucralose levels suggesting diet quality may have positive impact on the human GI community. Funding SourcesNo funding support.

Diet quality measured by four a priori-defined diet quality indices is associated with lipid-soluble micronutrients in the Multiethnic Cohort Study (MEC).

Background/ObjectivesThis study examined the long-term relation of lipid-soluble micronutrients with diet quality as assessed by four a priori-defined dietary patterns.Subjects/MethodsIn a prospective design, nutritional biomarkers (carotenoids, tocopherols, retinol, and coenzyme Q10) were measured using a validated HPLC based assay. General linear models were applied to obtain covariate-adjusted means of biomarkers for tertiles of 4 a priori diet quality indices: Healthy Eating Index (HEI) 2010, Alternative HEI (AHEI) 2010, Alternate Mediterranean Diet Score (aMED), and Dietary Approaches to Stop Hypertension (DASH). For a subcohort of 8 367 participants within the Multiethnic Cohort (MEC), diet was assessed by a validated quantitative food frequency questionnaire in 1993–96 and serum was collected in 2001–06.ResultsParticipants with the highest diet quality scores had significantly higher serum concentrations of all carotenoids, total tocopherols, and α-tocopherol, while γ-tocopherol was inversely associated with diet quality. Adjusted means for the lowest vs. highest tertile of HEI 2010 were 1.2 vs. 1.5 mg/L for total carotenoids, 11.4 vs. 12.3 mg/L for total tocopherols, and 1.9 vs. 1.6 mg/L for γ-tocopherol (ptrend<0.0001). The associations for the other dietary indices were similar; no indication for sex and ethnic differences was detected. Vegetable and fruit components were major predictors of most circulating micronutrients, but most other components were also associated.ConclusionsHigher diet quality scores measured by four a priori diet quality indices were significantly associated higher serum concentrations of carotenoids and α-tocopherol, while γ-tocopherol was inversely associated with diet quality.

Liquid Sucrose Consumption Promotes Liver Lipid Accumulation, Fat Mass, and Glucose Intolerance without Altering Circulating Insulin Levels

A variety of factors contribute to the rising rates of obesity and to difficulties in weight reduction that exist in the worldwide population. One factor that contributes to weight gain is caloric intake via consumption of sugar‐sweetened beverages (SSBs). Therefore, in this study, we investigated specific metabolic outcomes associated with ad libitum liquid sucrose intake over 12 weeks in male C57BL/6J mice. Mice consuming 30% sucrose in liquid form gained 39.6% more weight (p &lt; 0.001) with a 51% increase in fat mass (p&lt; 0.01), stored 3.5‐fold more fat in liver (p&lt; 0.05), and had impaired glucose tolerance relative to control mice (AUC p &lt; 0.01). Intriguingly, all of these metabolic perturbations occurred without alterations in circulating insulin levels and with no detectable changes in physical activity of the mice. In addition, liver and muscle glycogen content did not increase with sucrose consumption. However, sucrose intake produced higher RQ values (p &lt; 0.01), increased serum FGF21 levels (5.9 fold; p &lt; 0.01), promoted browning of white adipose tissue, and enhanced whole body energy expenditure (22% increase; p &lt; 0.01). A correlation analysis based on Pearson's correlation coefficient r indicated that energy expenditure (EE) correlated with total body mass (TBM: r = 0.91, p&lt;0.0001), oxygen consumption (VO2: r=0.75, p&lt;0.001), lean mass (LBM: r=0.94, p&lt;0001) and fat‐free mass (FFM: r=0.94, p&lt;0.0001). Oxygen consumption (VO2) also correlated with fat‐free mass (Pearson r = 0.76; p &lt; 0.001), moderately with total body mass (Pearson r = 0.60; p &lt; 0.05), but not with fat mass (Pearson r = 0.31; p = 0.25). Analysis of covariance (ANCOVA) for treatment effects on EE with TBM, VO2, LBM, and FFM taken as potential covariates for EE revealed that VO2 was the preferred single covariate. When the treatment means for EE were covariate adjusted for VO2, the EE mean for sucrose was significantly elevated (p&lt;0.025). When multiple covariates were considered, TBM and VO2 were significant, but the difference between covariate‐adjusted treatment means was not significant. Congruent with the increase in RQ, there was a marked increase in the glycolytic enzyme gene expression profile in skeletal muscle, but not in epididymal white adipose tissue. We further found that sucrose consumption downregulated the expression of the dgat1 and dgat2 genes in inguinal white adipose tissue (iWAT). By contrast, dgat1 and dgat2 expression are not suppressed in iWAT from db/db mice, a separate model of obesity that displays hyperinsulinemia. Taken together, we conclude that sucrose‐induced weight gain occurs without an increase in circulating insulin and is associated with enhanced lipid accumulation in liver, but not skeletal muscle. This study shows that obesity driven by enhanced consumption of carbohydrate calories in liquid form is distinct from the hyperinsulinemia promoted by high‐fat diet or by obesity driven secondary to deficiencies in leptin receptor signaling. Thus, molecular mechanisms responsible for the obese state are likely to be dependent on the macronutrient source of calories and route of delivery.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Plasma trans-fatty acid concentrations in fasting adults declined from NHANES 1999–2000 to 2009–20101–3

Background: The consumption of trans fatty acids (TFAs) is associated with an increased risk of cardiovascular disease, and reducing their consumption is a major public health objective. Food intake studies have provided estimates for TFA concentrations in the US population; however, there is a need for data on TFA blood concentrations in the population.Objective: The objective of this study was to determine plasma TFA concentrations in a nationally representative group of fasted adults in the US population in NHANES samples from 1999–2000 and 2009–2010.Design: Four major TFAs [palmitelaidic acid (C16:1n–7t), trans vaccenic acid (C18:1n–7t), elaidic acid (C18:1n–9t), and linoelaidic acid (C18:2n–6t,9t)] were measured in plasma in 1613 subjects from NHANES 1999–2000 and 2462 subjects from NHANES 2009–2010 by gas chromatography–mass spectrometry. Geometric means and distribution percentiles were calculated for each TFA and their sum by age, sex, and race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American), and covariate-adjusted geometric means were computed by using a model that included these demographic and other dietary factors, as well as survey year and any significant interaction terms.Results: These nationally representative data for the adult US population show that TFA concentrations were 54% lower in NHANES 2009–2010 than in NHANES 1999–2000. Covariate-adjusted geometric means for the sum of the 4 TFAs were 81.4 μmol/L (95% CI: 77.3, 85.6 μmol/L) and 37.8 μmol/L (95% CI: 36.4, 39.4 μmol/L) in NHANES 1999–2000 and 2009–2010, respectively. Even with the large decline in TFA concentrations, differences between demographic subgroups were comparable in the 2 surveys.Conclusion: The results indicate an overall reduction in TFA concentrations in the US population and provide a valuable baseline to evaluate the impact of the recent regulation categorizing TFAs as food additives.

Alternate Mediterranean diet score is positively associated with skeletal muscle mass index in middle-aged adults.

Researches have suggested Mediterranean diet might lower the risk of chronic diseases, but data on skeletal muscle mass (SMM) are limited. This community-based cross-sectional study examined the association between the alternate Mediterranean diet score (aMDS) and SMM in 2230 females and 1059 males aged 40-75 years in Guangzhou, China. General information and habitual dietary information were assessed in face-to-face interviews conducted during 2008-2010 and 3 years later. The aMDS was calculated by summing the dichotomous points for the items of higher intakes of whole grain, vegetables, fruits, legumes, nuts, fish and ratio of MUFA:SFA, lower red meat and moderate ethanol consumption. The SMM of the whole body, limbs, arms and legs were measured using dual-energy X-ray absorptiometry during 2011-2013. After adjusting for potential covariates, higher aMDS was positively associated with skeletal muscle mass index (SMI, SMM/height2, kg/m2) at all of the studied sites in males (all P trend<0·05). The multiple covariate-adjusted SMI means were 2·70 % (whole body), 2·65 % (limbs), 2·50 % (arms) and 2·70 % (legs) higher in the high (v. low) category aMDS in males (all P<0·05). In females, the corresponding values were 1·35 % (P trend=0·03), 1·05, 0·52 and 1·20 %, (P trend>0·05). Age-stratified analyses showed that the favourable associations tended to be more pronounced in the younger subjects aged less than the medians of 59·2 and 62·2 years in females and males (P interaction>0·10). In conclusion, the aMDS shows protective associations with SMM in Chinese adults, particularly in male and younger subjects.

Beta-cell function is associated with carotid intima-media thickness independently of insulin resistance in healthy individuals.

It is a common belief that early atherosclerosis in prediabetes is causally linked to endothelial insulin resistance. Another condition, a low insulin secretion, may be associated with insufficient insulin action on the vascular wall and consequently favor atherosclerosis. Our aim was to test this hypothesis in people without diabetes, taking into account the gold-standard measurement of insulin sensitivity, a major confounder in the relationship between insulin secretion and atherosclerosis. We studied the European Relationship between Insulin Sensitivity and Cardiovascular Risk cohort of 451 men and 593 women (44 ± 8 years, mean ± SD) who were free of diabetes, hypertension, dyslipidemia, and other known chronic or acute conditions. All underwent an oral glucose tolerance test, a euglycemic-hyperinsulinemic clamp (M/I measured insulin sensitivity), and B-mode carotid ultrasound. Intima-media thickness (IMT) in the common carotid artery was negatively associated with insulin secretion indexes, with Spearman partial correlation coefficients: -0.09, -0.08, -0.06 for respectively, the disposition index, the early insulin response and the beta cell glucose sensitivity, after adjusting for established factors, including clamp-measured insulin sensitivity (all P < 0.05). For quartiles 1 (lowest) to 4 of the disposition index, the covariate-adjusted geometric means of IMT (mm) were 0.605 (95% confidence interval: 0.596-0.614), 0.596 (0.587-0.605), 0.597 (0.587-0.606), and 0.586 (0.577-0.596) (Ptrend = 0.004). Similar results were found for the two other surrogate measures of insulin secretion. No interaction with sex was observed. Insulin secretion was associated with early carotid atherosclerosis in nondiabetic individuals, independently of other risk factors, including insulin sensitivity measured by the gold-standard method.

Serum Total Testosterone Concentrations in the US Household Population from the NHANES 2011-2012 Study Population.

Limited information is available about testosterone concentrations representative of the general US population, especially children, women, and non-Hispanic Asians. We obtained nationally representative data for total testosterone (totalT), measured with standardized LC-MS/MS, for the US population age 6 years and older from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). We analyzed 6746 serum samples and calculated the geometric means, distribution percentiles, and covariate-adjusted geometric means by age, sex, and race/ethnicity. The 10th-90th percentiles of totalT values in adults (≥20 years) was 150-698 ng/dL (5.20-24.2 nmol/L) in men, 7.1-49.8 ng/dL (0.25-1.73 nmol/L) in women, and 1.0-9.5 ng/dL (0.04-0.33 nmol/L) in children (6-10 years old). Differences among race/ethnic groups existed in children and men: covariate-adjusted totalT values in non-Hispanic Asians were highest among children (58% compared to non-Hispanic black children) and lowest among men (12% compared to Mexican-American men). Covariate-adjusted totalT values in men were higher at age 55-60 years compared to ages 35 and 80 years, a pattern different from that observed in previous NHANES cycles. TotalT patterns were different among age groups in men compared with previous NHANES cycles. Covariate-adjusted totalT values peaked at age 55-60 years in men, which appeared to be consistent with the increased use of exogenous testosterone. Differences among race/ethnic groups existed and appeared more pronounced in children than adults.

Energy and Nutrient Intakes from Processed Foods Differ by Sex, Income Status, and Race/Ethnicity of US Adults

BackgroundThe 2010 Dietary Guidelines for Americans (DGA) recommends nutrients to increase and to decrease for US adults. The contributions processed foods make to the US intake of nutrients to increase and decrease may vary by the level of processing and by population subgroup. ObjectiveThe hypotheses that the intakes of nutrients to increase or decrease, as specified by the DGA, are contributed exclusively from certain processed food categories and consumed differentially by population subgroups by sex, poverty-income ratio (ratio of household income to poverty threshold), and race/ethnicity was tested along with the hypothesis that specific processed food categories are responsible for nutrient intake differences between the population subgroups. DesignThe 24-hour dietary recall data from the cross-sectional 2003-2008 National Health and Nutrition Examination Survey was used to determine population subgroup energy and nutrient intake differences among processed food categories defined by the International Food Information Council Foundation Continuum of Processed Foods. Participants/settingFifteen thousand fifty-three US adults aged ≥19 years. Statistical analyses performedThe mean daily intake of energy and nutrients from processed food categories reported by population subgroups were compared using regression analysis to determine covariate-adjusted least square means. ResultsProcessed food categories that contributed to energy and nutrient intake differences within subgroups did not uniformly or exclusively contribute nutrients to increase or decrease per DGA recommendations. The between-group differences in mean daily intake of both nutrients to increase and decrease contributed by the various processed food categories were diverse and were not contributed exclusively from specific processed food categories. ConclusionsRecommendations for a diet adhering to the DGA should continue to focus on the energy and nutrient content, frequency of consumption, and serving size of individual foods rather than the level of processing.

Abstract 4152: Differences in nicotine metabolism among five racial/ethnic groups with disparate risks for lung cancer: The multiethnic cohort study

Abstract Introduction: Globally, lung cancer is the most common cancer and the leading cause of cancer-related deaths. Smoking is a well-established risk factor for this disease; however, self-reported dose does not fully explain the differences in lung cancer risk observed across ethnic/racial populations. Compared to whites, for the same lifetime number of cigarettes smoked, African Americans (AA) and Native Hawaiians (NH) have substantially higher rates of lung cancer, whereas Japanese Americans (JA) and Latinos (LA) have lower rates of disease. These differences may be due to variations in nicotine metabolism, thereby influencing smoking behavior. Methods: Using overnight or first morning urine samples collected in the Multiethnic Cohort study (MEC), we examined nicotine metabolism among 2,300 cancer-free smokers of five racial/ethnic groups with different lung cancer risks: AA (n=356), NH (n=330), whites (n=444), LA (n=459) and JA (n=711). Total and free urinary nicotine metabolites: nicotine, cotinine, and trans-3-hydroxycotinine (3-OH) were measured by liquid chromatography tandem mass spectrometry. Smoking dose was quantified by urinary nicotine equivalents (NE)=total cotinine + total nicotine + total 3-OH. The respective glucuronidation ratio of each metabolite was calculated as the total metabolite minus the free metabolite divided by the free metabolite. CYP2A6 enzymatic activity ratio was calculated as: (total cotinine + 3-OH)/ NE. To examine the difference in metabolite levels across racial/ethnic groups, covariate-adjusted geometric means were computed for each group from linear regression models, adjusting for age at urine collection, sex, creatinine, BMI, and CYP2A6 activity ratio (for the NE and glucuronides models), cigarettes per day (CPD) (for the NE model) or NE (for the glucuronides and CYP2A6 activity models). Results: We found that NE and nicotine, cotinine and 3-OH glucuronidation and CYP2A6 activity differed by race/ethnicity (p≤0.002). For NE, AA had the highest levels, followed by whites, LA, NH and JA (geometric means=30.9, 28.5, 28.3, 27.2 and 25.7 nmol/mL, respectively). For CYP2A6 activity, the ratio was highest in AA, followed by LA, whites, NH and JA (geometric means= 0.80, 0.81, 0.77, 0.73 and 0.62, respectively). We found that for each racial/ethnic group NE was greater for smokers in the higher compared to the lower tertile of CYP2A6 activity. This trend was significant for all groups, except NH (p-trend's= 0.02 [AA], 0.30 [NH], &amp;lt;0.0001 [W, LA and JA]; p-interaction&amp;lt;0.005). Conclusion: CYP2A6 enzymatic activity affects smoking dose beyond CPD, which in part may explain the relatively lower risk of lung cancer of Japanese Americans. Further investigation of racial differences in lung cancer risk using nicotine biomarkers is warranted. Citation Format: Sung-Shim L. Park, Christian Caberto, Maarit Tiirikainen, Lynne Wilkens, Daniel Stram, Christopher A. Haiman, Stephen S. Hecht, Sharon Murphy, Loic Le Marchand. Differences in nicotine metabolism among five racial/ethnic groups with disparate risks for lung cancer: The multiethnic cohort study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4152. doi:10.1158/1538-7445.AM2014-4152

Secondhand Smoke Exposure and Urine Cotinine Concentrations by Occupation among Korean Workers: Results from the 2008 Korea National Survey for Environmental Pollutants in the Human Body

This study aimed to estimate the status of secondhand smoke (SHS) exposure through urine cotinine analysis among nonsmoking workers in Korea and to analyze factors affecting urine cotinine concentrations. Data were based on “The 2008 Korea National Survey for Environmental Pollutants in the Human Body,” a cross-sectional study of the National Institute of Environmental Research of Korea. We selected 1448 nonsmoking adult workers from 200 localities to participate in this survey. Urine cotinine concentrations were analyzed using a gas chromatograph-mass selective detector. We calculated separate covariate-adjusted geometric means for socio-demographic variables for males, females, and total subjects by analysis of covariance (ANCOVA). Statistical analyses were performed using SPSS version 18.0 (SPSS Inc., Chicago, Ill.). The prevalence of self-reported exposure to SHS was 36.9%. The geometric mean (95% confidence interval) of urine cotinine concentrations among all participants was 16.50 (14.48–18.80) μg/L. Gender, living area, education, and SHS exposure showed significant differences in urine cotinine concentrations. The urine cotinine concentrations of farmworkers and blue-collar workers such as skilled agricultural, forestry, and fishery workers, and elementary occupations were higher than those of white-collar workers such as clerical support workers, technicians, and associate professionals. Such a high proportion of the population having high urine cotinine levels indicates widespread exposure to SHS among nonsmoking workers in Korea. Furthermore, the urine cotinine levels among nonsmoking workers exposed to SHS varied by occupation. The measured urine cotinine concentration is suggested to be a valuable indication of SHS exposure in Korea.

Mushroom Intake is associated with Better Nutrient Intake and Diet Quality: 2001-2010 National Health and Nutrition Examination Survey

Background: The association between mushroom consumption and nutrient intake or diet quality has not been reported. The purpose of this study was to determine the associations between these variables in a nationally representative sample of adults. Methods: Dietary intake was determined using a 24-hour recall on adult 19+ year (N=24,807) participants of the National Health and Nutrition Examination Survey 2001-2010. Mushroom consumption was defined in two ways: 1) intake of food codes (n=281) including mushrooms and 2) intake of food codes (n=32) designated as “mushrooms”. Sample weighted, covariate-adjusted least square means ± SE were determined and compared using t-tests (p<0.01). Diet quality was calculated using the Healthy Eating Index-2005 (HEI). Results: For consumer definitions 1 and 2, respectively: among consumers, mushroom consumption was 20.6 ± 0.75 g/d (n=2,399) and 39.5 ± 2.6 g/d (n=460). For definition 1: mushroom consumers had higher (p<0.01) intakes of energy, protein, thiamin, niacin, folate, copper, selenium, and sodium, and lower intakes of total and added sugars. HEI-2005 was higher among consumers 52.4 ± 0.4 v 51.3 ± 0.2. For definition 2: mushroom consumers had higher (p<0.01) intakes of protein, fiber, vitamin E, riboflavin, niacin, vitamin C, total choline, copper, potassium, selenium, and sodium than non-consumers. Mushroom consumers had lower (p<0.01) intakes of added sugars and a higher (p<0.01) total HEI-2005 score (54.6 ± 0.9 v 51.4 ± 0.2) than non-consumers. Conclusions: Mushroom consumption was positively associated with higher intake of many nutrients, but lower intake of some nutrients to limit and better diet quality; health professionals should encourage the addition of mushrooms to the diet, especially in ways that are prepared with lower levels of sodium.

Urinary arsenic levels in the French adult population: The French National Nutrition and Health Study, 2006–2007

The French Nutrition and Health Survey (ENNS) was conducted to describe dietary intakes, nutritional status, physical activity, and levels of various biomarkers for environmental chemicals (heavy metals and pesticides) in the French population (adults aged 18–74years and children aged 3–17years living in continental France in 2006–2007). The aim of this paper was to describe the distributions of total arsenic and the sum of iAs+MMA+DMA in the general adult population, and to present their main risk factors.In the arsenic study, 1500 and 1515 adults (requested to avoid seafood intake in the previous 3days preceding urine collection) were included respectively for the analysis of the sum of inorganic arsenic (iAs) and its two metabolites, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), and for the total arsenic. Results were presented as geometric means and selected percentiles of urinary arsenic concentrations (μg/L) and creatinine-adjusted urinary arsenic (μg/g of creatinine) for total arsenic, and the sum of inorganic arsenic and metabolites (iAs+MMA+DMA). The geometric mean concentration of the sum of iAs+MMA+DMA in the adult population living in France was 3.34μg/g of creatinine [3.23–3.45] (3.75μg/L [3.61–3.90]) with a 95th percentile of 8.9μg/g of creatinine (10.68μg/L). The geometric mean concentration of total arsenic was 11.96μg/g of creatinine [11.41–12.53] (13.42μg/L [12.77–14.09]) with a 95th percentile of 61.29μg/g of creatinine (72.75μg/L).Urinary concentrations of total arsenic and iAS+MMA+DMA were influenced by sociodemographic and economic factors, and by risk factors such as consumption of seafood products and of wine. In our study, covariate-adjusted geometric means demonstrated several slight differences, due to consumption of fish, shellfish/crustaceans or wine.This study provides the first reference value for arsenic in a representative sample of the French population not particularly exposed to high levels of arsenic (10μg/g of creatinine). It shows that urinary arsenic concentrations in the French adult population (in particular concentrations of iAs+MMA+DMA) were relatively low compared with foreign data.

Influence of Prenatal Arsenic Exposure and Newborn Sex on Global Methylation of Cord Blood DNA

BackgroundAn emerging body of evidence indicates that early-life arsenic (As) exposure may influence the trajectory of health outcomes later in life. However, the mechanisms underlying these observations are unknown.ObjectiveThe objective of this study was to investigate the influence of prenatal As exposure on global methylation of cord blood DNA in a study of mother/newborn pairs in Matlab, Bangladesh.DesignMaternal and cord blood DNA were available from a convenience sample of 101 mother/newborn pairs. Measures of As exposure included maternal urinary As (uAs), maternal blood As (mbAs) and cord blood As (cbAs). Several measures of global DNA methylation were assessed, including the [3H]-methyl-incorporation assay and three Pyrosequencing assays: Alu, LINE-1 and LUMA.ResultsIn the total sample, increasing quartiles of maternal uAs were associated with an increase in covariate-adjusted means of newborn global DNA methylation as measured by the [3H]-methyl-incorporation assay (quartile 1 (Q1) and Q2 vs. Q4; p = 0.06 and 0.04, respectively). Sex-specific linear regression analyses, while not reaching significance level of 0.05, indicated that the associations between As exposures and Alu, LINE-1 and LUMA were positive among male newborns (N = 58) but negative among female newborns (N = 43); tests for sex differences were borderline significant for the association of cbAs and mbAs with Alu (p = 0.05 and 0.09, respectively) and for the association between maternal uAs and LINE-1 (p = 0.07). Sex-specific correlations between maternal urinary creatinine and newborn methyl-incorporation, Alu and LINE-1 were also evident (p<0.05).ConclusionsThese results suggest that prenatal As exposure is associated with global DNA methylation in cord blood DNA, possibly in a sex-specific manner. Arsenic-induced epigenetic modifications in utero may potentially influence disease outcomes later in life. Additional studies are needed to confirm these findings and to examine the persistence of DNA methylation marks over time.

Nut Consumption Is Associated with Decreased Health Risk Factors for Cardiovascular Disease and Metabolic Syndrome in U.S. Adults: NHANES 1999–2004

Background: Few recent epidemiologic studies have assessed the effect that nut consumption (including tree nuts and peanuts) has on health risks, including metabolic syndrome (MetS).Objective: This study compared the health risk for cardiovascular disease, type 2 diabetes, and MetS of nut consumers with that of nonconsumers.Design: Adults 19+ years (n = 13,292) participating in the 1999–2004 National Health and Nutrition Examination Survey were used. Intake from 24-hour recalls was used to determine intake. Nut/tree nut consumers consumed ≥¼ ounce per day. Covariate-adjusted means, standard errors, and prevalence rates were determined for the nut consumption groups.Results: The prevalence of nut consumers was 18.6% ± 0.7% and 21.0% ± 0.9% in those 19–50 years and 51 years and older, respectively. Nut consumption was associated with a decreased body mass index (27.7 kg/m2 ± 0.2 vs 28.1 ± 0.1 kg/m2, p < 0.05), waist circumference (95.6 ± 0.4 cm vs 96.4 ± 0.3 cm, p < 0.05), and systolic blood pressure (121.9 ± 0.4 mmHg vs 123.20 ± 0.3 mmHg, p < 0.01) compared with nonconsumers. Tree nut consumers also had a lower weight (78.8 ± 0.7 kg vs 80.7 ± 0.3 kg, p < 0.05). Nut consumers had a lower percentage of two risk factors for MetS: hypertension (31.5% ± 1.0% vs 34.2% ± 0.8%, p < 0.05) and low high density lipoprotein-cholesterol (HDL-C) (29.6% ± 1.0% vs 34.8% ± 0.8%, p < 0.01). Tree nut consumers had a lower prevalence of four risk factors for MetS: abdominal obesity (43.6% ± 1.6% vs 49.5% ± 0.8%, p < 0.05), hypertension (31.4% ± 1.2% vs 33.9% ± 0.8%, p < 0.05), low HDL-C (27.9% ± 1.7% vs 34.5% ± 0.8%, p < 0.01), high fasting glucose (11.4% ± 1.4% vs 15.0% ± 0.7%, p < 0.05), and a lower prevalence of MetS (21.2% ± 2.1% vs 26.6% ± 0.7%, p < 0.05).Conclusion: Nut/tree nut consumption was associated with a decreased prevalence of selected risk factors for cardiovascular disease, type 2 diabetes, and MetS.

Effects of Dronabinol, a Non-Selective Cannabinoid Receptor Agonist, on Gastrointestinal and Colonic Transit in Diarrhea-Predominant Irritable Bowel Syndrome

Purpose: Cannabinoid receptors (CBR) are widely expressed on cholinergic neurons in both the central and enteric nervous systems. CBR activation delays gastric emptying in healthy female volunteers. In diarrheapredominant irritable bowel syndrome (IBS-D) patients, CBR activation with dronabinol 5 mg inhibits phasic contractile activity in the left colon [Wong B et al. Gastroenterology 2011;140 (Issue 5, Supplement 1):S-2] without altering high amplitude propagated contractions (HAPC). Nearly 50% of IBS-D patients have accelerated colonic transit. Aim: To compare acute effects of dronabinol, a non-selective CBR agonist, and placebo on colonic transit in IBS-D patients. Methods: We conducted a randomized, double-blind trial in 36 patients with IBS-D by Rome III criteria of oral placebo (n=13), dronabinol 2.5 mg (n=10), or dronabinol 5 mg (n=13) given twice daily (b.i.d.) for 2 consecutive days. A validated scintigraphic method was used to measure gastrointestinal and colonic transit during the 2 days of treatment. We used an intention-to-treat analysis of covariance (ANCOVA) to assess post-drug effects overall and by dronabinol dosage using BMI and the pre-drug baseline colonic geometric center at 24 hours (GC24) as covariates. The primary transit endpoint was post-drug GC24 (on a 0 to 5 scale). Data are reported as covariate-adjusted means ± standard errors. Results: In IBS-D patients, there were no significant overall treatment effects on GC24 (p>0.5) for either dronabinol 2.5 mg b.i.d. (2.69±0.42; p>0.5) or dronabinol 5 mg b.i.d. (3.03±0.34; p>0.5) compared to placebo (3.08±0.36). Dronabinol also had no effect on gastric emptying, or small bowel transit at either dosages compared to placebo in IBS-D. A numerical (non-significant) decrease in ascending colon (AC) emptying t1/2, which correlates with faster colonic transit, was observed with the dronabinol 5 mg b.i.d. dosage (8.9±1.7 hr vs. 11.7±1.9 hr with placebo; p=0.3). Similarly, the numerically greater colonic transit at 48 hours with 5mg dose (4.53±0.27) compared to placebo (4.10±0.29, p=0.3) was not significant. Conclusion: In IBS-D patients, the non-selective CBR agonist, dronabinol 2.5 mg or 5 mg twice daily, did not delay gastrointestinal or colonic transit. The numerically faster colonic emptying with the 5mg dosage is consistent with A.M. Connell's demonstration (Gut 1962;3:342-8) that irregular phasic activity slows colonic transit, since the inhibition of phasic contractility by dronabinol 5 mg dose is associated with a trend to facilitated colonic transit. This study was supported by RO1 DK-079866 award from National Institutes of Health.

Dried fruit consumption is associated with improved diet quality and reduced obesity in US adults: National Health and Nutrition Examination Survey, 1999-2004

Epidemiological studies examining potential associations between dried fruit consumption, diet quality, and weight status are lacking. The goal of this study was to examine the association of dried fruit consumption with nutrient intake, diet quality, and anthropometric indicators of overweight/obesity. A secondary analysis of dietary and anthropometric data collected from adult (19+ years) participants (n = 13292) of the 1999-2004 National Health and Nutrition Examination Survey was conducted. Dried fruit consumers were defined as those consuming amounts ⅛ cup-equivalent fruit per day or more and identified using 24-hour recalls. Diet quality was measured using the Healthy Eating Index 2005. Covariate-adjusted means, SEs, prevalence rates, and odds ratios were determined to conduct statistical tests for differences between dried fruit consumers and nonconsumers. Seven percent of the population consumed dried fruit. Mean differences (P < .01) between consumers and nonconsumers in adult shortfall nutrients were dietary fiber (+6.6 g/d); vitamins A (+173 μg retinol activity equivalent per day), E (+1.5 mg α-tocopherol per day), C (+20 mg/d), and K (+20 mg/d); calcium (+103 mg/d); phosphorus (+126 mg/d); magnesium (+72 mg/d); and potassium (+432 mg/d). Dried fruit consumers had improved MyPyramid food intake, including lower solid fats/alcohol/added sugars intake, and a higher solid fats/alcohol/added sugars score (11.1 ± 0.2 vs 8.2 ± 0.1) than nonconsumers. The total Healthy Eating Index 2005 score was significantly higher (P < .01) in consumers (59.3 ± 0.5) than nonconsumers (49.4 ± 0.3). Covariate-adjusted weight (78.2 ± 0.6 vs 80.7 ± 0.3 kg), body mass index (27.1 ± 0.2 vs 28.1 ± 0.2), and waist circumference (94.0 ± 0.5 vs 96.5 ± 0.2 cm) were lower (P < .01) in consumers than nonconsumers, respectively. Dried fruit consumption was associated with improved nutrient intakes, a higher overall diet quality score, and lower body weight/adiposity measures.

Trends in health-related quality of life and health service use associated with comorbid diabetes and major depression in South Australia, 1998–2008

To investigate the trends in health-related quality of life and health service use associated with diabetes and/or major depression in South Australia from 1998 to 2008. Data analyzed were from 9,059 persons aged ≥15years who participated in representative surveys of the South Australian population in 1998, 2004 and 2008. Major depression was determined using the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Diagnosed diabetes and health service use were determined by self-report. Health-related quality of life was assessed using the 36-item Short-Form Health Survey (SF-36) and the 15-item Assessment of Quality of Life (AQoL) instruments. Socio-demographics (including mental health literacy), arthritis, asthma, osteoporosis, and obesity covariates were determined by self-report. Weighted age-standardized and multiple covariate-adjusted means of dependent measures were computed. The prevalence of diabetes only, major depression only, and comorbid diabetes and major depression increased by 3.0 (74%), 2.6 (36%), and 0.4 (53%) percentage points, respectively, from 1998 to 2008. Mean health-related quality of life scores were 9 to 41% lower (worse), and health service use was 49% higher for persons with comorbid diabetes and major depression than for those with diabetes only (all P values <0.05) independent of all covariates, consistently over the 10-year period. If past trends continue, our results suggest that the increased population health and economic burden of comorbid diabetes and major depression could persist over the next decade or so. These trends have important implications for making health policy and resource allocation decisions.

Candy consumption was not associated with body weight measures, risk factors for cardiovascular disease, or metabolic syndrome in US adults: NHANES 1999-2004

There is limited research examining the relationship of candy consumption by adults on diet and health. The purpose of this study was to determine total, chocolate, or sugar candy consumption and their effect on energy, saturated fatty acid and added sugar intake, weight, risk factors for cardiovascular disease, metabolic syndrome (MetS), and diet quality in adults 19 years and older (n = 15,023) participating in the 1999-2004 National Health and Nutrition Examination Survey. Twenty-four-hour dietary recalls were used to determine intake. Covariate-adjusted means ± SE and prevalence rates were determined for candy consumption groups. Odds ratios were used to determine the likelihood of cardiovascular risk factors and MetS. A total of 21.8%, 12.9%, and 10.9% of adults consumed total, chocolate, and sugar candy, respectively. Mean daily per capita intake of total, chocolate, and sugar candy was 9.0 ± 0.3, 5.7 ± 0.2, and 3.3 ± 0.2 g, respectively; intake in consumers was 38.3 ± 1.0, 39.9 ± 1.1, and 28.9 ± 1.3 g, respectively. Energy (9973 ± 92 vs 9027 ± 50 kJ; P < .0001), saturated fatty acid (27.9 ± 0.26 vs 26.9 ± 0.18 g; P = .0058), and added sugar (25.7 ± 0.42 vs 21.1 ± 0.41 g; P < .0001) intake were higher in candy consumers than nonconsumers. Body mass index (27.7 ± 0.15 vs 28.2 ± 0.12 kg/m(2); P = .0092), waist circumference (92.3 ± 0.34 vs 96.5 ± 0.29 cm; P = .0051), and C-reactive protein (0.40 ± 0.01 vs 0.43 ± 0.01 mg/dL; P = .0487) levels were lower in candy consumers than nonconsumers. Candy consumers had a 14% decreased risk of elevated diastolic blood pressure (P = .0466); chocolate consumers had a 19% decreased risk of lower high-density lipoprotein cholesterol (P = .0364) and a 15% reduced risk of MetS (P = .0453). Results suggest that the current level of candy consumption was not associated with health risks.