Fourth Quintile Research Articles

Red and processed meat consumption and food insecurity are associated with hypertension; analysis of the National Health and Nutrition Examination Survey data, 2003-2016.

This study examined the joint association of red and processed meat intake and food insecurity with hypertension. Adult participants of the National Health and Nutrition Examination Survey 2003-2016 were included. Total red meat intake was estimated using 24 h dietary recalls. Food insecurity was defined as having three or more affirmative responses using the Food Security Survey Module. Hypertension was defined as having mean SBP of at least 130 mmHg or DBP of at least 85 mmHg or use of antihypertensive drugs. Multivariable surveylogistic regression models were used to examine the independent and joint associations of total red meat and food insecurity with hypertension. A total of 31 314 participants [mean (SE) age of 46.8 (0.3) years] were included, of whom 18.3% were food insecure. Total red meat consumption and food insecurity were independently associated with higher odds of hypertension. Compared with the first quintile of total red meat intake, participants in the fourth and fifth quintiles of total red meat intake had 29 and 39% higher odds of hypertension, respectively (P = 0.003). These associations were stronger among food insecure participants (P value for interaction <0.001). Substituting one serving/day of poultry, fish, eggs, dairy products, or plant-based protein sources for total red meat was each associated with 8-15% lower odds of hypertension. This study provides further evidence regarding the health hazards of total red meat consumption in relation with hypertension and calls for more awareness among food insecure groups.

The Association of Socioeconomic Factors With Outcomes for Coronary Artery Bypass Surgery

BackgroundNumerous studies have identified the associations of socioeconomic factors with outcomes of cardiac procedures. The majority have focused on easily measured factors like sex, race, and insurance status, or on socioeconomic characteristics of patients’ 5-digit zip codes. The impact of more granular census-derived socioeconomic information on outcomes has rarely been studied. MethodsThe independent impact of the Area Deprivation Index (ADI) on short-term mortality and readmissions was tested on patients undergoing isolated coronary artery bypass grafting (CABG) surgery in New York by using it in logistic regression models in conjunction with patient risk factors and typical disparities measures (race, ethnicity, payer). Changes in hospitals’ risk-adjusted outcomes and outlier status with the addition of socioeconomic measures were also tested. ResultsAfter adjusting for numerous patient characteristics, patients in the fourth and fifth highest ADI quintiles (most deprived) were more likely to experience in-hospital/30-day mortality after CABG surgery (adjusted odds ratio [AOR] 1.54, 95% confidence interval [CI] 1.08, 2.20; and AOR 1.50, 95% CI 1.02, 2.21), respectively. ADI was not associated with readmissions, but African Americans (AOR 1.49, 95% CI 1.18, 1.87), Hispanics (AOR 1.33, 95% CI 1.06, 1.65) and Medicaid patients (AOR 1.34, 95% CI 1.09, 1.64) were more likely to be readmitted. ConclusionsPatients with high ADIs are more likely to experience short-term mortality after CABG surgery. African Americans, Hispanics, and Medicaid patients are more likely to experience 30-day readmissions. This information should be taken into account when monitoring patients to reduce adverse events following surgery, and more studies related to ADI are needed to fully understand its implications.

Association between carbohydrate quality index and general and central obesity in adults: A population-based study in Iran.

Introduction: To determine whether dietary carbohydrates quality index (CQI), glycemic index, and glycemic load is associated with general and abdominal obesity. Methods: 850 participants, 20 to 59 years old, were enrolled in a cross-sectional study from five Tehran districts through health houses. The 168 items in the semi--quantitative food frequency questionnaire were used to assess dietary intake. The CQI was calculated by using the following four components: glycemic index, total fiber, solid carbohydrate to total carbohydrate ratio, and whole grains: total grains ratio. Results: After adjusting for confounding factors, the chance of obesity in men (OR=0.38, 95% CI 0.15to 0.95; P =0.04) measured by waist circumference (WC) was significantly lower in the fourth quintile of CQI in comparison with the first quintile. In addition, OR for obesity in men (OR=2.53, 95% CI0.52 to 1.37; P =0.04) was significantly 2.5 times higher among those in the fourth quintile of glycemic index compared with those in the lowest quintile. There was no significant association between dietary carbohydrates with general obesity in men and women. Conclusion: In summary, dietary CQI is significantly inversely related to central obesity in men,according to this study. Additionally, adherence to a diet with a higher glycemic index in men is positively associated with central obesity.

Moderate Freshwater Fish Intake, but Not n-3 Polyunsaturated Fatty Acids, Is Associated with a Reduced Risk of Small for Gestational Age in a Prospective Cohort of Chinese Pregnant Women

BackgroundAlthough previous studies have found that maternal fish intake is associated with fetal growth, the role of freshwater fish intake remains unknown. ObjectiveOur aim was to examine the relationships of freshwater fish and n-3 polyunsaturated fatty acids (PUFAs) intake with the risk of small for gestational age (SGA) in Chinese pregnant women. DesignThis was a prospective analysis of data from the Tongji Birth cohort in Wuhan, China, from 2018 to 2021. Participants/settingsThis study included 1,701 pregnant women who had completed a food frequency questionnaire dietary assessment during mid-pregnancy. Main outcome measuresIntake of fish was assessed by a semi-quantitative food frequency questionnaire. Total intake of n-3 PUFAs was the sum of data collected from both dietary and supplemental sources of n-3 PUFAs. Birth information was extracted from medical records. Statistical analysesMultivariate logistic regression models were applied to estimate odds ratios and 95% CIs. ResultsThe median (interquartile range) intake of freshwater fish and total n-3 PUFAs was 12.1 (4.3 to 26.4) g/d and 68.2 (24.5 to 370.0) mg/d, respectively. Moderate intake of freshwater fish was associated with reduced risk of SGA. Compared with the lowest quintile (0–3.2 g/d), the multivariable-adjusted odds ratio for women in the fourth quintile of freshwater fish intake (17.9 to 30.0 g/d) was 0.50 (95% CI 0.25 to 0.96). We found a nonlinear association between freshwater fish intake and SGA risk (Pnonlinearity = .027). However, maternal n-3 PUFAs intake was not significantly associated with SGA risk, either from total intake or from dietary sources alone. ConclusionsModerate freshwater fish intake during pregnancy is associated with lower risk of SGA in a Chinese population. This finding provides supportive evidence for freshwater fish intake during pregnancy, particularly for the inland areas of developing countries.

Risky youth to risky adults: Sustained increased risk of crash in the DRIVE study 13 years on

The objective of this study was to investigate if drivers who exhibit risky driving behaviours during youth (aged 17–24 years) have an increased risk of car crash up to 13 years later.We used data from the DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia. The data were linked with police crash, hospital and deaths data up to 2016. We analysed differences in crash associated with 13 items of risky driving behaviours using negative binominal regression models adjusted for driver demographics, driving exposure and known crash risk factors. The items were summarised in one index and grouped into quintiles for the analysis.After adjusting for confounding, drivers of the third (RR 1.16, 95% CI 1.05–1.30), fourth (RR1.22, 95% CI1.09–1.36) and fifth quintile (RR 1.36, 95% CI 1.21–1.53) had higher crash rates compared to the lowest risk-takers. Drivers with the highest scores on the risky driving measure had higher rates of crash related hospital admission or death (RR 1.92, 95% CI 1.13–3.27), crashes in wet conditions (RR 1.35,95% CI 1.05–1.73), crashes in darkness (RR 1.55, 95% CI 1.25–1.93) and head-on crashes (RR 2.14, 95% CI 1.07–4.28), compared with drivers with the lowest scores.Novice adolescent drivers who reported high levels of risky driving when they first obtained a driver licence remained at increased risk of crash well into adulthood. Measures that successfully reduce early risky driving, have the potential to substantially reduce road crashes and transport related injuries and deaths over the lifespan.

886Serum folate and risk of disabling dementia: Community-based nested case-control study

Abstract Background Folate regulates homocysteine metabolism and high blood homocysteine level has been associated with risk of dementia. Accordingly, serum folate is hypothesized to decrease the risk of dementia but epidemiological evidence, especially for Japanese, is scant. The aim of this study was to examine associations between serum folate and risk of disabling dementia within a Japanese cohort over 20 years of follow-up. Methods We performed an intracohort case-control study nested in a community-based cohort, the Circulatory Risk in Communities Study (CIRCS), involving 13934 Japanese individuals aged 40-84 years at the baseline period of 1984-2005. Serum folate was measured in 511 cases of incident disabling dementia, and in 1022 controls whose age (±1 years), sex, area, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. Results Serum folate was inversely associated with risk of disabling dementia. The multivariate odds ratios (95% confidence intervals) were 0.62(0.43-0.88), 0.71(0.49-1.00), 0.63(0.43-0.91), and 0.51(0.34-0.76) for persons with the second, third, fourth, and highest quintiles of serum folate, respectively, compared with the lowest quintiles (P for trend = 0.19). Conclusions Low serum folate level was associated with increased risk of disabling dementia among Japanese. Key messages e Low folate intake may have an adverse effect on developing dementia.

Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting

AbstractIron deficiency (ID) anemia in pregnancy is associated with poor maternal and childhood outcomes, yet ferritin testing, the standard test for ID, is not considered part of routine prenatal bloodwork in Canada. We conducted a retrospective cohort study of 44 552 pregnant patients with prenatal testing at community laboratories in Ontario, Canada, to determine the prevalence of ferritin testing over 5 years. Secondary objectives were to determine the prevalence and severity of ID and to identify clinical and demographic variables that influence the likelihood of ID screening. A total of 59.4% of patients had a ferritin checked during pregnancy; 71.4% were ordered in the first trimester, when the risk of ID is lowest. Excluding patients with abnormally elevated ferritins, 25.2% were iron insufficient (30-44 µg/L) and 52.8% were iron deficient (≤29 µg/L) at least once in pregnancy. A total of 8.3% were anemic (hemoglobin <105 g/L). The proportion of anemic patients with a subsequent ferritin test in pregnancy ranged from 22% to 67% in the lowest and highest anemia severity categories, respectively. Lower annual household income was negatively associated with the odds of a ferritin test; compared with those in the fifth (ie, highest) income quintile, the odds of ferritin testing for patients in the first, second, and fourth quintiles were 0.83 (95% confidence interval [CI], 0.74-0.91), 0.82 (95% CI, 0.74-0.91), and 0.86 (95% CI, 0.77-0.97), respectively. These data highlight gaps in prenatal care and issues of health equity that warrant harmonization of obstetrical guidelines to recommend routine ferritin testing in pregnancy.

Red cell distribution width is a predictor of all-cause mortality in hospitalized dogs.

To determine whether RBC distribution width (RDW) is associated with an increased odds of mortality in hospitalized dogs and cats. Retrospective, single-center study; data collected from 2007 to 2017. University teaching hospital. Six thousand six hundred and sixty-one animals (5183 dogs and 1478 cats). None. Medical records were identified from animals presented to the emergency service and admitted to the ICU with a CBC and serum biochemistry performed on admission. Patients were stratified into quintiles based upon presenting RDW, and logistic regression modeling was performed to evaluate the relationship between RDW and in-hospital mortality. Canine patients with a presenting RDW in the upper fourth and fifth quintiles had an increased odds of all-cause in-hospital mortality (p<0.0001). Specifically, dogs in the upper fifth quintile had a 2.1-fold greater odds of death compared to dogs in the first quintile, and dogs in the upper fourth quintile had a 1.9-fold greater odds of death compared to dogs in the first quintile. This relationship remained significant after adjusting for age, sex, key laboratory values excluding HCT, medical versus surgical disease, and diagnosis category. This relationship was no longer significant with the inclusion of HCT. No significant association was identified between presenting RDW and in-hospital mortality in cats. Hospitalized dogs with higher RDW on presentation to the emergency service have greater odds of all-cause in-hospital mortality compared to dogs with a lower RDW. A similar association between RDW and mortality was not found in cats. Further studies are warranted to assess the usefulness of this biomarker for specific diseases in dogs and to better understand the mechanisms driving the association between increased RDW and mortality in canine patients.

The association between postnatal exposure to ambient temperature and rapid infant weight gain

BACKGROUND AND AIM: The global prevalence of childhood overweight and obesity has risen dramatically in recent years. Previous studies found associations between rapid infant weight gain and risk of obesity. We suggest exposure to high ambient temperatures may lead to infant weight gain, potentially through lower energy expenditure from reduced brown adipose tissue activation. We aimed to examine associations between exposure to ambient temperature and weight gain during infancy. METHODS: This is a large population-based historical cohort study, using data from the Israeli national public network of maternal and child health clinics from 2008 to 2013. We assessed exposure to ambient temperature using a high-resolution hybrid spatio-temporal model and calculated the annual mean and minimum temperature for each infant based on daily mean and minimum temperatures at the child health clinic location. We fitted logistic regression and general additive models with thin plate regression splines to explore the association between ambient temperature and rapid infant weight gain, defined as a difference of 0.66 in adjusted weight z-scores between birth and one year of age. RESULTS:The study population included 217,310 singleton-term infants. Logistic regression models demonstrated a J-shaped association between minimum ambient temperature exposure and rapid infant weight gain. When compared to infants exposed to the third quintile of minimum temperature, infants exposed to the fourth and fifth quintiles presented a higher adjusted risk of rapid infant weight gain, odds ratio = 1.06 (95% CI 1.03, 1.10) and odds ratio = 1.09 (95% CI 1.05, 1.13) respectively. These associations were similar but slightly weaker when examining mean ambient temperature. CONCLUSIONS:Exposure to higher ambient temperatures in Israel is associated with an increased risk of rapid infant weight gain. Since this association has not been previously examined, it should be studied in other populations, and causality should be explored. KEYWORDS: Children's environmental health, Climate, Temperature

Proxy exposure indicators for indoor air pollution, health impact and deprivation in the Marche region, Italy

BACKGROUND AND AIM: In 2016 indoor pollution caused 3.8 million deaths attributable to respiratory, cardiovascular diseases and cancers. The aim of this study is to evaluate in our Marche region, possible association between hospitalization for asthma, Extrinsic Allergic Alveolitis (EAA) and Carbon Monoxide Intoxication (COI) and two proxy indicators of the exposure to indoor air pollution, such as PM2.5 concentration and socioeconomic deprivation index (DI). METHODS: We included subject’s hospital admissions residing in the Marche region between 2006 and 2013. For PM2.5 air concentrations we used estimates provided by the atmospheric modelling system of Italian National Integrated Assessment Model (AMS-MINNI). Exposure was defined on the basis of the quintiles of PM2.5 municipalities distribution values. Socio-economic disadvantage was measured through the DI built considering five features of the resident population: low instruction, unemployment/first job-employment, rent living, being part of a single parent family and high population density. The DI provides following municipalities classification: very wealthy, wealthy, middle, deprived, very deprived. RESULTS:Regarding asthma, results show a higher risk of hospitalization with the increasing of PM2.5 concentration quintiles. The risk increases by 35% (90% CI 1.09-1.65) for the third and fourth quintile compared to the first and 30% (90% CI 1.07-1.59) for the highest quintile. For EAA and CO intoxication there is an evident risk gradient of hospitalization as the DI increases despite the low number of events for these pathologies. CONCLUSIONS:This work confirms that PM2.5 concentration has an impact in increasing hospital admissions due to asthma and suggests a possible correlation between lower socio-economic status and increased risk of hospitalization due to EAA and CO intoxication. KEYWORDS: Air pollution, Socio-economic factors, Allergies, Respiratory outcomes, Asthma

The perils of using predicted values in place of observed covariates: an example of predicted values of body composition and mortality risk

Several studies have assessed the relation of body composition to health outcomes by using values of fat and lean mass that were not measured but instead were predicted from anthropometric variables such as weight and height. Little research has been done on how substituting predicted values for measured covariates might affect analytic results. We aimed to explore statistical issues causing bias in analytical studies that use predicted rather than measured values of body composition. We used data from 8014 adults ≥40 y old included in the 1999-2006 US NHANES. We evaluated the relations of predicted total body fat (TF) and predicted total body lean mass (TLM) with all-cause mortality. We then repeated the evaluation using measured body composition variables from DXA. Quintiles and restricted cubic splines allowed flexible modeling of the HRs in unadjusted and multivariable-adjusted Cox regression models. The patterns of associations between body composition and all-cause mortality depended on whether body composition was defined using predicted values or DXA measurements. The largest differences were observed in multivariable-adjusted models which mutually adjusted for both TF and TLM. For instance, compared with analyses based on DXA measurements, analyses using predicted values for males overestimated the HRs for TF in splines and in quintiles [HRs (95% CIs) for fourth and fifth quintiles compared with first quintile, DXA: 1.22 (0.88, 1.70) and 1.46 (0.99, 2.14); predicted: 1.86 (1.29, 2.67) and 3.24 (2.02, 5.21)]. It is important for researchers to be aware of the potential pitfalls and limitations inherent in the substitution of predicted values for measured covariates in order to draw proper conclusions from such studies.

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg

ObjectivesWe investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability...

Birth Weight and Adult Obesity Index in Relation to the Risk of Hypertension: A Prospective Cohort Study in the UK Biobank.

Objectives: To investigate the association between birth weight and the risk of hypertension, and to examine the interaction between birth weight and the adult obesity index.Methods: We included 199,893 participants who had birth weight data and no history of hypertension at baseline (2006–2010) from the UK Biobank. A multivariate cubic regression spline was used to visually explore the dose-response relationship. Multivariate Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).Results: We observed a nonlinear inverse association between birth weight and hypertension. The risk for hypertension decreased as birth weight increased up to approximately 3.80 kg. Compared with the participants with the fourth quintile of birth weight (3.43–3.80 kg), those with the first quartile of birth weight (<2.88 kg) were associated with a 25% higher risk of hypertension [HR 1.25; 95% CI (1.18–1.32)]. In addition, the participants with birth weight <2.88 kg and body mass index ≥30 kg/m2 had the highest risk [HR 3.54; 95% CI (3.16–3.97); p for interaction <0.0001], as compared with those with birth weight between 3.43–3.80 kg and body mass index between 18.5–25.0 kg/m2. These associations were largely consistent in the stratified and sensitivity analyses.Conclusion: Our findings indicate that lower birth weight is nonlinearly correlated with higher risk of hypertension, and birth weight between 3.43–3.80 kg might represent an intervention threshold. Moreover, lower birth weight may interact with adult obesity to significantly increase hypertension risk.

Perceived Neighborhood Environment Associated with Sarcopenia in Urban-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS).

Sarcopenia is associated with adverse health outcomes among older individuals. However, little is known about its association with neighborhood environmental factors. We explored the relationship between sarcopenia and perceived neighborhood environmental factors among community-dwelling older adults aged 70–84 years. We analyzed 1778 participants (mean age of 75.9 ± 3.8 years; 54.0% women) who lived in urban areas and underwent dual-energy X-ray absorptiometry from the Korean Frailty and Aging Cohort Study. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 definition. Perceived neighborhood environmental factors were assessed using the Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). In the multivariate analysis, compared to the fifth quintile of the IPAQ-E score, the odds ratios (ORs) and 95% confidence intervals (CIs) for sarcopenia in the first, second, third, and fourth quintiles were 2.13 (1.40–3.24), 1.72 (1.12–2.64), 1.75 (1.15–2.66), and 1.62 (1.06–2.47), respectively. These neighborhood environmental characteristics were linked with an increased likelihood of sarcopenia: no public transportation access (OR = 2.04; 95% CI = 1.19–3.48), poor recreational facilities access (OR = 1.39; 95% CI = 1.01–1.90), absence of destination (OR = 1.53; 95% CI = 1.06–2.20), many hill hazards (OR = 1.36; 95% CI = 1.03–1.78), and lack of traffic safety (OR = 1.35; 95% CI = 1.02–1.78). Thus, better neighborhood environmental strategies may help prevent sarcopenia among urban-dwelling older adults.

Association of dietary fiber intake with metabolic syndrome among adult cancer survivors: a population-based cross-sectional study

Nutrient intake for adult cancer survivors is of clinical importance for managing metabolic health. Whether dietary fiber intake is associated with metabolic syndrome (MetS) or not in adult cancer survivors is uncertain. We aim to investigate the association between dietary fiber intake and MetS in adult cancer survivors using a population-based cross-sectional study. A study sample of 1301 adult cancer survivors aged more than 20 years from the sixth and seventh Korea Nutrition Examination Survey (KNHANES) from 2013 to 2018 was identified. Odds ratio (OR) and 95% confidence intervals (95% CI) were estimated from multiple logistic regression adjusted for sociodemographic factors, health behavior, and nutritional status. Among 1,301 adult cancer survivors identified from the KNHANES 2013–2018, the mean dietary fiber intake was 28.1 g/day (standard error, 0.54). Compared to the first quintile of dietary fiber intake, the adjusted ORs and 95% CIs for MetS in the second, third, fourth, and fifth quintiles of dietary fiber intake were 0.84 (0.27–2.61), 0.77 (0.16–3.74), 0.55 (0.14–2.22), and 0.26 (0.05–1.39), respectively (p value for trend = 0.0007). Our findings suggest that high dietary fiber intake is marginally associated with reduced odds of MetS in adult cancer survivors.

Serum Folate and All-Cause Mortality is of Non-Linear Relationship Among Population with Chronic Kidney Disease: A Retrospective Cohort Study.

AimA transition toward high serum folate concentrations has been noticed following the mandatory folate fortification. To explore this further, we studied the relationship between folate and health outcomes in population with chronic kidney disease (CKD).MethodsWe retrospectively explored the relationships between serum folate and risk of all-cause death in this population. We analyzed data of 2142 subjects with CKD who participated in the National Health and Nutrition Examination Survey (NHANES) 1999–2006. Vital status was followed through December 31, 2006.ResultsCox regression was used to estimate hazard ratios (HRs) of mortality for individuals with serum folate in rest quintiles compared with individuals with the fourth quintile. After an average follow-up of 57.4 months with 157 deaths recorded, a reversed J-shaped association was revealed after conducting multivariable adjustment. The mortality rate in population with lower and higher folate levels were 8.29% and 12.67%, respectively, and the corresponding adjusted HRs were 2.41 (95% confidence interval, CI=1.32–4.40) and 2.10 (1.20–3.70). Kaplan–Meier curve showed survival benefits for the fourth quintile of serum folate as compared to the first and fifth quintile.ConclusionSerum folate concentrations may influence all-cause mortality in a non-linear pattern in the CKD population. It is reasonable to recommend periodic surveillance in the CKD population to maintain the serum folate concentration in an appropriate level.

Association between birth weight and risk of cardiovascular disease: Evidence from UK Biobank

Background and aimsBirth weight has been linked to cardiovascular disease (CVD) risk in adulthood, but no consensus has emerged on the threshold of birth weight for the lowest CVD risk and few studies have examined potential interaction between birth weight and adult adiposity. Methods and resultsA total of 256,787 participants, who had birth weight data and were free of CVD at baseline, were included from UK Biobank. Multivariate restricted cubic splines and Cox regression models were used to assess the association between birth weight and CVD. We observed nonlinear inverse associations of birth weight with the risk of coronary heart disease (CHD), stroke, and heart failure. Participants with the first quintile of birth weight (≤2.85 kg) had higher risks for CHD (hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.15–1.32), stroke (HR = 1.19, 95% CI: 1.03–1.37), and heart failure (HR = 1.28, 95% CI: 1.11–1.48), as compared to the fourth quintile (3.41–3.79 kg). There was a significant interaction between birth weight and adult body mass index (BMI) on CHD and heart failure (both P for interaction <0.001), showing the highest risk for those who had birth weight ≤2.85 kg and BMI ≥30 kg/m2 (HR = 1.96, 95% CI: 1.70–2.25 and HR = 2.39, 95% CI: 1.77–3.22, respectively). ConclusionsOur findings indicate nonlinear inverse associations between birth weight and CVD risk, with a threshold of 3.41–3.79 kg for the lowest risk. Moreover, low birth weight may interact with adult obesity to increase the risk of CHD and heart failure.

Nursing Home Profit Margins and Citations for Infection Prevention and Control

ObjectivesRecent rampant spread of COVID-19 cases in nursing homes has highlighted the concerns around nursing homes’ ability to contain the spread of infections. The ability of nursing homes to invest in quality improvement initiatives may depend on resource availability. In this study, we sought to examine whether lower profit margins, as a proxy for lack of resources, are associated with persistent infection control citations. DesignWe conducted a retrospective study. Setting and ParticipantsMedicare-certified nursing homes in the US with financial and facility characteristics data (n = 12,194). MethodsWe combined facility-level data on nursing home profit margins from Medicare Cost Reports with deficiency citation data from Nursing Home Compare (2017-2019) and facility characteristics data from LTCFocus.org. We descriptively analyzed infection control citations by profit margins quintiles. We used logistic regressions to examine the relationship between profit margin quintiles and citations for infection prevention and control, adjusting for facility and market characteristics. ResultsAbout three-fourths of all facilities received deficiency citations for infection prevention and control during 1 or more years from 2017 to 2019 with about 10% of facilities cited in all 3 years. Facilities in the highest profit margin quintile had 7.6% of facilities with citations for infection prevention and control in each of the 3 years compared with 8.1%, 10.0%, 10.7%, and 13.7% for facilities in the fourth, third, second, and first quintiles of profit margins, respectively. Multivariable regressions showed that facilities with the lowest profit margins (first quintile) had 54.3% higher odds of being cited in at least 1 year and 87.6% higher odds of being cited in each of the 3 years compared with facilities with the highest profit margins (fifth quintile). Conclusions and ImplicationsOur findings indicate that nursing homes may need more resources to prevent citations for infection prevention and control.

Association between Eating Patterns and Excess Body Weight in Adolescents.

Background: Excess body weight is a risk factor for the development of diseases. Adolescence is a nutritionally vulnerable age group that suffers due to influences on food intake. We aimed to identify the main dietary patterns of adolescents to investigate their association with excess body weight. Methods: This was a cross-sectional study. Anthropometric measurements (weight and height) were collected to calculate the BMI. Nutritional statuses were classified according to World Health Organization classification. Food consumption data were obtained through a 24-hour recall and food patterns were identified through factor analyses of the main components. The patterns were categorized into quintiles and dichotomized into greater (fourth and fifth quintile) and lower (first to third quintile) adherences. Binomial regression was used to assess the association between food patterns and excess body weight. The study was conducted in a capital city in Northeast Brazil from adolescents aged between 10 and 19 years in 826 public schools. Results: Three main food patterns were identified in women and men: coffee with bread (white bread, coffee, fat, and eggs), common Brazilian (white rice, beans, meat, pasta, with negative factor load for regional foods), and mixed pattern (sweets, fruits, biscuits and cakes, vegetables, and dairy products). Adolescents with a greater adherence to the coffee and bread pattern [odds ratio (OR) = 0.68; 95% confidence interval (95% CI): 0.50-0.93] and the common Brazilian pattern (OR = 0.72; 95% CI: 0.53-0.99) had a lower chance of being excess body weight than those with lower adherence. Conclusions: Three main eating patterns were identified among adolescents, and greater adherence to the coffee with bread and common Brazilian patterns implied a lower chance of excess body weight.

Plasma Concentrations of Magnesium and Risk of Dementia: A General Population Study of 102 648 Individuals.

Low and high concentrations of plasma magnesium are associated with increased risk of future all-cause dementia; however, the underlying reasons remain elusive. The magnesium ion is an important electrolyte serving as a cofactor in many enzymatic processes in the human organism. Magnesium affects both neuronal and vascular functions. We investigated the associations of plasma concentrations of magnesium associate with common subtypes of dementia as Alzheimer dementia and non-Alzheimer dementia, and potential pathways by which magnesium may affect risk of dementia. Plasma concentrations of magnesium were measured in 102 648 individuals from the Copenhagen General Population Study. Cox regression and natural effects mediation analyses evaluated associations with either Alzheimer dementia or non-Alzheimer dementia. Multifactorially adjusted hazard ratios for non-Alzheimer dementia were 1.50(95% confidence interval (CI):1.21-1.87) for the lowest and 1.34(1.07-1.69) for the highest vs the fourth quintile (reference) of plasma magnesium concentrations. Diabetes, cumulated smoking, stroke, and systolic blood pressure mediated 10.4%(3.1-22.8%), 6.8%(1.2-14.0%), 1.3%(0.1-3.6%), and 1.0%(0.2-2.6%), respectively, in the lowest quintile, whereas stroke mediated 3.2%(0.4-11.9%) in the highest quintile. No associations were observed for Alzheimer dementia. Low and high plasma magnesium concentrations were associated with high risk of vascular-related non-Alzheimer dementia, with the lowest risk observed at a concentration of 2.07 mg/dL (0.85 mmol/L). No association was observed for Alzheimer dementia. Mediation analysis suggested that diabetes may be in the causal pathway between low plasma magnesium concentrations and high risk of non-Alzheimer dementia, while cumulated smoking, stroke, and systolic blood pressure played minor mediating roles.