Higher Risk Of Chronic Disease Research Articles

Metabolomic and genomic prediction of common diseases in 700,217 participants in three national biobanks

Identifying individuals at high risk of chronic diseases via easily measured biomarkers could enhance efforts to prevent avoidable illness and death. Using ’omic data can stratify risk for many diseases simultaneously from a single measurement that captures multiple molecular predictors of risk. Here we present nuclear magnetic resonance metabolomics in blood samples from 700,217 participants in three national biobanks. We built metabolomic scores that identify high-risk groups for diseases that cause the most morbidity in high-income countries and show consistent cross-biobank replication of the relative risk of disease for these groups. We show that these metabolomic scores are more strongly associated with disease onset than polygenic scores for most of these diseases. In a subset of 18,709 individuals with metabolomic biomarkers measured at two time points we show that people whose scores change have different risk of disease, suggesting that repeat measurements capture changes both to health status and disease risk possibly due to treatment, lifestyle changes or other factors. Lastly, we assessed the incremental predictive value of metabolomic scores over existing clinical risk scores for multiple diseases and found modest improvements in discrimination for several diseases whose clinical utility, while promising, remains to be determined.

Experiences in healthcare for weight management – a qualitative interview study of retired individuals with obesity and low or high education

BackgroundOverweight and obesity are global health concerns, especially significant for older adults at higher risk for chronic diseases. The transition to retirement, altering daily routines, highlights the need for adequate weight management support. Since obesity is a challenging topic in healthcare and socioeconomic inequalities exist in access and utilization, we examined how retired individuals with obesity and low or high education describe their experiences of unmet needs, mismatches, and successes within the healthcare service system for weight management.MethodsThis qualitative interview study is part of the Helsinki Health Study. The participants (N = 20, with a body mass index of at least 30 kg/m2) were selected from a cohort of retired former employees of the City of Helsinki. Half of the interviewees had low education, and the other half had high education. Women and men were equally represented. The interviews were conducted in 2023 and the data were analyzed using inductive thematic analysis.ResultsThree main themes were formed: Deficiencies in engaged care, Services are mismatched with needs, and Facilitating conditions for individual successes. The first main theme had two sub-themes: Condescending attitude and Ignoring weight during the appointment. The second main theme had one sub-theme: Inadequate personnel resources. The third main theme had one sub-theme: Individual opportunities to acquire information and treatment. Educational differences were most clearly reflected in the sub-themes. Participants with low education more often described experiencing a condescending attitude towards them when seeking care and had had difficulties in obtaining time for appointments due to inadequate resources. Participants with high education described broader experiences related to individual opportunities to acquire information and treatment within the healthcare service system than participants with low education.ConclusionsThe participants in this study highlighted the importance of respectful engagement with the subject of their weight and felt that these kinds of interaction skills should still be developed in healthcare personnel. The participants articulated a need for approaches that are tailored to their unique circumstances. According to the participants, long-term group intervention, provided with peer support and supported by a multidisciplinary team, could sustain their weight management.

Co-occurrence of unhealthy lifestyle behaviours in middle-aged adults: findings from the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Middle-aged adults engaging in unhealthy lifestyle behaviors are at higher risk of chronic diseases. However, little is known about the co-occurrence of these behaviors and their determinants. This cohort study examined the co-occurrence of unhealthy lifestyle behaviors (alcohol consumption, diet, physical inactivity, and smoking) in 30,154 middle-aged adults and their associations with sociodemographic factors, social support, and disease history. Alcohol use was measured by the AUDIT, diet by the MiniMeal-Q, and physical inactivity and smoking by single questions. Participants had a mean age of 58 years, with 51% being female. Of them, 14% had no unhealthy behaviors, 38% had one, 36% had two, 10% had three, and 2% had all four. The most common co-occurrence was between physical inactivity and poor diet (38%). Higher education decreased the likelihood of having three or four unhealthy behaviors, while financial difficulties, having no one around who appreciated one’s efforts, and suffering of a lung disease increased it. In conclusion, middle-aged adults exhibit varying levels of unhealthy lifestyle behaviors. Higher education is linked to reduced engagement in multiple unhealthy behaviors, whereas financial strain, lower quality of social support, and lung disease increase the risk.

A research of omics-based biological aging clocks and their applications

Aging, a process of functional decline with the increase of chronological age, is a major risk factor for chronic diseases. Aging shows significant individual differences, which is influenced by both genetic and environmental factors. Accurate measurement of physiological age helps identify individuals with accelerated aging and those at high risk for chronic diseases and mortality, which would promote individual health management and precision medicine for healthy aging. In this paper, we summarize the omics-based aging clocks and discuss their current and future applications.

Optimizing Bodybuilding Training Frequency for Weight Loss and Psychological Well-Being in Overweight Individuals: A 12-Week Study

Background: The increasing incidence of overweight and obesity raises a global public health challenge, with overweight individuals (BMI 25–29.9) at higher risk for chronic diseases like cardiovascular conditions and diabetes (WHO, 2024). While lifestyle changes, including dieting and exercise, are key strategies for weight management, bodybuilding is gaining attention for its potential in fat loss and improving body composition. However, the optimal frequency for bodybuilding sessions in overweight individuals remains unclear. This study explores the effects of different training frequencies on body weight, BMI, and fat loss. Methods: This cross-sectional study involved 90 participants, all classified as overweight (BMI 25–29.9). Participants were recruited through online advertisements and were divided into three groups, each following a 12-week bodybuilding training regimen with varying frequencies: twice, thrice, or five times weekly. Baseline body weight and BMI were recorded before training, and changes were assessed at the end of the program. A short questionnaire evaluated the effects of the training on weight loss, body composition, and psychological outcomes. Results: This study involved 90 participants, primarily aged 25-34 (48.9%). The demographic analysis revealed that males constituted 66.7% of the sample, exhibiting a mean weight loss of 75.23 pounds (p < 0.001) after 12 weeks of bodybuilding training, effectively rejecting the hypothesis that bodybuilding training has no significant impact on weight loss. Additionally, while no significant differences in weight loss were observed based on training frequency (F(2, 87) = 0.791, p = 0.457), both weight loss and body mass index (BMI) significantly improved with training. Conclusion: Overall, regular bodybuilding training positively influenced weight loss, body composition, and psychological well-being.

Risk for hypertension and heart failure linked to high normal serum sodium and tonicity in electronic medical records.

Population aging is fueling an epidemic of age-related chronic diseases. Managing risk factors and lifestyle interventions have proven effective in disease prevention. Epidemiological studies have linked markers of poor hydration with higher risk of chronic diseases and premature mortality. Many individuals do not adhere to recommended hydration levels and could benefit from improved hydration habits. Our study evaluates the use of electronic medical records to confirm the relationship between inadequate hydration and the risk of chronic diseases, which may inform hydration-focused interventions in general healthcare. We analyzed 20-year electronic medical records for 411,029 adults from Israel's Leumit Healthcare Services. Hydration status was assessed using serum sodium and tonicity. We included adults without significant chronic diseases or water balance issues, defined as having normal serum sodium (135-146 mmol/l) and no diagnosis of diabetes. We used Cox proportional hazards models, adjusted for age, to assess the risk of developing hypertension and heart failure. Our findings showed an increased risk of hypertension with elevated serum sodium levels: a 12% rise for the 140-142 mmol/l group and 30% for levels above 143 mmol/l (HR1.30, 95%CI:1.26-1.34). Tonicity over 287 mosmol/kg was associated with a 19% increased risk of hypertension (HR1.19, 95%CI:1.17-1.22). The risk of heart failure also increased, reaching 20% for sodium levels above 143 mmol/l (HR1.20,95%CI:1.12-1.29) and 16% for tonicity above 289 mosmol/kg (HR1.16, 95%CI: 1.10-1.22). The association between sodium and hypertension was observed across genders, while the risk of heart failure was more pronounced in females. Within the healthy Leumit cohort, 19% had serum sodium levels within the 143-146 mmol/l range, and 39% were in the 140-142 mmol/l range. Data analysis from electronic medical records identified a link between serum sodium of 140 mmol/l and above and increased risk of hypertension and heart failure in the general Israeli population. Identifying individuals with high-normal sodium values in healthcare records could guide improvements in hydration habits, potentially leading to better health outcomes.

Child Telomere Length at 11–12 Years of Age Is Not Associated with Pregnancy Complications

Children born from pregnancy complications are at higher risk of chronic diseases in adulthood. Identifying which children born from a complicated pregnancy are likely to suffer from later chronic disease is important in order to intervene to prevent or delay the onset of disease. This study examined the associations between the major pregnancy complications (gestational diabetes, high blood pressure, small- and large for gestational age, and preterm birth) and child telomere length, a biomarker of chronic disease risk. This was a population-based longitudinal analysis using data from the Longitudinal Study of Australian Children. The primary outcome is telomere length, measured in 11–12-year-old children. Multivariable linear regression was used to estimate the association between pregnancy complications and child telomere length, adjusting for a range of a priori confounders. Data from 841 families were used. One in four pregnancies (27.1%) featured a pregnancy complication. In the adjusted analysis, there was no association between pregnancy complications and child telomere length (high blood pressure: mean difference (95% CI): 0.00 (−0.12, 0.12); gestational diabetes (0.05 (−0.10, 0.19)); small for gestational age (0.07 (−0.04, 0.19)); large for gestational age (−0.06 (−0.15, 0.03)); and preterm birth (−0.10 (−0.21, 0.01)). Our results do not support the notion that telomere length is shorter in children born to mothers after a pregnancy complication. Methodological considerations should be rigorous to improve the reproducibility of findings.

Going Beyond Childhood and Gender-Based Violence: Epigenetic Modifications and Inheritance.

Being exposed to childhood or gender-based violence is associated with subsequent adverse events in individual lives. Not only can it cause psychological distress but violence survivors suffer from a range of long-term adverse health outcomes, including higher morbidity, higher mortality, and higher risk of chronic diseases. Epigenetics may be involved in the determinisms of these long-term detrimental effects. A large body of evidence supports this biological mechanism to explain violence-related health impairment in the long term. However, studies specifically focusing on violence are scant and nonunivocal. Epigenetic modifications of genes involved in stress response and in the hypothalamus-pituitary-adrenal axis regulation are the most commonly and consistently reported. Promising evidence also emerged for the use of epigenetic clocks. Finally, although very limited, there is evidence supporting the notion that long-term health impairment may be transmitted from one generation to the other. Overall, despite promising, available evidence is yet incomplete. The overlap with pure psychological mechanisms of health impairment exposes the findings to confounders and hampers strong conclusions. Based on a literature search on PubMed/Embase, our narrative review aims to illustrate the evidence concerning the potential bond between epigenetics and violence, including also possible impacts on later generations. The goal is to encourage further research to help the development of a more holistic approach for such a vulnerable and often neglected population. Further research is warranted to precisely disentangle the role of epigenetics in mediating the long-term health impairment associated with childhood or gender-based violence. Advances in this area may open new avenues of treatment. Epigenetic modifications may indeed be reversible and could be an attractive therapeutic target to minimize the long-term consequences of childhood or gender-based violence.

Triglyceride-glucose index is capable of identifying metabolically obese, normal-weight older individuals

BackgroundThe concept of metabolically obese, normal weight (MONW) has emerged to describe individuals with a normal body mass index (BMI) who are at a relatively high risk of chronic diseases. However, BMI itself is a suboptimal index for the assessment of the health risks associated with visceral fat. The triglyceride-glucose (TyG) index is considered to be a reliable and cost-effective marker of insulin resistance. Therefore, in the present study, we aimed to determine the TyG index cut-off values that could be used to define MONW in older people and to determine the usefulness of these values for the prediction of chronic diseases.MethodsA total of 4,721 participants in the Korea National Health and Nutritional Examination Survey who were ≥ 60 years of age and did not have underweight or obesity were included. MONW was defined using the criteria for metabolic syndrome (MS), and the TyG index was calculated on the basis of the fasting plasma triglyceride and glucose concentrations. Chronic diseases, including T2DM, hypertension, and non-alcoholic fatty liver disease (NAFLD), were diagnosed.ResultsThe prevalence of MS increased from the lowest to the highest TyG index tertile. The cut-off values of the TyG index for MONW were calculated as 8.88 and 8.80 for males and females, respectively. MONW, defined using these cut-off values, was associated with high odds ratios for NAFLD, T2DM, and hypertension in both males and females.ConclusionsThe TyG index cut-off values calculated in the present study can be used to discriminate individuals with MONW from other older individuals without obesity and to predict the risk of chronic diseases. These findings show that the TyG index is an effective and cost-efficient method of assessing the risk of chronic diseases in people with MONW.

Daily Consumption of Golden Berry (Physalis peruviana) Has Been Shown to Halt the Progression of Insulin Resistance and Obesity in Obese Rats with Metabolic Syndrome.

In a study addressing the high risk of chronic diseases in people with diabetes and obesity linked to metabolic syndrome, the impact of a Golden Berry diet was investigated using a diabetic animal model. Obese rats with diabetic characteristics were fed a diet containing five percent Golden Berry for 16 days. This study focused on various parameters including organ weights, expression of metabolic genes, and urinary biomarkers. Post-Golden Berry intake, there was a notable decrease in the body, liver, pancreas, visceral, and subcutaneous adipose tissue weights in these obese, hyperglycemic rats. In contrast, an increase in brown adipose tissue (BAT) cell mass was observed. This diet also resulted in reduced blood glucose levels and normalized plasma biochemical profiles, including cholesterol, triglycerides, LDL, and HDL levels. Additionally, it modulated specific urinary biomarkers, particularly pipe-colic acid, a primary marker for type 2 diabetes. Bioinformatics analysis linked these dietary effects to improved insulin signaling and adipogenesis. Regular consumption of Golden Berry effectively prevented insulin resistance and obesity in rats, underscoring its significant health benefits and the protective role of an antioxidant-rich diet against metabolic syndrome. These findings offer promising insights for future therapeutic strategies to manage and prevent obesity and related chronic diseases.

A LONGITUDINAL STUDY ON SNAP PARTICIPATION AND SELF-REPORTED HEALTH AMONG DIABETIC AND NON-DIABETIC INDIVIDUALS

Abstract Self-reported health is a strong predictor of future health status, new morbidity, mobility decline, illness recovery, and healthcare utilization. Because self-reported health is rooted in social position and social comparison, it dually reflects individual health perceptions and health inequities, especially among those who experience a social struggle for resources. Food insecurity is associated with higher risk of chronic diseases and higher mortality rates. Interventions such as the supplemental nutrition assistance program (SNAP) were created to help address food insecurity. Although morbidity and mortality risks caused by food insecurity is exacerbated for those with nutrition-centered chronic disease, such as diabetes, limited research has assessed the impact of food insecurity and SNAP participation on health among diabetics. Using Health and Retirement Study data, we explore the effect of SNAP participation and food insecurity on the likelihood of reporting fair or poor health comparing 24,446 diabetes to 69,260 non-diabetics individuals aged 65 and above (2004-2020). Our analysis controls for key socioeconomic factors, including age, gender, race/ethnicity, and wealth, accounting for the complex design of HRS. Our key findings reveal that food insecure diabetics have significantly higher odds of reporting fair/poor health, and diabetic SNAP participants also had significantly higher odds of reporting fair/poor health. Our study demonstrates how food insecurity and diabetes concurrently influence health and how, despite the presence of resources, such as SNAP, there was no improvement in self-reported health. This study is important as it highlights the need for future research on the effects of SNAP participation and self-reported health.

What is the association between adverse childhood experiences and late-life cognitive decline? Study of Healthy Aging in African Americans (STAR) cohort study

ObjectivesAdverse childhood experiences (ACEs) are associated with higher risk of chronic disease, but little is known about the association with late life cognitive decline. We examined the longitudinal association between...

Food and Nutrition Literacy as means to fight against inequalities in diet and nutrition

Abstract The concepts of nutrition (or nutritional) (NL) literacy, food literacy (FL), and the extensively described concept of health literacy (HL) are based on the same idea of increasing the degree to which individuals and groups can access and use specific information needed to make health decisions that benefit the community. More specifically, the terms of FL and NL refer to a set of knowledge, competencies, and abilities that are necessary for people to use information regarding food and nutrition in order to achieve and preserve a healthful diet. Nonetheless, the core elements of the two constructs partially differ, since NL mostly involves nutritional information and individuals’ capacity or interest in relation to accessing and using such information in order to maintain nutritional health status, while FL considers mainly the relationship between people and food (or food system) and the capacity to use food responsibly. From a public health nutrition perspective, NL/FL could help to identify individuals with low diet quality and unhealthy eating habits that make them at higher risk of chronic diseases and other health consequences. In fact, although a very large amount of information about food and nutrition is now available to citizens/consumers, they often struggle to recognize evidence-based information and effectively manage their diet in the current “dietary infodemic”. Thus, there is a need to develop and implement interventions in order to increase the public's NL/FL level, beginning from establishing valid instruments to measure the NL/FL and finding specific targets on which to intervene by education and other preventive measures, so as to develop specific awareness to counteract the pressure from GDOs and the effects generated by commercial determinants.

Association of Stair Use With Risk of Major Chronic Diseases

Physical inactivity is associated with a higher risk of chronic diseases. Regular stair use can contribute to increasing physical activity in the population. This study aimed to investigate the association between flights of stairs used daily at home and all-cause mortality and cause-specific incidence and mortality. Of the 502,628 UK Biobank participants recruited between 2007 and 2010, 442,027 (mean age, 56±8 years) had available data and were included in the analyses conducted in 2023. Participants were categorized on the basis of flights of stairs climbed daily (1-5, 6-10, 11-15, >15). The disease-specific outcomes were cardiovascular disease, respiratory disease, cancer, type 2 diabetes, and all-cause dementia. Cox proportional hazard models, adjusted for sociodemographic, lifestyle, and health-related confounding factors, were used to analyze the associations between stair use frequency and health outcomes. Participants were followed up for a median of 10.9 years. Climbing stairs >15 times per day was associated with a lower risk of 8 of the 9 outcomes analyzed than not using stairs. The magnitude of association ranged from 3% (95% CI=0.94, 0.99) lower risk for all-cause cancer to 51% (95% CI=0.39, 0.60) lower risk of chronic obstructive pulmonary disease. Findings were similar for mortality outcomes, with the hazard ratios ranging from 0.82 (95% CI=0.77, 0.87) for all-cause cancer to 0.46 (95% CI=0.23, 0.92) for chronic obstructive pulmonary disease mortality. Stair use was associated with a lower risk of all-cause mortality and cause-specific incidence and mortality independent of confounding factors, including adiposity and multimorbidity.

Chronic refractory immune thrombocytopenia in adolescents and young adults.

Defining immune thrombocytopenia (ITP) in two age groups-children and adults-overlooks the specific clinical features and needs of adolescents and young adults (AYAS). We previously reported a high risk of chronic disease at 12 months (50%); however, data on the course of chronic ITP, the risk of refractoriness and treatment strategies in AYAS are limited. Data from patients aged 12-25 years with chronic primary ITP at 12 months were extracted from three large registries between 2004 and 2021. Clinical and laboratory data were evaluated until 48 months of follow-up (FU). Refractory ITP was defined as the administration of ≥3 different lines of therapy. A total of 427 AYAS (64% female) with chronic ITP were included. Overall, 7% and 14% were classified as 'refractory' at 12 and 48 months of FU respectively. The proportion of males was greater in the refractory group than in the non-refractory group (43% vs. 35%). AYAS with refractory disease displayed lower median platelet counts, more bleeding and a higher need for treatment at initial diagnosis and FU than non-refractory patients. This study reveals that refractory ITP is uncommon in AYAS; however, AYAS with refractory ITP display a high disease burden at all time points, including at initial diagnosis.

Effects of Short- And Medium-Term Exposures to Lower Air Temperature on 71 Novel Biomarkers of Subclinical Inflammation: Results from the KORA F4 Study.

Increasing evidence has revealed that exposure to low temperatures is linked to a higher risk of chronic diseases and death; however, the mechanisms underlying the observed associations are still poorly understood. We performed a cross-sectional analysis with 1115 participants from the population-based KORA F4 study, which was conducted in Augsburg, Germany, from 2006 to 2008. Seventy-one inflammation-related protein biomarkers were analyzed in serum using proximity extension assay technology. We employed generalized additive models to explore short- and medium-term effects of air temperature on biomarkers of subclinical inflammation at cumulative lags of 0-1 days, 2-6 days, 0-13 days, 0-27 days, and 0-55 days. We found that short- and medium-term exposures to lower air temperature were associated with higher levels in 64 biomarkers of subclinical inflammation, such as Protein S100-A12 (EN-RAGE), Interleukin-6 (IL-6), Interleukin-10 (IL-10), C-C motif chemokine 28 (CCL28), and Neurotrophin-3 (NT-3). More pronounced associations between lower air temperature and higher biomarker of subclinical inflammation were observed among older participants, people with cardiovascular disease or prediabetes/diabetes, and people exposed to higher levels of air pollution (PM2.5, NO2, and O3). Our findings provide intriguing insight into how low air temperature may cause adverse health effects by activating inflammatory pathways.

Racial Discrimination and Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Adolescents With Overweight and Obesity: Does Context Matter?

In adolescents at higher risk for chronic disease, the role that context of a discriminatory event may play on cortisol dysregulation is unclear. The purpose of this study was to perform a cross-sectional analysis examining the association between racial discrimination context (peer, educational, institutional, and cumulative) and diurnal cortisol patterning in adolescents with overweight and obesity. One hundred adolescents (13-19 years; 49% non-Hispanic Black; 65% female; body mass index percentile = 93.9% [4.14%]) were included in this analysis. Racial discrimination context was measured using the self-reported Adolescent Discrimination Distress Index. Salivary cortisol, collected across 3 days at five time points during the day, was used to calculate Δ 0-30 minutes, diurnal slope, and average total diurnal cortisol area under the curve. Sixteen separate multivariable linear regression models were performed to analyze the relationship between racial discrimination and diurnal cortisol patterns. Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004, p = .03; peer: β = 0.023 ± 0.010, p = .026). Findings from this study identified cross-sectional associations between racial discrimination experienced among peers and diurnal cortisol patterns in adolescents with overweight/obesity. If our findings were to be confirmed in longitudinal analyses, evidence-based programs should be considered to buffer the effects of discrimination on adolescent health, and more importantly, policy makers should work to eliminate discrimination exposure.

Latest Findings in Key Research Areas of Precision Nursing for Chronic Diseases in Older Adults

The advent of the era of biomedical big data has helped promote the development of precision nursing. Precision nursing for chronic diseases in older adults is an interdisciplinary research field in which accurate individualized data are utilized to carry out early screening and health management of older adult populations at high risk for chronic diseases and early intervention of diseases, which plays an important role in improving the prognosis of diseases and the health level of the older adult population. Herein, we introduced the concept of precision nursing, and discussed the latest research findings in the key areas of precision nursing for chronic diseases in older adults, including precision symptom management in cancer patients and precision nursing in older patients with multimorbidity. At present, research concerning precise symptom management of cancer patients is mainly focused on prediction modelling for risks of symptoms, longitudinal change trajectories, core symptom identification, etc. Investigations in the precise nursing of cancer patients are conducted in the following areas, risk prediction, the timing of interventions, and intervention targets. Research on precision nursing for multimorbidity is mainly focused on assessment of chronic disease multimorbidity, multimorbidity pattern recognition, and health management of multimorbidity. We also discussed potential opportunities and challenges of precision nursing in the future, in order to provide a scientific basis for the improving the practice and theories of precision nursing. In the future, precision nursing will play an ever more important role in uncovering pathogenic information, the diagnosis and treatment of diseases, the health of the research population, and the promotion of medical research.

Brief peer coaching complements daily digital messages for chronic disease prevention among young adult Latinas.

Young Latinas face multiple health challenges that place them at high risk for chronic diseases. Digital health promotion interventions can offer education and support to activate self-care and preventive behaviors. This pilot study evaluated a brief, theory-informed, culturally tailored intervention, Examen Tu Salud, that provided daily text and multimedia messages and weekly peer coaching via videoconference to improve health behaviors among young adult Latina women. Thirty-four participants who self-identified as Latina, female, and 18-29 years old were recruited from an urban college in Northern California to participate in a brief pilot test of the new intervention. Paired sample T-tests assessed health behavior and health activation changes from baseline to 1 month follow-up. Program participation and satisfaction were analyzed to assess feasibility of the intervention. Among 31 participants (91% completion), there were medium to large improvements in health outcomes. Confidence in preventing and managing one's health (t[30] = 5.18, p < .001, d = 0.93), days of moderate-intensity physical activity (t[30] = 3.50, p < .001, d = 0.63), and fruit (t[30] = 3.32, p = .001, d = 0.60) and vegetable (t[30] = 2.04, p = .025, d = 0.37) consumption in a typical day increased. Intervention satisfaction and engagement with health coaches was high. We found that a brief digital coaching intervention designed for young adult Latinas has the potential to improve health activation and behaviors. More attention is needed to prevent chronic conditions among a growing number of Latinos in the USA.

The costs of treating dementia among American Indians with diabetes within the Indian Health Service and Tribal health programs

AbstractBackgroundAmerican Indian and Alaska Native (AI/AN) adults have one of the highest prevalence of diabetes (14.7%) in the United States, nearly double that of the White population. As AI/ANs age, they are at high risk for chronic diseases that have diabetes as a well‐established risk factor, such as cardiovascular complications and dementia. Approximately half of AI adults with dementia have diabetes, but little is known about their treatment costs. Our aims were to profile treatment costs of AI adults with diabetes, with and without dementia, and to understand how dementia influences costs by type of service.MethodWe analyzed fiscal year 2013 treatment cost data from the Indian Health Service and Tribal health programs for American Indian (AI) adults aged ≥65 years with diabetes. Using data for 921 adults with dementia and a matched sample without dementia (n = 921), matched by age, sex, and location, we report actual and adjusted total treatment costs and costs by service type. Adjusted costs were estimated using a generalized linear model with a log link function and gamma distribution.ResultsThe morbidity burden of AI adults with both diabetes and dementia was high. Over seventy percent (71.4%) had cardiovascular disease (CVD) and 39.4% had renal disease. The prevalence of these conditions was lower (57.8% and 30.6%, respectively) among adults with diabetes without dementia. Mean total treatment cost was higher for adults with dementia ($15,978) than for adults without dementia ($8,857), a difference of $7,121. The difference in adjusted total treatment costs between adults with and without dementia was $3,891 (95% confidence interval [CI]: $2,122‐$5,659), most of which was due to the difference in hospital inpatient costs ($3,754; 95% CI: $2,221‐$5,286). Furthermore, among adults with both dementia and CVD, adjusted hospital inpatient costs were $8,114 (95% CI: $6,018‐$10,211), significantly higher than that among adults with dementia only ($2,075; 95% CI: $992‐$3,158) and among adults with CVD only ($3,050; 95% CI: $2,399‐$3,701) (Figure 1).ConclusionKnowing CVD is strongly associated with high inpatient costs among AI adults with both diabetes and dementia may inform enhancements to outpatient and home‐based services that address their CVD health risks.