Large Adult Population Research Articles

Predicting mood outcome following traumatic brain injury (TBI): PTA & demographic variables

AbstractBackground and aims:Mood disturbance is frequent after traumatic brain injury (TBI), often assessed using the Hospital Anxiety and Depression Scale (HADS). Research supports a three-factor HADS structure (anxiety, depression, and psychomotor), although this has not been used to investigate demographic variables and mood outcome post-TBI. This study examined severity of TBI, demographic variables [age, gender, estimated premorbid IQ (EIQ), relationship status, employment status, socio-economic status (SES)], and mood outcome, using HADS factor scores from a large adult population sample in Tasmania.Method:HADS factor scores were calculated for an initial sample of 596 adults. The sample sizes varied according to those attending at 1, 6, 12 and 24 months post-TBI and the available data for each dependent variable.Results:Significantly higher anxiety, depression, and psychomotor scores were reported at most follow-ups by females, the middle-aged, and those with lower IQs. Longer post-traumatic amnesia (PTA) was associated with significantly greater mood problems. Occasional significant findings at earlier follow-ups for the factors were noted for those unemployed. Other variables were rarely significant. PTA, premorbid IQ, and Age were included in most Multiple Regression equations predicting outcome for the factors, with Gender included for Anxiety and depression at 6 months after injury.Conclusions:Key demographic variables and PTA severity relate to mood post-TBI, and contribute to predicting mood outcome. Differences in findings for the three factors support their use in clinical practice.

Deep learning-based muscle segmentation and quantification at abdominal CT: application to a longitudinal adult screening cohort for sarcopenia assessment.

To investigate a fully automated abdominal CT-based muscle tool in a large adult screening population. A fully automated validated muscle segmentation algorithm was applied to 9310 non-contrast CT scans, including a primary screening cohort of 8037 consecutive asymptomatic adults (mean age, 57.1±7.8 years; 3555M/4482F). Sequential follow-up scans were available in a subset of 1171 individuals (mean interval, 5.1 years). Muscle tissue cross-sectional area and attenuation (Hounsfield unit, HU) at the L3 level were assessed, including change over time. Mean values were significantly higher in males for both muscle area (190.6±33.6 vs 133.3±24.1 cm2, p<0.001) and density (34.3±11.1 HU vs 27.3±11.7 HU, p<0.001). Age-related losses were observed, with mean muscle area reduction of -1.5 cm2/year and attenuation reduction of -1.5 HU/year. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes up to the age of 70 years. Between ages 50 and 70, relative muscle attenuation decreased significantly more in females (-30.6% vs -18.0%, p<0.001), whereas relative rates of muscle area loss were similar (-8%). Between ages 70 and 90, males lost more density (-22.4% vs -7.5%) and area (-13.4% vs -6.9%, p<0.001). Of the 1171 patients with longitudinal follow-up, 1013 (86.5%) showed a decrease in muscle attenuation, 739 (63.1%) showed a decrease in area, and 1119 (95.6%) showed a decrease in at least one of these measures. This fully automated CT muscle tool allows for both individualized and population-based assessment. Such data could be automatically derived at abdominal CT regardless of study indication, allowing for opportunistic sarcopenia detection. This fully automated tool can be applied to routine abdominal CT scans for prospective or retrospective opportunistic sarcopenia assessment, regardless of the original clinical indication. Mean values were significantly higher in males for both muscle area and muscle density. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes, and therefore may be a more valuable predictor of adverse outcomes.

Adherence to Mediterranean dietary pattern is inversely associated with depression, anxiety and psychological distress

ABSTRACT Background: Few studies have assessed adherence to the Mediterranean diet in relation to psychological health, in particular in the Middle East. Objective: To examine the association between adherence to Mediterranean dietary pattern and prevalence of psychological disorders among a large population of Iranian adults. Design: In this cross-sectional study on 3172 Iranian adults aged 18–55 years, we used a validated food frequency questionnaire for the assessment of dietary intakes. Adherence to the Mediterranean dietary pattern was examined using the Trichopoulou et al. method. To assess psychological health, the Iranian validated version of the Hospital Anxiety and Depression Scale (HADS) was used. Psychological distress was assessed through the use of General Health Questionnaire (GHQ). Results: Mean age of study participants was 36.54 ± 4.97 years. After controlling for potential confounders, participants with the greatest adherence to the Mediterranean diet had lower odds for depression (OR: 0.60, 95% CI: 0.46–0.78), anxiety (OR: 0.61, 95% CI: 0.42–0.86) and psychological distress (OR: 0.60, 95% CI: 0.45–0.79) compared with those with the lowest adherence. When the association with components of Mediterranean diet was examined, we found that high intake of fruits and vegetables was associated with a lower odds of depression, anxiety and psychological distress. In contrast, high intake of grains was positively associated with depression, anxiety and psychological distress. Conclusion: We found evidence indicating an inverse association between adherence to Mediterranean dietary pattern and odds of psychological disorders including depression, anxiety and psychological distress.

Association between dietary insulin index and load with obesity in adults.

Hyperinsulinemia is linked to the development of various chronic diseases, especially obesity given to the role of insulin responses in body fat accumulation; hence, the current study aimed to examine the association of insulinemic potential of the diet with general and abdominal obesity among a large population of Iranian adults. This cross-sectional study was carried out among 8691 adult participants aged 18-55years. Dietary data were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire. Dietary insulin index (DII) was computed through considering food insulin index values published earlier. Dietary insulin load (DIL) was also calculated using a standard formula. Assessment of anthropometric measures was conducted through a self-administered questionnaire. General obesity was defined as body mass index ≥ 25kg/m2, and abdominal obesity as waist circumference ≥ 94cm for men and ≥ 80cm for women. Mean age of study participants was 36.8 ± 8.1years; 60.3% were women. Compared with the lowest quintile, women in the highest quintile of DIL were less likely to be abdominally obese (OR 0.73; 95% CI 0.57-0.92). Such significant association was not seen after controlling for potential confounders (OR 0.86; 95% CI 0.44-1.67). Neither in crude nor in adjusted models, we observed a significant association between DIL and general obesity among men and women. In terms of dietary insulin index, men in the top quintile of DII were more likely to be generally overweight or obese compared with those in the bottom quintile (OR 1.27; 95% CI 1.00-1.62). This association became non-significant after controlling for demographic characteristics (OR 1.14; 95% CI 0.84-1.56). Furthermore, in thefully adjusted model, women in the top quintile of DII were more likely to have general obesity compared with those in the bottom quintile (OR 1.40; 95% CI 1.07-1.84). We found that adherence to a diet with a high DII was associated with greater odds of general obesity among women, but not in men. Although such information might help to draw conclusions on the practical relevance of the shown findings, further studies, specifically of prospective design, are warranted.

Peak nasal inspiratory flow measurement and visual analogue scale in a large adult population.

Nasal obstruction is the most common symptom in nasal diseases. It can be evaluated objectively, that is by means of peak nasal inspiratory flow (PNIF) measures and/or subjectively by means of validated questionnaires. However, it has been reported that there is a lack of reliable correlation between subjective and objective measurements of nasal obstruction. The aim of the present study was to evaluate the correlation between PNIF measurements and the subjective sensation of nasal obstruction measured by means of a visual analogue scale (VAS) in a large population of consecutive rhinologic patients. Prospective clinical study. Tertiary rhinological referral centre. A total of 641 consecutive subjects were enrolled. Visual analogue scale and PNIF were performed to assess nasal obstruction. Nasal septal deviation was classified according to Mladina classification, and its severity was assessed using three levels of severity. Although weak, there was a significant negative correlation (r=-0.13, P=0.001) between PNIF and VAS. Dividing the population in those affected by nasal septal deviation (NSD) and those affected by chronic rhinosinusitis (CRS), a week negative correlation between PNIF and VAS was again confirmed in both groups (r=-0.208, P=0.006 for NSD and r=-0.13, P=0.04 for CRS). Peak nasal inspiratory flow and VAS were also evaluated according to the grade of polyps and the type and level of septal deviation. Visual analogue scale and PNIF significantly correlated, although with a low degree, in a large population of rhinologic patients. Peak nasal inspiratory flow, being cheap and simple to use, could be a good candidate to assist clinicians dealing with "airway" diseases in their daily clinical practice in order to provide comprehensive information on nasal function. Peak nasal inspiratory flow can in fact give some important rough insights on VAS, but these measurements cannot be alternative to each other.

Validated outcome of treatment changes according to International League Against Epilepsy criteria in adults with drug-resistant focal epilepsy.

SummaryObjectiveAlthough many studies have attempted to describe treatment outcomes in patients with drug‐resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population of adults with drug‐resistant focal epilepsy according to the International League Against Epilepsy (ILAE) outcome criteria.MethodsThis is a multicenter, observational, prospective study of 1053 patients with focal epilepsy diagnosed as drug‐resistant by the investigators. Patients were assessed at baseline and 6, 12, and 18 months, for up to a maximum of 34 months after introducing another AED into their treatment regimen. Drug resistance status and treatment outcomes were rated according to ILAE criteria by the investigators and by at least two independent members of an external expert panel (EP).ResultsA seizure‐free outcome after a newly administered AED according to ILAE criteria ranged from 11.8% after two failed drugs to 2.6% for more than six failures. Significantly fewer patients were rated by the EP as having a “treatment failure” as compared to the judgment of the investigator (46.7% vs 62.9%, P < 0.001), because many more patients were rated as “undetermined outcome” (45.6% vs 27.7%, P < 0.001); 19.3% of the recruited patients were not considered drug‐resistant by the EP.SignificanceThis study validates the use of ILAE treatment outcome criteria in a real‐life setting, providing validated estimates of seizure freedom in patients with drug‐resistant focal epilepsy in relation to the number of previously failed AEDs. Fewer than one in 10 patients achieved seizure freedom on a newly introduced AED over the study period. Pseudo drug resistance could be identified in one of five cases.

Respiratory resistance and reactance in adults with sickle cell anemia: Part 2-Fractional-order modeling and a clinical decision support system for the diagnosis of respiratory disorders.

BackgroundA better understanding of sickle cell anemia (SCA) and improvements in drug therapy and health policy have contributed to the emergence of a large population of adults living with this disease. The mechanisms by which SCA produces adverse effects on the respiratory system of these patients are largely unknown. Fractional-order (FrOr) models have a high potential to improve pulmonary clinical science and could be useful for diagnostic purposes, offering accurate models with an improved ability to mimic nature. Part 2 of this two-part study examines the changes in respiratory mechanics in patients with SCA using the new perspective of the FrOr models. These results are compared with those obtained in traditional forced oscillation (FOT) parameters, investigated in Part 1 of the present study, complementing this first analysis.Methodology/Principal findingsThe data consisted of three categories of subjects: controls (n = 23), patients with a normal spirometric exam (n = 21) and those presenting restriction (n = 24). The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). Initially, it was observed that biomechanical changes in SCA included increased values of fractional inertance, as well as damping and hysteresivity (p<0.001). The correlation analysis showed that FrOr parameters are associated with functional exercise capacity (R = -0.57), pulmonary diffusion (R = -0.71), respiratory muscle performance (R = 0.50), pulmonary flows (R = -0.62) and airway obstruction (R = 0.60). Fractional-order modeling showed high diagnostic accuracy in the detection of early respiratory abnormalities (AUC = 0.93), outperforming spirometry (p<0.03) and standard FOT analysis (p<0.01) used in Part 1 of this study. A combination of machine learning methods with fractional-order modeling further improved diagnostic accuracy (AUC = 0.97).ConclusionsFrOr modeling improved our knowledge about the biomechanical abnormalities in adults with SCA. Changes in FrOr parameters are associated with functional exercise capacity decline, abnormal pulmonary mechanics and diffusion. FrOr modeling outperformed spirometric and traditional forced oscillation analyses, showing a high diagnostic accuracy in the diagnosis of early respiratory abnormalities that was further improved by an automatic clinical decision support system. This finding suggested the potential utility of this combination to help identify early respiratory changes in patients with SCA.

Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population.

This study describes psychotropic medication use in a pediatric and young adult solid organ transplant population. We conducted a retrospective review of the lifetime incidence of psychotropic medication use and associated characteristics in patients seen over a 6-year period at a large pediatric transplant center utilizing univariate and multivariate statistical analyses. The lifetime incidence of psychotropic medication use was 36.5% in 393 patients. Transplant psychiatry provided psychopharmacological consultation to 21.9% of patients. Controlling for age and sex, there were significant associations between psychotropic use and thoracic organ disease (heart/lung) (AOR=2.14; 95% CI: 1.2-3.8; P=0.01), White race (P=0.0002), histories of depressive/mood disorders (AOR=3.68; 95% CI: 1.8-7.7; P=0.0005), attention/learning disorders (AOR=3.30; 95% CI: 1.6-6.9; P=0.001), acute and post-traumatic stress disorders (AOR=10.54; 95% CI: 2.6-42.8; P=0.001), and experiencing bullying (AOR=2.16; 95% CI: 1.03-4.55; P=0.04). In unadjusted tests, significant associations were found between lifetime psychotropic usage and patient anxiety history (OR=2.26; 95% CI: 1.5-3.5; P=0.0002), end-of-life disease progression (OR=3.04; 95% CI: 1.7-5.4; P=0.0002), family psychiatric history (OR=2.17; 95% CI: 1.4-3.4; P=0.0007), and adherence concerns (OR=2.67; 95% CI: 1.7-4.1; P<0.0001). The lifetime incidence of psychotropic medication use among pediatric and young adult transplant patients is substantial. Patients with thoracic organ disease, end-of-life illness, individual/family psychiatric histories, trauma, and bullying histories have particularly high rates. Integrating child psychiatry as part of pediatric transplant teams should be an important consideration for the care of these patients.

Objectively measured sleep and body mass index: a prospective bidirectional study in middle-aged and older adults

BackgroundIn recent years, short sleep has been increasingly recognized as a risk factor for obesity. However, current evidence has so far been limited to cross-sectional studies or longitudinal studies using self-reported sleep. Therefore, we explored the directionality of the association between objectively measured sleep and body mass index (BMI). MethodsThe study consists of 1031 participants from the general population (52% women, 45–91 years at baseline). Sleep, BMI and waist circumference (WC) were measured twice across a follow-up of six years. BMI and WC were measured at the research center. Total sleep time (TST, hrs), sleep onset latency (SOL, min), sleep efficiency (SE, %) and wake after sleep onset (WASO, min) were estimated by a wrist-worn actigraph. In addition, cross-sectional and longitudinal associations in both directions were explored. ResultsAn hour shorter TST was cross-sectionally associated with approximately 0.5 kg/m2 higher BMI. Longitudinally, longer TST and higher SE were associated with lower BMI (βTST = −0.75, 95% CI: −1.08, −0.42; βSE = −0.04, 95% CI: −0.08, −0.01). Conversely, one kg/m2 higher BMI was prospectively associated with 0.02 h shorter TST (95% CI: −0.03, −0.01), and this association was more pronounced over time. Results from analyses with WC were in line with those of BMI. ConclusionsThis is the first study to explore bidirectionality in the association between objectively measured sleep and BMI in a large population of middle-aged and older adults. Indices of poor sleep were associated with higher and less stable BMI across time. Conversely, a high BMI was associated with a decrease in sleep duration. This confirms that the relation between sleep and body size is bidirectional, and changes in either sleep or BMI are likely to co-occur with changes in health through multiple pathways.

Comb Irradiation Has Limited, Interactive Effects on Colony Performance or Pathogens in Bees, Varroa destructor and Wax Based on Two Honey Bee Stocks.

Parasitic mites and pathogens compromise honey bee health. Development of sustainable and integrative methods of managing these problems will minimize their detrimental impact on honey bees. Here, we aimed to determine if the combination of using mite-resistant stocks along with gamma-irradiated combs influences colony health and productivity. The major finding concerned honey bee genotype confirming that Russian honey bees are more resistant to Varroa destructor than Italian honey bees. The effect of comb irradiation was inconsistent showing a significant increase in adult bee population and amount of stored pollen in 2015, but not in 2016. The increased amount of stored pollen was probably associated with larger adult population in colonies with irradiated combs in September 2015 regardless of honey bee stock. Nevertheless, the ability of bees to collect and store more pollen in the irradiated group does not appear to compensate the negative impacts of mite parasitism on honey bees especially in the Italian bees, which consistently suffered significant colony losses during both years. Results of viral analyses of wax, newly emerged bees, and Varroa and their pupal hosts showed common detections of Deformed wing virus (DWV), Varroa destructor virus (VDV-1), Chronic bee paralysis virus (CBPV), and Black queen cell virus (BQCV). Wax samples had on average ~4 viruses or pathogens detected in both irradiated and non-irradiated combs. Although pathogen levels varied by month, some interesting effects of honey bee stock and irradiation treatment were notable, indicating how traits of mite resistance and alternative treatments may have additive effects. Further, this study indicates that wax may be a transmission route of viral infection. In addition, pupae and their infesting mites from Italian colonies exhibited higher levels of DWV than those from Russian colonies suggesting potential DWV resistance by Russian honey bees. CBPV levels were also reduced in mites from Russian colonies in general and in mites, mite-infested pupae, and newly emerged bees that were collected from irradiated combs. However, BQCV levels were not reduced by comb irradiation. Overall, the contribution of irradiating comb in improving honey bee health and colony survival appears to be subtle, but may be useful as part of an integrated pest management strategy with the addition of using mite-resistant stocks.

Influence of overjet and overbite on soft tissue profile in mature adults: A cross-sectional population study.

The aim of this study was to explore the association of soft tissue profile and severity of overbite and overjet in a large adult population. The study population consisted of 1630 adults (age, 46years; 712 men, 919 women), all part of the Northern Finland Birth Cohort 1966. A clinical examination was performed on all subjects, including recording of overjet and overbite, and digital facial (frontal and profile) photographs were obtained. A multivariate regression model was developed to study the correlation of soft tissue measurements with overjet and overbite, considering the effect of sex. The regression model explained approximately 30% of the variability in overjet in our sample and approximately 22% of the variability in overbite. Overjet was related more significantly to upper and lower anteroposterior lip position, and upper and lower facial height (P<0.05). Overbite showed a stronger association with anteroposterior position of the lower lip, pogonion, and soft tissue B-point (P<0.05). Soft tissue profile was weakly to moderately correlated with severity of overjet and overbite in the entire sample. However, in subjects with negative overjet (mandibular prognathism), this association was highly significant.

Spiritual belief and its link with potentially addictive behaviors in a youth sample in Switzerland.

Earlier studies suggested a positive impact of spirituality on addictive disorders, but this effect has rarely been studied in a large adolescent and young adult population. To examine the association between spiritual beliefs (general belief, the supporting role of spiritual belief, the critical role of spiritual belief) and potentially addictive behaviors (tobacco, alcohol, cannabis and other illegal drugs, excessive Internet use and gambling). Data were collected using online self-report questionnaires among a sample of 5179 adolescents and young adults aged 15-24 years in post-mandatory education in Switzerland. Statistical analysis at bivariate and multivariate level was performed. At the bivariate level, spiritual beliefs were linked to a lower risk of tobacco smoking, alcohol misuse and cannabis use as well as an increased risk of Internet overuse and gambling. However, at the multivariate level, controlling for age, gender, language and place of birth, significant associations were found only for alcohol misuse, Internet overuse and gambling. The study provides evidence that spiritual belief could protect youth from the risk of alcohol misuse but could also increase the risk of excessive Internet use and gambling. The role of spiritual beliefs in preventing or motivating these problematic behaviors is of great interest for adolescent health care providers and should be considered in the light of the separation-individuation process and transition from adolescence to adulthood.

The hippocampus underlies the association between self-esteem and physical health

Self-esteem refers to the extent to which we feel positive or negative about ourselves, and reflects an individual’s subjective evaluation of personal worth and attitudes about the self. As one kind of positive psychosocial resources, high self-esteem has been found to buffer the effects of stress on physical health. However, little is known about the possible neural basis underlying the association between physical health and self-esteem. In the present study, we investigated whether the hippocampus served as a neuroanatomical basis for the association between self-esteem and physical health in a large population of healthy young adults. We examined self-esteem and self-reported physical health with the Rosenberg Self Esteem Scale (RSES) and the Chinese Constitution Questionnaire (CCQ) respectively, and gray matter volume of the hippocampus was measured using magnetic resonance imaging. As expected, we found that individuals with higher levels of self-esteem had better self-reported physical health. Importantly, the mediation analysis showed that the gray matter volume of the hippocampus mediated the link between self-esteem and physical health, suggesting its critical role in the neural circuitry through which self-esteem is related to physical health.

Differences in Risk of Sudden Cardiac Death Between Blacks and Whites

BackgroundPrior studies have consistently demonstrated that blacks have an approximate 2-fold higher incidence of sudden cardiac death (SCD) than whites; however, these analyses have lacked individual-level sociodemographic, medical comorbidity, and behavioral health data. ObjectivesThe purpose of this study was to evaluate whether racial differences in SCD incidence are attributable to differences in the prevalence of risk factors or rather to underlying susceptibility to fatal arrhythmias. MethodsThe Reasons for Geographic and Racial Differences in Stroke study is a prospective, population-based cohort of adults from across the United States. Associations between race and SCD defined per National Heart, Lung, and Blood Institute criteria were assessed. ResultsAmong 22,507 participants (9,416 blacks and 13,091 whites) without a history of clinical cardiovascular disease, there were 174 SCD events (67 whites and 107 blacks) over a median follow-up of 6.1 years (interquartile range: 4.6 to 7.3 years). The age-adjusted SCD incidence rate (per 1,000 person-years) was higher in blacks (1.8; 95% confidence interval [CI]: 1.4 to 2.2) compared with whites (0.7; 95% CI: 0.6 to 0.9), with an unadjusted hazard ratio of 2.35; 95% CI: 1.74 to 3.20. The association of black race with SCD risk remained significant after adjustment for sociodemographics, comorbidities, behavioral measures of health, intervening cardiovascular events, and competing risks of non-SCD mortality (hazard ratio: 1.97; 95% CI: 1.39 to 2.77). ConclusionsIn a large biracial population of adults without a history of cardiovascular disease, SCD rates were significantly higher in blacks as compared with whites. These racial differences were not fully explained by demographics, adverse socioeconomic measures, cardiovascular risk factors, and behavioral measures of health.

The effect of cervical spine subtypes on center of pressure parameters in a large asymptomatic young adult population

BackgroundRecent research highlighted that non-lordotic subtypes are common within an asymptomatic population of young adults. The potential mechanisms responsible for the decreased postural control witnessed in healthy participants exhibiting non-lordotic cervical alignment are unclear. Research questionTherefore, the aim of this study is to compare and contrast asymptomatic radiographically derived sagittal cervical alignment subtypes with Center of Pressure (CoP) parameters. MethodsIn this cross-sectional study strict asymptomatic inclusion criteria were met by 150 of the original 182 volunteers. All radiographs were assessed using a multi-method subtype system with participants classified into lordotic and non-lordotic groups. Participants performed 90s narrow stance trials with their eyes closed whilst standing on both a firm surface (FS) and compliant surface (CS) (3 trials per surface). CoP parameters were recorded from a force platform sampling at 100 Hz. Nonparametric statistical tests were conducted to assess differences between groups for each surface type and to determine differences in CoP parameters between FS and CS types. ResultsSignificant differences were found between groups on both surfaces for the anterior to posterior range (FS: p = 0.013; CS: p = 0.023), total excursion (FS: p = 0.029; CS: p = 0.005) and mean velocity of total excursion (FS: p = 0.032; CS: p = 0.004). SignificanceOur data suggest that sagittal plane cervical alignment is a measure capable of distinguishing between the postural control of asymptomatic lordotic and non-lordotic young adult participants on both surfaces types. Furthermore, decreased postural control is present in asymptomatic participants across all non-lordotic subtypes and is not isolated exclusively to those with forward head posture. Consequently, future research endeavours should investigate the clinical significance of these non-lordotic findings in relation to both the potential for early cervical osseous degeneration and the transitional stages of non-specific pain sufferers from previously asymptomatic young adults.

Fat-to-Muscle Ratio: A New Anthropometric Indicator as a Screening Tool for Metabolic Syndrome in Young Colombian People.

Fat-to-muscle ratio has been proposed as an alternative approach for assessing body fat. The objective of this study was to explore fat-to-muscle ratio thresholds in metabolic syndrome (MetS) diagnosis; it was hypothesised that the fat-to-muscle ratio is a good predictive indicator of MetS in a large population of young Colombian adults. For this purpose, a cross-sectional study was conducted on 1416 subjects (66.6% female), aged from 18.1 to 25.1. As part of the study, measurements of the subjects’ anthropometric indicators, serum lipid indices, blood pressure, and fasting plasma glucose were taken. Body composition was measured through bioelectrical impedance analysis (BIA). A new variable (ratio of fat mass to muscle mass, in kg) was calculated. Following the International Diabetes Federation (IDF) definition, MetS includes three or more metabolic abnormalities. Receiver operating characteristic (ROC) curves and logistic regression determined the discriminatory ability of the fat-to-muscle ratio to predict MetS. According to the IDF, the best fat-to-muscle ratio cut-off point for detecting MetS in men was 0.225 kg, with an area under the curve (AUC) of 0.83, sensitivity of 80%, and specificity of 70%. For women, the fat-to-muscle ratio cut-off point was 0.495 kg, the AUC was 0.88, and the sensitivity and specificity were 82% and 80%, respectively. In conclusion, our results showed that the fat-to-muscle ratio cut-off points from ROC analyses demonstrate good discriminatory power for detecting MetS in young Colombian adults.

Ocular signatures of proactive versus reactive cognitive control in young adults.

During the execution of a cognitive task, the brain maintains contextual information to guide behavior and achieve desired goals. The AX-Continuous Performance Task is used to study proactive versus reactive cognitive control. Young adults tend to behave proactively in standard testing conditions. However, it remains unclear how interindividual variability (e.g., in cognitive and motivational factors) may drive people into more reactive or proactive control under the same task demands. We investigated the use of control strategies in a large population of healthy young adults. We computed the proactive behavioral index and consequently divided participants into proactive, reactive, and intermediate groups. We found that reactive participants were generally slower, presented lower context sensitivity, and larger response variability. Pupillary changes and blink rate index cognitive effort allocation. We measured, concomitantly to the task, the pupil size and frequency of blinks associated with the cue maintenance and response intervals. During the cue period, nonfrequent, nontarget cues led to increased pupil dilation and number of blinks in all participants. During the response interval, we found more errors and increased pupil dilation to the probe when all participants had to overcome a response bias generated by the frequent cue. Only reactive participants showed larger response-related pupil when they had to overcome a response bias related to the frequent probe. Contrary to expectations, groups did not differ in ocular measures in the cue period. In conclusion, interindividual differences in cognitive control between healthy adults can be mapped onto different patterns of effort allocation indexed by the pupil.

Greenhouse gas emissions and water footprints of typical dietary patterns in India

Agriculture is a major contributor to India's environmental footprint, particularly through greenhouse gas (GHG) emissions from livestock and fresh water used for irrigation. These impacts are likely to increase in future as agriculture attempts to keep pace with India's growing population and changing dietary preferences. Within India there is considerable dietary variation, and this study therefore aimed to quantify the GHG emissions and water usage associated with distinct dietary patterns.Five distinct diets were identified from the Indian Migration Study – a large adult population sample in India – using finite mixture modelling. These were defined as: Rice & low diversity, Rice & fruit, Wheat & pulses, Wheat, rice & oils, Rice & meat. The GHG emissions of each dietary pattern were quantified based on a Life Cycle Assessment (LCA) approach, and water use was quantified using Water Footprint (WF) data. Mixed-effects regression models quantified differences in the environmental impacts of the dietary patterns.There was substantial variability between diets: the rice-based patterns had higher associated GHG emissions and green WFs, but the wheat-based patterns had higher blue WFs. Regression modelling showed that the Rice & meat pattern had the highest environmental impacts overall, with 0.77 (95% CI 0.64–0.89) kg CO2e/capita/day (31%) higher emissions, 536 (95% CI 449–623) L/capita/day (24%) higher green WF and 109 (95% CI 85.9–133) L/capita/day (19%) higher blue WF than the reference Rice & low diversity pattern.Diets in India are likely to become more diverse with rising incomes, moving away from patterns such as the Rice & low diversity diet. Patterns such as the Rice & meat diet may become more common, and the environmental consequences of such changes could be substantial given the size of India's population. As global environmental stress increases, agricultural and nutrition policies must recognise the environmental impacts of potential future dietary changes.

Abstract 2070: The prevalence of DICER1 pathogenic variation in cancer population databases

Abstract DICER1 is an RNaseIII endonuclease that is crucial for processing pre-microRNA into mature microRNA. The DICER1 syndrome is a rare, autosomal dominant tumor-predisposition disorder associated with pleuropulmonary blastoma, a rare pediatric lung cancer. Somatic missense variation in “hotspot” codons in the RNaseIIIb domain (E1705, D1709, G1809, D1810, E1813) is observed in DICER1-associated tumors. Previously, we found in the general population (non-TCGA ExAC) that the prevalence of pathogenic DICER1 variation is approximately 1:10,000. In this study, we investigated the prevalence of pathogenic DICER1 variation in common adult and pediatric cancers. We examined two publicly-available cancer datasets: TCGA (adult; 32 cancer types; 9,173 exomes) and TARGET (pediatric; 3 cancer types; 236 exomes). TCGA bam files were downloaded and germline variants were called. Germline VCF files were obtained from TARGET investigators. All datasets were annotated with snpEff and ANNOVAR. Variants were binned into 4 categories: likely benign (LB), variant of unknown significance (VUS), likely pathogenic (LP), or pathogenic (P). We reviewed publicly-available pathology images for the TCGA tumors. The prevalence of DICER1 P/LP variants (in all cancers combined) was 1:834 and 1:118 in TCGA and TARGET, respectively. To reduce potential prevalence inflation, we conducted a more stringent prevalence calculation by only considering loss-of-function and hotspot variants. The prevalence of P variants was approximately 1:4586 in TCGA and 1:236 in TARGET. With these more stringent criteria, a single participant with a uterine corpus endometrial carcinoma (UCEC in TCGA) harbored a two pathogenic germline DICER1 (hotspot and splice donor) variants, and a second UCEC harbored a somatic DICER1 (hotspot) variant. In TARGET, a single participant with a neuroblastoma harbored a germline DICER1 canonical splice variant. There were no atypical or unusual features noted on pathology review of publicly-available slides from TCGA tumors. In TCGA, across many types of cancer, the prevalence of pathogenic DICER1 variation was higher compared with the general population (~1:4,600 vs. ~1:10,000), a finding driven by one cancer type (UCEC). In the smaller TARGET dataset, we observed a single pathogenic germline variant in neuroblastoma. This is the first comprehensive analysis of DICER1 pathogenic variation in large adult and pediatric cancer populations. The novel association of DICER1 variation with UCEC merits additional investigation. Citation Format: Jung Kim, Kris Ann P. Schultz, D. Ashley A. Hill, Douglas R. Stewart. The prevalence of DICER1 pathogenic variation in cancer population databases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2070.

Anxiety is common and independently associated with clinical features of epilepsy

ObjectiveThe objective of this study was to assess for independent association of anxiety symptoms with epilepsy localization and other epilepsy-related and demographic factors in a large tertiary care adult epilepsy population. MethodsAmong 540 adults, anxiety was measured by the Symptom Checklist 90-R (SCL-90R) anxiety subscale, and detailed demographics, epilepsy localization, and depression scores (SCL-90R) were collected. High anxiety was defined by SCL-90R anxiety T-score ≥ 60. Stepwise multiple logistic regression was carried out to assess for independent association of high anxiety scores with demographic and clinical factors. ResultsHigh anxiety symptoms were present in 46.1% of participants (N = 250). Focal or unknown epilepsy type and depression scores were independently associated with high anxiety (adjusted odds ratios (OR): 2.89 (95% confidence interval [CI] = 1.33–6.29, p = 0.007) and 2.12 (95% CI = 1.83–2.45, p < 0.001), respectively; depression odds per 5-point increase in scale). Among the focal epilepsy subpopulation, mesial temporal sclerosis was also independently associated with high anxiety, with adjusted OR: 2.12 (95% CI = 1.11–4.04, p = 0.023). Lower education, non-white race/ethnicity, Spanish native language, prior head trauma, antiseizure drug polytherapy, and left focus or bilateral foci (in focal epilepsy) were associated with high anxiety in simple logistic regression, but these associations were not independent. A total of 46 individuals (18.4% of those with high anxiety) scored high for anxiety but not depression. Only 26% of those with high anxiety symptoms were taking a potentially anxiolytic medication. ConclusionAnxiety symptoms, often without concomitant depression, were highly prevalent in this epilepsy sample and independently associated with focal/unknown epilepsy and mesial temporal sclerosis. These results strongly support the value of screening specifically for anxiety in the epilepsy clinic, to direct patients to appropriate treatment.