Poor Cardiometabolic Health Research Articles

Nightshift Work and Nighttime Eating Are Associated With Higher Insulin and Leptin Levels in Hospital Nurses.

BackgroundCircadian misalignment between behaviors such as feeding and endogenous circadian rhythms, particularly in the context of shiftwork, is associated with poorer cardiometabolic health. We examined whether insulin and leptin levels differ between dayshift versus nightshift nurses, as well as explored whether the timing of food intake modulates these effects in nightshift workers.MethodsFemale nurses (N=18; 8 dayshift and 10 nightshift) completed daily diet records for 8 consecutive days. The nurses then completed a 24-h inpatient stay, during which blood specimens were collected every 3 h (beginning at 09:00) and meals were consumed at regular 3-h intervals (09:00, 12:00, 15:00, and 18:00). Specimens were analyzed for insulin and leptin levels, and generalized additive models were used to examine differences in mean insulin and leptin levels.ResultsMean insulin and leptin levels were higher in nightshift nurses by 11.6 ± 3.8 mU/L (p=0.003) and 7.4 ± 3.4 ng/ml (p=0.03), respectively, compared to dayshift nurses. In an exploratory subgroup analysis of nightshift nurses, predominately eating at night (21:00 – 06:00) was associated with significantly higher insulin and leptin levels than consuming most calories during the daytime (06:00 – 21:00).ConclusionsIn our study of hospital nurses, working the nightshift was associated with higher insulin and leptin levels, and these effects were driven by eating predominately at night. We conclude that although nightshift work may raise insulin and leptin levels, eating during the daytime may attenuate some of the negative effects of nightshift work on metabolic health.

The Oral, Gut Microbiota and Cardiometabolic Health of Indigenous Orang Asli Communities

The Orang Asli (OA) of Malaysia have been relatively understudied where little is known about their oral and gut microbiomes. As human health is closely intertwined with the human microbiome, this study first assessed the cardiometabolic health in four OA communities ranging from urban, rural to semi-nomadic hunter-gatherers. The urban Temuan suffered from poorer cardiometabolic health while rural OA communities were undergoing epidemiological transition. The oral microbiota of the OA were characterised by sequencing the V4 region of the 16S rRNA gene. The OA oral microbiota were unexpectedly homogenous, with comparably low alpha diversity across all four communities. The rural Jehai and Temiar PP oral microbiota were enriched for uncharacterised bacteria, exhibiting potential for discoveries. This finding also highlights the importance of including under-represented populations in large cohort studies. The Temuan oral microbiota were also elevated in opportunistic pathogens such as Corynebacterium, Prevotella, and Mogibacterium, suggesting possible oral dysbiosis in these urban settlers. The semi-nomadic Jehai gut microbiota had the highest alpha diversity, while urban Temuan exhibited the lowest. Rural OA gut microbiota were distinct from urban-like microbiota and were elevated in bacteria genera such as Prevotella 2, Prevotella 9, Lachnospiraceae ND3007, and Solobacterium. Urban Temuan microbiota were enriched in Odoribacter, Blautia, Parabacetroides, Bacteroides and Ruminococcacecae UCG-013. This study brings to light the current health trend of these indigenous people who have minimal access to healthcare and lays the groundwork for future, in-depth studies in these populations.

Examination of Early Childhood Temperament of Shyness and Social Avoidance and Associations With Cardiometabolic Health in Young Adulthood

A child temperament characterized by shyness and avoidance of social interactions is associated with poor peer relationships and emotional problems, yet its long-term associations with adult cardiometabolic health are largely unknown. To examine whether a childhood temperament characterized by shyness and avoidance of social interactions is associated with poor cardiometabolic health. This cohort study included participants who were recruited at birth between April 1991 to December 1992 as part of a prospective longitudinal cohort, the Avon Longitudinal Study of Parents and Children. Follow-up assessments of health behaviors and cardiometabolic health extended into young adulthood (age 24 years). Data analysis was conducted between April and October 2021. Parent reports of temperament across ages 3 to 6 years were used to derive childhood temperament profiles in a longitudinal clustering analysis. Accelerometry measures of adolescent moderate to vigorous physical activity (MVPA) from ages 11 to 15 years and adult social occupation class were examined as mediators using path analyses. At age 24 years, 9 cardiometabolic outcomes were measured through anthropometrics and fasting blood samples: triglyceride levels, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels, glycated hemoglobin levels, insulin levels, systolic and diastolic blood pressure, body mass index, and C-reactive protein (CRP) levels. Of the 9491 participants included in the analyses, 4908 (51.7%) were male, and 8668 of 9027 (96.0%) were White. Four childhood temperament profiles were identified: (1) introverted (2810 [29.6%]), (2) extraverted (2527 [26.6%]), (3) conflicted-shy (2335 [24.6%]), and (4) avoidant-shy (1819 [19.2%]). Lower childhood socioeconomic status was a precursor associated with the development of an avoidant-shy temperament (eg, introvert vs avoidant-shy: odds ratio, 1.13; 95% CI, 1.04-1.23). Path analyses showed that avoidant-shy children spent less time in MVPA in adolescence compared with all other temperament profiles (eg, introvert vs avoidant-shy: β = 0.10; b = 0.25; 95% CI, 0.14-0.35; P < .001), which in turn was associated with a cluster of cardiometabolic indices at age 24 years, including lower HDL cholesterol levels (β = 0.07; b = 0.95; 95% CI, 0.12-1.78; P = .03) and higher LDL cholesterol levels (β = -0.07; b = -1.69; 95% CI = -3.32 to -0.06; P = .04), insulin levels (β = -0.10; b = -0.57; 95% CI, -1.04 to -0.10; P = .02), diastolic blood pressure (β = -0.09; b = -0.59; 95% CI, -0.97 to -0.21; P = .002), and body mass index (β = -0.07; b = -0.32; 95% CI, -0.56 to -0.07; P = .01). Additionally, children classified as avoidant-shy attained lower social occupation classes at age 24 years, which was concurrently associated with higher BMI (β = 0.06; b = 0.21; 95% CI, 0.08-0.35; P = .002). Notably, these results were adjusted for a range of early developmental precursors and confounders, suggesting an independent association of temperament. In this cohort study, less engagement in physical activity across adolescence seemed to be a developmental mechanism connecting an avoidant-shy childhood temperament and greater cardiometabolic risks over the life course. Future studies should examine the efficacy of physical activity and social skill programs that specially target the needs of different children to thereby reduce cardiometabolic risks.

Gene-Environment Interaction Analysis Incorporating Sex, Cardiometabolic Diseases, and Multiple Deprivation Index Reveals Novel Genetic Associations With COVID-19 Severity.

Increasing evidence indicates that specific genetic variants influence the severity of outcomes after infection with COVID-19. However, it is not clear whether the effect of these genetic factors is independent of the risk due to more established non-genetic demographic and metabolic risk factors such as male sex, poor cardiometabolic health, and low socioeconomic status. We sought to identify interactions between genetic variants and non-genetic risk factors influencing COVID-19 severity via a genome-wide interaction study in the UK Biobank. Of 378,051 unrelated individuals of European ancestry, 2,402 were classified as having experienced severe COVID-19, defined as hospitalization or death due to COVID-19. Exposures included sex, cardiometabolic risk factors [obesity and type 2 diabetes (T2D), tested jointly], and multiple deprivation index. Multiplicative interaction was tested using a logistic regression model, conducting both an interaction test and a joint test of genetic main and interaction effects. Five independent variants reached genome-wide significance in the joint test, one of which also reached significance in the interaction test. One of these, rs2268616 in the placental growth factor (PGF) gene, showed stronger effects in males and in individuals with T2D. None of the five variants showed effects on a similarly-defined phenotype in a lookup in the COVID-19 Host Genetics Initiative. These results reveal potential additional genetic loci contributing to COVID-19 severity and demonstrate the value of including non-genetic risk factors in an interaction testing approach for genetic discovery.

The Effect of Heat Therapy and High-Intensity Interval Training on Cardiometabolic Health in Patients with Severe Lower-Limb Osteoarthritis

Osteoarthritis is a degenerative joint condition making traditional exercise painful and difficult to perform. Due to the lack of activity, patients with osteoarthritis have poorer cardiometabolic health and fitness (i.e., peak oxygen consumption [VO2]), compared to those without osteoarthritis. The purpose of this study was to compare the effect of three low-/no-impact interventions on resting blood pressure, peak VO2 and glycaemic control in patients with severe lower-limb osteoarthritis.

Adipose tissue distribution from body MRI is associated with cross-sectional and longitudinal brain age in adults

There is an intimate body-brain connection in ageing, and obesity is a key risk factor for poor cardiometabolic health and neurodegenerative conditions. Although research has demonstrated deleterious effects of obesity on brain structure and function, the majority of studies have used conventional measures such as waist-to-hip ratio, waist circumference, and body mass index. While sensitive to gross features of body composition, such global anthropometric features fail to describe regional differences in body fat distribution and composition. The sample consisted of baseline brain magnetic resonance imaging (MRI) acquired from 790 healthy participants aged 18–94 years (mean ± standard deviation (SD) at baseline: 46.8 ± 16.3), and follow-up brain MRI collected from 272 of those individuals (two time-points with 19.7 months interval, on average (min = 9.8, max = 35.6). Of the 790 included participants, cross-sectional body MRI data was available from a subgroup of 286 participants, with age range 19–86 (mean = 57.6, SD = 15.6). Adopting a mixed cross-sectional and longitudinal design, we investigated cross-sectional body magnetic resonance imaging measures of adipose tissue distribution in relation to longitudinal brain structure using MRI-based morphometry (T1) and diffusion tensor imaging (DTI). We estimated tissue-specific brain age at two time points and performed Bayesian multilevel modelling to investigate the associations between adipose measures at follow-up and brain age gap (BAG) – the difference between actual age and the prediction of the brain’s biological age – at baseline and follow-up. We also tested for interactions between BAG and both time and age on each adipose measure. The results showed credible associations between T1-based BAG and liver fat, muscle fat infiltration (MFI), and weight-to-muscle ratio (WMR), indicating older-appearing brains in people with higher measures of adipose tissue. Longitudinal evidence supported interaction effects between time and MFI and WMR on T1-based BAG, indicating accelerated ageing over the course of the study period in people with higher measures of adipose tissue. The results show that specific measures of fat distribution are associated with brain ageing and that different compartments of adipose tissue may be differentially linked with increased brain ageing, with potential to identify key processes involved in age-related transdiagnostic disease processes.

The Effects of a Preconception Lifestyle Intervention on Childhood Cardiometabolic Health-Follow-Up of a Randomized Controlled Trial.

Maternal obesity is associated with adverse metabolic outcomes in her offspring, from the earliest stages of development leading to obesity and poorer cardiometabolic health in her offspring. We investigated whether an effective preconception lifestyle intervention in obese women affected cardiometabolic health of their offspring. We randomly allocated 577 infertile women with obesity to a 6-month lifestyle intervention, or to prompt infertility management. Of the 305 eligible children, despite intensive efforts, 17 in the intervention and 29 in the control group were available for follow-up at age 3–6 years. We compared the child’s Body Mass Index (BMI) Z score, waist and hip circumference, body-fat percentage, blood pressure Z scores, pulse wave velocity and serum lipids, glucose and insulin concentrations. Between the intervention and control groups, the mean (±SD) offspring BMI Z score (0.69 (±1.17) vs. 0.62 (±1.04)) and systolic and diastolic blood pressure Z scores (0.45 (±0.65) vs. 0.54 (±0.57); 0.91 (±0.66) vs. 0.96 (±0.57)) were similar, although elevated compared to the norm population. We also did not detect any differences between the groups in the other outcomes. In this study, we could not detect effects of a preconception lifestyle intervention in obese infertile women on the cardiometabolic health of their offspring. Low follow-up rates, perhaps due to the children’s age or the subject matter, combined with selection bias abating contrast in periconceptional weight between participating mothers, hampered the detection of potential effects. Future studies that account for these factors are needed to confirm whether a preconception lifestyle intervention may improve the cardiometabolic health of children of obese mothers.

Cardiometabolic health risks, lifestyle behaviours and quality of life in people diagnosed with early psychosis – A cross‐sectional study

WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and low quality of life (QOL). There is a lack of understanding about CVD-R scores in people diagnosed with early psychosis and no studies have quantified CVD-R using the QRISK® 3calculator in this client group. Establishing potential relationships between modifiable lifestyle behaviours/treatment characteristics with CVD-R or QOL may identify targets for early intervention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to quantify the individual 10-year CVD-R of people diagnosed with early psychosis utilising the QRISK® 3calculator. This is also the first study to investigate relationships between QOL and CVD-R and lifestyle factors in a cohort of Thai people diagnosed with early psychosis. We observed low levels of physical health-related QOL and high levels of CVR-R despite participants reporting relatively positive lifestyle behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The cardiometabolic health state of this client group warrants as much attention as for those with an enduring severe mental illness; early preventative interventions are warranted. It may be useful to routinely quantify the CVD-R of people diagnosed with early psychosis using the QRISK® 3calculator, even in the absence of immediate concerns about lifestyle behaviours. Mental health nurses should utilise evidence-based approaches such as increasing activity levels, dietary counselling and behaviour change interventions to mitigate poor physical health in this client group. ABSTRACT: Introduction People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims To quantify CVD-R in people diagnosed with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD-R/QOL. Method Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK® 3, BMI and waist circumference). Participants self-reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD-R were explored. Results Participants' relative risk for CVD over 10years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD-R or QOL with treatment characteristics and lifestyle factors. Discussion Despite positive lifestyle behaviours, participants had elevated CVD-R scores and poor physical health-related QOL. Quantifying CVD-R with QRISK® 3may highlight the need for health promotion interventions. Implications for practice Mental health professionals should be aware that elevated CVD-R exists in the context of relatively healthy lifestyle behaviours and utilise evidence-based interventions to address these issues.

Metabolomic architecture of obesity implicates metabolonic lactone sulfate in cardiometabolic disease

ObjectiveIdentify and characterize circulating metabolite profiles associated with adiposity to inform precision medicine. MethodsUntargeted plasma metabolomic profiles in the Insulin Resistance Atherosclerosis Family Study (IRASFS) Mexican American cohort (n = 1108) were analyzed for association with anthropometric (body mass index, BMI; waist circumference, WC; waist-to-hip ratio, WHR) and computed tomography measures (visceral adipose tissue, VAT; subcutaneous adipose tissue, SAT; visceral-to-subcutaneous ratio, VSR) of adiposity. Genetic data, inclusive of genome-wide array-based genotyping, whole exome sequencing (WES) and whole genome sequencing (WGS), were evaluated to identify the genetic contributors. Phenotypic and genetic association signals were replicated across ancestries. Transcriptomic data were analyzed to explore the relationship between genetic and metabolomic data. ResultsA partially characterized metabolite, tentatively named metabolonic lactone sulfate (X-12063), was consistently associated with BMI, WC, WHR, VAT, and SAT in IRASFS Mexican Americans (PMA <2.02 × 10−27). Trait associations were replicated in IRASFS African Americans (PAA < 1.12 × 10−07). Expanded analyses revealed associations with multiple phenotypic measures of cardiometabolic health, e.g. insulin sensitivity (SI), triglycerides (TG), diastolic blood pressure (DBP) and plasminogen activator inhibitor-1 (PAI-1) in both ancestries. Metabolonic lactone sulfate levels were heritable (h2 > 0.47), and a significant genetic signal at the ZSCAN25/CYP3A5 locus (PMA = 9.00 × 10−41, PAA = 2.31 × 10−10) was observed, highlighting a putative functional variant (rs776746, CYP3A5∗3). Transcriptomic analysis in the African American Genetics of Metabolism and Expression (AAGMEx) cohort supported the association of CYP3A5 with metabolonic lactone sulfate levels (PFDR = 6.64 × 10−07). ConclusionsVariant rs776746 is associated with a decrease in the transcript levels of CYP3A5, which in turn is associated with increased metabolonic lactone sulfate levels and poor cardiometabolic health.

Long-term air pollution exposure and sex-specific cardiometabolic health trajectories: the Framingham Offspring Study

BACKGROUND AND AIM: We assessed whether annual average particulate matter (PM2.5) exposure modified sex-specific cardiometabolic health (CMH) trajectories. METHODS: We evaluated 3113 Framingham Offspring Study participants by classifying their CMH at each of nine examination cycles (1971-2014) into six categories: (1) cardiometabolically healthy and no cardiometabolic medications, (2) 1-2 sub-clinical risk factors (body mass index ≥25 kg/m2, waist circumference ≥102 cm in men/≥88 in women, total cholesterol ≥200 mg/dL, low-density lipoprotein ≥130 mg/dL, high-density lipoprotein 40 mg/dL in men/50 in women, triglycerides ≥150 mg/dL, systolic blood pressure ≥120 mmHg, diastolic blood pressure ≥80 mmHg, fasting plasma glucose ≥100 mg/dL), (3) 3-4 sub-clinical risk factors, (4) one of hypertension, diabetes, or chronic kidney disease, (5) clinical cardiovascular disease or ≥2 cardiometabolic diagnoses from category four, and (6) cardiovascular-related mortality. Each participants’ annual average PM2.5 exposure (in 2000) was previously assessed using a validated model. We calculated sex-specific CMH trajectories with age as the time scale. We determined the number and polynomial order of trajectory groups based on the Bayesian information criterion and an average posterior probability 0.8 for each group. We identified trajectories based on average CMH status at age 35 years (good 2; intermediate = 2-3; poor 3) and trajectory slope through age 70 years (fast aging ≥2 average increase in group classification; medium = 1-2 average increase; slow ≤1 average increase). RESULTS:Men were more likely to have intermediate or poor CMH at age 35 years, but women were more likely to experience intermediate or fast aging between 35-70 years of age. PM2.5 exposure did not modify average CMH status at 35 years or trajectory slope for either men or women. Higher PM2.5 exposure was significantly associated with decreased likelihood of membership in the healthiest CMH trajectory group for both men and women. CONCLUSIONS:Long-term PM2.5 exposure is associated with CMH trajectories throughout middle age. KEYWORDS: Cardiovascular diseases, Obesity and metabolic disorders, Particulate matter, Female

Cardiorespiratory Fitness, Fat Mass, and Cardiometabolic Health with Endothelial Function, Arterial Elasticity, and Stiffness.

This study aimed to determine whether estimated cardiorespiratory fitness (CRF), fat mass (FM), lean mass (LM), and adiponectin bidirectionally associate with arterial function and structure and if CRF mediates the relationship between cardiometabolic health and arterial outcomes in 9- to 11-yr-old children drawn from the Avon Longitudinal Study of Parents and Children birth cohort, United Kingdom. Brachial artery flow-mediated dilation (FMD), distensibility coefficient (DC), and carotid-radial pulse wave velocity (PWV) were measured by ultrasonography; CRF was measured during the submaximal ergometer test; total FM, trunk FM, and LM were measured by dual-energy x-ray absorptiometry; plasma adiponectin was measured by enzyme assay; and cardiometabolic health was computed based on the International Diabetes Federation criteria for diagnosing metabolic syndrome. We tested bidirectionality by including CRF, FM, LM, and adiponectin as exposures and FMD, DC, and PWV as outcomes, alternatively. Among 5566 participants (2816 (51%) girls; median age, 9.75 yr), CRF per body mass0.21 was directly related to DC (β (95% confidence interval) = 0.004 (<0.0001 to 0.008); P = 0.046), whereas CRF per LM0.54 was inversely associated with PWV (-0.034 (-0.063 to -0.003); 0.032) after adjusting for covariates. These associations remained in bidirectional analyses. Total FM, trunk FM, and LM were bidirectionally and positively associated with FMD and DC. Total FM and trunk FM but not LM had bidirectional and inverse associations with PWV. Adiponectin was not related to FMD, DC, or PWV. CRF partially mediated the associations of cardiometabolic health with FMD (1.5% mediation), DC (12.1% mediation), and PWV (3.5% mediation). Associations of poor cardiometabolic health with adverse arterial structure and function in childhood may be mitigated by increasing CRF. Higher CRF was associated with better arterial structure whereas higher total FM and trunk FM were associated with better arterial function and structure. In the reverse analysis, healthy arterial structure and function were independently associated with increased total FM and trunk FM, suggesting an "arterial paradox."

Psychological resilience predicting cardiometabolic conditions in adulthood in the Midlife in the United States Study

Early adversity is associated with poor cardiometabolic health, potentially via psychological distress. However, not everyone exposed to adversity develops significant distress. Psychological resilience and positive psychological health despite adversity may protect against unfavorable cardiometabolic outcomes that are otherwise more likely. We examined early adversity, psychological resilience, and cardiometabolic risk among 3,254 adults in the Midlife in the United States Study. Psychological resilience was defined according to both early psychosocial adversity and adult psychological health (characterized by low distress and high wellbeing) at Wave 1 (1994 to 1995). Categorical resilience was derived by cross-classifying adversity (exposed versus unexposed) and psychological health (higher versus lower). We also assessed count of adversities experienced and psychological symptoms as separate variables. Incident cardiometabolic conditions (e.g., heart attack, stroke, and diabetes) were self-reported at Waves 2 (2004 to 2005) and 3 (2013 to 2014). Secondary analyses examined biological cardiometabolic risk using a composite of biomarkers available within a Wave-2 subsample. Logistic and Poisson regressions evaluated associations of resilience with cardiometabolic health across 20 follow-up y, adjusting for relevant covariates. In this initially healthy sample, nonresilient (adversity-exposed, lower psychological health) versus resilient (adversity-exposed, high psychological health) individuals had 43% higher odds of cardiometabolic conditions (95% CI 1.10 to 1.85). Odds of cardiometabolic conditions were similar among resilient versus unexposed, psychologically healthy individuals. More adversity experiences were associated with increased odds, while better psychological health with decreased odds of cardiometabolic conditions, and effects were largely independent. Patterns were similar for objectively assessed cardiometabolic risk. Psychological resilience in midlife may protect against negative cardiometabolic impacts of early adversity.

Similar fat and carbohydrate oxidation in response to arm cycling exercise in persons with spinal cord injury versus able-bodied

Context Persons with spinal cord injury (SCI) present with low fat oxidation that is associated with poor cardiometabolic health. This study compared changes in fat and carbohydrate (CHO) oxidation during moderate intensity continuous exercise in persons with SCI and able-bodied adults (AB). Design Repeated measures, within-subjects study. Setting University laboratory in San Diego, CA. Participants Nine men and women with SCI (age and time since injury = 32 ± 11 yr and 7 ± 6 yr) and 10 AB adults (age = 25 ± 8 yr). Interventions To assess peak oxygen uptake (VO2peak) and peak power output (PPO), participants performed progressive arm ergometry to volitional exhaustion. Subsequently, they completed 25 min of continuous exercise at 45%PPO. Outcome Measures Respiratory exchange ratio (RER), fat and CHO oxidation, and blood lactate concentration (BLa) were assessed. Results Data showed a similar RER (P = 0.98) during exercise in SCI (0.97 ± 0.04) versus AB (0.97 ± 0.03) reflecting high CHO use and no differences in BLa (3.5 ± 1.1 and 3.0 ± 0.9 vs. mM, P = 0.56) or fat and CHO oxidation between groups (P > 0.05). However, participants with SCI exercised at a higher relative intensity (P < 0.01, 84 ± 7 vs. 75 ± 7%HRpeak) versus AB. Conclusion Data confirm high reliance on CHO during arm ergometry in persons with SCI. To better compare substrate utilization to AB adults, we recommend that exercise be prescribed according to peak heart rate due to differences in cardiorespiratory fitness between groups.

Contribution of 20-year body mass index and waist circumference history to poor cardiometabolic health in overweight/obese and normal weight adults: A cohort study

Background and aimsWe investigated the associations of 20-year body mass index (BMI) and waist circumference (WC) histories with risk of being 1) metabolically unhealthy overweight/obese (MUOO) vs metabolically healthy overweight/obese (MHOO) and 2) metabolically unhealthy normal weight (MUNW) vs metabolically healthy normal weight (MHNW). Methods and resultsParticipants comprised 3018 adults (2280 males; 738 females) with BMI and WC measured, every ~5 years, in 1991–1994, 1997–1999, 2002–2004, 2007–2009, and 2012–2013. Mean age in 2012–2013 was 69.3 years, with a range of 59.7–82.2 years. Duration was defined as the number of times a person was overweight/obese (or centrally obese) across the 5 visits, severity as each person's mean BMI (or WC), and variability as the within-person standard deviation of BMI (or WC). At the 2013–2013 visit, participants were categorised based on their weight (overweight/obese or normal weight; body mass index (BMI) ≥25 kg/m2) and health status (healthy or unhealthy; two or more of hypertension, low high-density lipoprotein cholesterol, high triglycerides, high glucose, and high homeostatic model assessment of insulin resistance). Logistic regression was used to estimate associations with the risk of being MUNW (reference MHNW) and MUOO (reference MHOO) at the last visit. BMI and WC severity were each related to increased risk of being unhealthy, with estimates being stronger among normal weight than overweight/obese adults. The estimates for variability exposures became null upon adjustment for severity. Individuals who were overweight/obese at all 5 time points had a 1.60 (0.96–2.67) times higher risk of being MUOO than MHOO compared to those who were only overweight/obese at one (i.e., the last) time point. The corresponding estimate for central obesity was 4.20 (2.88–6.12). Greater duration was also related to higher risk of MUNW than MHNW. ConclusionBeing overweight/obese yet healthy seems to be partially attributable to lower exposure to adiposity across 20 years of adulthood. The results highlight the importance of maintaining optimum and stable BMI and WC, both in adults who become and do not become overweight/obese.

Genetic correlation and causal relationships between cardio-metabolic traits and lung function impairment

BackgroundAssociations of low lung function with features of poor cardio-metabolic health have been reported. It is, however, unclear whether these co-morbidities reflect causal associations, shared genetic heritability or are confounded by environmental factors.MethodsWe performed three analyses: (1) cardio-metabolic health to lung function association tests in Northern Finland Birth cohort 1966, (2) cross-trait linkage disequilibrium score regression (LDSC) to compare genetic backgrounds and (3) Mendelian randomisation (MR) analysis to assess the causal effect of cardio-metabolic traits and disease on lung function, and vice versa (bidirectional MR). Genetic associations were obtained from the UK Biobank data or published large-scale genome-wide association studies (N > 82,000).ResultsWe observed a negative genetic correlation between lung function and cardio-metabolic traits and diseases. In Mendelian Randomisation analysis (MR), we found associations between type 2 diabetes (T2D) instruments and forced vital capacity (FVC) as well as FEV1/FVC. Body mass index (BMI) instruments were associated to all lung function traits and C-reactive protein (CRP) instruments to FVC. These genetic associations provide evidence for a causal effect of cardio-metabolic traits on lung function. Multivariable MR suggested independence of these causal effects from other tested cardio-metabolic traits and diseases. Analysis of lung function specific SNPs revealed a potential causal effect of FEV1/FVC on blood pressure.ConclusionsThe present study overcomes many limitations of observational studies by using Mendelian Randomisation. We provide evidence for an independent causal effect of T2D, CRP and BMI on lung function with some of the T2D effect on lung function being attributed to inflammatory mechanisms. Furthermore, this analysis suggests a potential causal effect of FEV1/FVC on blood pressure. Our detailed analysis of the interplay between cardio-metabolic traits and impaired lung function provides the opportunity to improve the quality of existing intervention strategies.

1066-P: Association of Food Security with Cardiometabolic Health during Young Adulthood: Comparison by Race and Ethnicity

Food insecurity, defined as insufficient access to nutritious foods, poses a significant public health problem in the U.S. In the general population, food insecurity is related to poor cardiometabolic health. American Indians (AIs) have some of the greatest burdens of food insecurity and cardiometabolic disease in comparison to other racial/ethnic groups. However, few studies have established how food insecurity is related to cardiometabolic health with data disaggregated for AIs. The objective of this study was to assess the cross-sectional association of food insecurity and cardiometabolic risk factors among AI adults during young adulthood in comparison with non-Hispanic white, non-Hispanic Black, and Hispanic respondents. Data from the fourth wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health) was used. Measures included one survey item on risk of food insecurity, objective measures of cardiometabolic health (body mass index, hemoglobin A1c, fasting blood glucose), and sociodemographic items. Multivariable regression models were used to assess the association of food insecurity with cardiometabolic health, while controlling for sociodemographic variables. All analyses were weighted and accounted for complex sampling survey design. In models inclusive of all adults, AI and non-Hispanic Black adults had significantly higher odds of reporting risk of food insecurity than non-Hispanic white adults. In models stratified by race, measures of cardiometabolic health were not significantly associated with risk of food insecurity among AI adults. Results suggest that AIs’ elevated risk of food insecurity is present in young adulthood, but its relationship with cardiometabolic health is unclear. Study implications are limited by the cross-sectional design, age of respondents, and reliance on a single-item measure of food insecurity. Future work should capitalize on longitudinal data and the USDA food security surveys. Disclosure C. J. Nikolaus: None. L. E. Hebert: None. A. Zamora-kapoor: None. K. Sinclair: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092923)

Abstract 015: Geographic Variation In Pre-pregnancy Cardiometabolic Health In The United States, 2016-2018

Introduction: Poor cardiometabolic health is a major contributor to growing rates of maternal morbidity and mortality. Given known state-level variation in maternal outcomes, we sought to describe the geographic distribution of pre-pregnancy cardiometabolic health as it could inform policy changes to optimize maternal and offspring outcomes. Hypothesis: We hypothesized that pre-pregnancy cardiometabolic health has declined over time and varies by state. Methods: We conducted a nationwide, serial cross-sectional analysis using maternal birth record data from the CDC Natality Files 2016-2018, which include all live births in the US. We included all live births to women aged 20-44 years (N= 10,693,708). Pre-pregnancy cardiometabolic health was quantified by number of pre-pregnancy risk factors: overweight or obesity (body mass index &gt; 25 kg/m 2 ), diabetes, and/or hypertension. We calculated annual age-standardized prevalence of favorable (no risk factors), suboptimal (any single risk factor), or poor ( &gt; 2 risk factors) pre-pregnancy cardiometabolic health and quantified percentage change between 2016-2018 by state. Results: From 2016-2018, the percentage of live births to women with favorable cardiometabolic health decreased from 43.5% (43.4, 43.6) to 41.3% (41.2, 41.3), suboptimal health increased from 51.1% (51.1, 51.2) to 53.3% (53.3, 53.4), and poor health increased from 2.1% (2.1, 2.1) to 2.4% (2.4, 2.4). All states experienced declines in favorable cardiometabolic health. There was significant geographic variation with prevalence of favorable pre-pregnancy cardiometabolic health ranging from 32.7% (32.2, 33.3) in Mississippi to 48.2% (47.7, 48.6) in Utah in 2018 (FIGURE) ; poor health ranged from 1.3% (1.3, 1.4) in California to 4.6% (4.4, 4.8) in Louisiana in 2018. Conclusions: Less than half of women had favorable pre-pregnancy cardiometabolic health between 2016-2018, with significant geographic heterogeneity. Public health efforts to improve pre-conception cardiometabolic health are needed.

Abstract P221: Metabolic Syndrome And Its Factors Associate With Non-calcified Coronary Plaque Burden In Chronic Inflammation: Results From A Prospective Observational Study

Introduction: Psoriasis is a common, inflammatory skin disease associated with systemic inflammation and heightened risk of cardiovascular diseases (CVD). Population studies have shown that psoriasis is associated with metabolic syndrome (MetSyn) and its individual components. However, the impact of MetSyn on early atherosclerosis in chronic inflammatory diseases assessed as non-calcified coronary plaque burden (NCB) by coronary computed CT angiography (CCTA) is not known. Hypothesis: We hypothesized that those with MetSyn in psoriasis would have increased NCB compared to non-MetSyn and that MetSyn and its components would associate with NCB in fully adjusted models. Methods: The cohort consisted of 336 psoriasis patients free of cardiovascular disease, of which 326 had adequate data to classify MetSyn based on the International Diabetes Federation criteria (waist circumference, triglycerides, HDL cholesterol, blood pressure and fasting glucose). Of these, 260 had quantitative CCTA data available for analyses (Stata 16). Results: Of the 260 patients, 80 had MetSyn (31%). The MetSyn group had increased cardiometabolic disease and more adverse coronary characteristics including higher non-calcified ( p &lt;.001) and high-risk plaque ( p =.02) (Table) . In fully adjusted models for Framingham risk score, lipid lowering therapy and biologic use, MetSyn (β=0.31; p&lt; .001) and its individual components of waist circumference (β=0.33; p &lt;.001), triglycerides (β=0.17; p =.005), blood pressure (β=0.18; p =.005) and fasting glucose (β=0.17; p =.009) associated with NCB. Conclusions: MetSyn and its components were associated with NCB in psoriasis suggesting that early atherosclerosis is importantly impacted by poor cardiometabolic health. Components of MetSyn should be assessed in psoriasis patients and patients educated about this heightened risk of CVD associated with MetSyn.

Abstract P208: The Differential Impact Of Residential Segregation On Gestational Hypertension Development Among Minority Women

Introduction: Higher levels of residential segregation have been associated with poorer cardiometabolic health profiles among women. Still, it remains unclear whether segregation may differentially impact the development of gestational hypertension (gHTN) among an ethnically-diverse cohort of pregnant women. We used birth record data from 2003-2009 and data from the 2000 US Census to determine whether racial and economic segregation are associated with gHTN among a diverse cohort of child-bearing women in the greater Philadelphia area. Methods: We quantified racial and economic segregation using sociodemographic data from the US Census and the local Getis-Ord (Gi*) spatial statistic. The Gi* produces a spatially-weighted z-score for each census tract reflecting the degree of clustering of racially-similar neighborhoods in an area relative to the surrounding Philadelphia region. We categorized each type of segregation as low (Gi*&lt;0), moderate (Gi*0-1.96), or high (Gi*&gt;1.96), and assigned these to each woman by her census tract of residence. Gestational hypertension was defined in the birth record data as the development of pregnancy-induced hypertension or preeclampsia. We used hierarchical generalized linear mixed effect models to obtain risk ratios and differences (per 1000 women) for the relationships between each form of residential segregation and gHTN. All models were stratified by maternal race/ethnicity, and sequentially adjusted for maternal sociodemographics, health behaviors, medical histories, and neighborhood-level characteristics. Results: Our sample consisted of 220,897 Non-Hispanic (NH) Black (26%), NH White (64%), and Hispanic (10%) women, of whom 4% developed gHTN. However, a much greater proportion of NH Black women both developed gHTN and lived in high segregation neighborhoods compared to NH Whites and Hispanics. After adjustment, NH Black women in moderate and high economic segregation areas had 16% higher risk (RR=1.16, 95% CI: 1.03-1.31) and 23% higher risk (RR=1.23, 95% CI: 1.08-1.39) of gHTN, respectively, compared to NH Black women living in low segregation areas. NH Black women in highly racially segregated neighborhoods saw an additional 9 cases of gHTN (per 1000 women) compared to NH Black women living in more racially integrated neighborhoods (RD=8.47, 95% CI: 3.14-13.80). Among NH White and Hispanic women, economic segregation was not associated with gHTN, and only marginally significant findings were observed for racial segregation. Conclusions: In our diverse sample of child-bearing women from the greater Philadelphia area, higher levels of racial and economic segregation were associated with greater risk of gHTN among NH Black women. Future work should seek to delineate the specific pathways by which neighborhoods differentially impact individual level cardiovascular health based upon race.

Interplay between diet and gut microbiome, and circulating concentrations of trimethylamine N-oxide: findings from a longitudinal cohort of US men

ObjectivesGut-produced trimethylamine N-oxide (TMAO) is postulated as a possible link between red meat intake and poor cardiometabolic health. We investigated whether gut microbiome could modify associations of dietary precursors with...