SD Increase In Score Research Articles

Abstract P207: Blood Metabolomic Signatures of 24-hr Urinary Sodium and Potassium Excretion Were Associated With Cardiometabolic Diseases in the Hispanic Community Health Study/Study of Latinos

Background: 24hr urinary sodium (Na) potassium (K) excretions are considered as accurate measures of sodium and potassium intake, but data are limited in large population-based studies due to the difficulties of 24hr urine sample collection. Hypothesis: 24hr urinary Na and K excretion can be predicated by blood metabolomic signatures, which are associated with the risk of cardiometabolic diseases. Methods: We assessed 24hr urinary Na, K excretion and sodium/potassium ratio (Na/K) in 447 apparently healthy individuals from the SOL-Nutrition & Physical Activity Assessment Study (SOLNAS) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We calculated urinary Na, K excretion, and Na/K metabolite scores by using the Least Absolute Shrinkage and Selection Operator regression on 199 serum metabolites in SOLNAS, and evaluated their associations with incident CVD (heart failure, stroke, myocardial infarction), type 2 diabetes (T2D), and hypertension (HTN) in up to 5738 individuals in HCHS/SOL. Results: There were 41, 22, and 71 metabolites selected to be predictive of urinary Na, K excretion, and Na/K, respectively. Metabolite scores were significantly correlated with measured urinary Na (r=0.35, p < 5e -14 ), K (r=0.58, p< 5e -50 ) excretion and Na/K (r=0.6, p< 5e -50 ). After multivariate adjustment, metabolite scores of urinary Na excretion and Na/K were significantly associated with incident CVD risk (hazard ratio=2.6 for Na and 1.91 for Na/K, per 1 SD increase in score), incident T2D (relative risk [RR]=1.33 for Na and 1.16 for Na/K), and incident HTN (RR=1.53 for Na and 1.35 for Na/K) over a median 7.6 years of follow-up. The metabolite score of urinary K excretion was not associated with CMD risk. Conclusion: In US Hispanics/Latinos, higher levels of 24hr urinary Na excretion and Na/K indicated by blood metabolomics signatures were associated with increased risk of CVD, HTN, and T2D.

Rare and Common Genetic Variation Underlying the Risk of Hypertrophic Cardiomyopathy in a National Biobank

Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death in young people. Although rare genetic variants are well-established contributors to HCM risk, common genetic variants have recently been implicated in disease pathogenesis. To assess the contributions of rare and common genetic variation to risk of HCM in the general population. This cohort study of the UK Biobank (data from 2006-2010) and the Mass General Brigham Biobank (2010-2019) assessed the relative and joint contributions of rare genetic variants and a common variant (polygenic) score to risk of HCM. Both rare and common variant predictors were then evaluated in the context of relevant clinical risk factors. Data analysis was conducted from May 2021 to February 2022. Pathogenic rare variants, common-variant (polygenic) score, and clinical risk factors. Risk of HCM. The primary study population comprised 184 511 individuals from the UK Biobank. Mean (SD) age was 56 (8) years, 83 690 (45%) of participants were men, and 204 (0.1%) participants had HCM. Of 51 genes included in clinical genetic testing panels for HCM, pathogenic or likely pathogenic variants in 14 core genes (designated by the American College of Medical Genetics and Genomics [ACMG]) were associated with 55-fold higher odds (95% CI, 35-83) of HCM, while those in the remaining 37 non-ACMG genes were not significantly associated with HCM (OR, 1.8; 95% CI, 0.6-4.0). ClinVar pathogenic or likely pathogenic mutations in MYBPC3 (OR, 72; 95% CI, 39-124) and MYH7 (OR, 61; 95% CI, 26-121) were strongly associated with HCM, as were loss-of-function variants in ALPK3 (OR, 13; 95% CI, 4.4-28). A polygenic score was strongly associated with HCM (OR per SD increase in score, 1.6; 95% CI, 1.4-1.8), with concordant results in the Mass General Brigham Biobank. Genetic factors enhanced clinical risk prediction for HCM: addition of rare variant carrier status and the polygenic score to clinical risk factors (obesity, hypertension, atrial fibrillation, and coronary artery disease) improved the area under the receiver operator characteristic curve from 0.71 (95% CI, 0.65-0.77) to 0.82 (95% CI, 0.77-0.87). Both rare and common genetic variants contribute substantially to HCM susceptibility in the general population and improve HCM risk prediction beyond that achieved with clinical factors.

Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study.

We examined the associations between pre-pregnancy dietary patterns and the incidence of gestational diabetes mellitus (GDM) in a population-based cohort study of women of reproductive age. The Australian Longitudinal Study on Women's Health included 3,853 women without pre-existing diabetes who were followed-up between 2003 and 2012. Pre-pregnancy dietary patterns were derived using factor analysis based on 101 food items from a validated food frequency questionnaire. GDM was self-reported and validated in a subsample. Multivariable regression models with generalised estimating equations were used to estimate RR and 95% CI. During 9 years follow-up, 292 GDM cases (4.4%) were documented in 6,626 pregnancies. No associations were found for the 'Fruit and low-fat dairy' and 'Cooked vegetables' patterns. The 'Meats, snacks and sweets' pattern was associated with higher GDM risk after adjustment for socioeconomic, reproductive and lifestyle factors (RR [95% CI] per SD increase in score: 1.38 [1.02, 1.86]). Further adjustment for BMI attenuated the results (1.35 [0.98, 1.81]). In stratified analysis, the 'Meats, snacks and sweets' pattern was associated with significantly higher GDM risk in parous and obese women, and in women with lower educational qualifications. The 'Mediterranean-style' pattern was associated with lower GDM risk in the fully adjusted model (0.85 [0.76, 0.98]). These findings support general dietary recommendations for women of reproductive age to consume a diet rich in vegetables, whole grains, nuts and fish, and low in red and processed meats and snacks. Further prospective studies are needed to confirm these findings.

Long-Term Change in Diet Quality Is Associated with Body Weight Change in Men and Women1–3

Background: Little evidence exists on change in diet quality and weight change.Objectives: We examined the association between change of diet quality indexes and concurrent weight change over 20 y.Methods: In this analysis we followed 50,603 women in the Nurses’ Health Study (NHS), 22,973 men in the Health Professionals Follow-Up Study (HPFS) between 1986 and 2006, and 72,495 younger women from the Nurses’ Health Study II (NHS II) between 1989 and 2007. Diet was measured every 4 y. We computed the Alternate Mediterranean Diet, the Alternate Health Eating Index-2010 (AHEI-2010), and the Dietary Approaches to Stop Hypertension adherence scores for each participant. All scores emphasize fruits and vegetables, whole grains, and nuts, but they differ in score range and components such as dairy, sodium, and sweetened beverages. Regression models were used to examine 4-y changes in these scores and weight change within the same period, adjusting for lifestyle factors.Results: Mean age at baseline was 49.4 y for NHS, 48.0 y for HPFS, and 36.3 y for NHS II. Baseline BMI (in kg/m2) was similar (23.7 for NHS, 24.7 for HPFS, and 23.0 for NHS II). We observed significantly less weight gain over 4-y periods with each SD increase of each diet quality score in both men and women. Results were significantly stronger in the younger cohort (NHS II) than in the older cohorts (e.g., −0.67 kg less weight gain in NHS II vs. −0.39 kg in NHS for each SD increase in AHEI-2010; P-heterogeneity: <0.001). Improvement of any of the diet scores benefited overweight (−0.27 to −1.08 kg less weight gain for each SD increase in score) more than normal-weight individuals (−0.10 to −0.40 kg; P-interaction: <0.001).Conclusion: Improvement of diet quality is associated with less weight gain, especially in younger women or overweight individuals.

Asthma control in pregnancy is associated with pre-conception dietary patterns.

To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy. Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern (Z-score), with values presented as odds ratio and 95 % confidence interval. Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009-July 2013. One hundred and fifty-eight asthmatic pregnant women. Three dietary patterns were identified: (i) 'high protein/fruit' (strong food group loadings for fish, meat, chicken, fruit); (ii) 'high fat/sugar/takeaway' (takeaway foods, crisps, refined grains); and (iii) 'vegetarian-type' (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54; 95 % CI 1·07, 2·23; P=0·022). Women with uncontrolled asthma (n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma (n 43, all P≤0·05). Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond.

Risk Scores of Common Genetic Variants for Lipid Levels Influence Atherosclerosis and Incident Coronary Heart Disease

Circulating levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and triglycerides are recognized risk factors for cardiovascular disease. We tested the hypothesis that the cumulative effects of common genetic variants for lipids are collectively associated with subclinical atherosclerosis and incident coronary heart disease. Participants were drawn from the Erasmus Rucphen Family Study (n=2269) and the Rotterdam Study (n=8130). Linear regression and Cox proportional hazards models were applied to assess the influence of 4 risk scores derived from common genetic variants for lipids (total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides) on carotid plaque, intima-media thickness, incident myocardial infarction, and coronary heart disease. Adjusted for age and sex, all 4 risk scores were associated with carotid plaque. This relationship was the strongest for the LDL-C score, which increased plaque score by 0.102 per SD increase in genetic risk score (P=3.2 × 10(-8)). The LDL-C score was also nominally associated with intima-media thickness, which increased 0.006 mm per SD increase in score (P=0.05). Both the total cholesterol and LDL-C scores were associated with incident myocardial infarction and coronary heart disease with hazard ratios between 1.10 and 1.13 per SD increase in score. Inclusion of additional risk factors as covariates minimally affected these results. Common genetic variants with small effects on lipid levels are, in combination, significantly associated with subclinical and clinical cardiovascular outcomes. As knowledge of genetic variation increases, preclinical genetic screening tools might enhance the prediction and prevention of clinical events.

Common mental disorders and mortality in the West of Scotland Twenty-07 Study: comparing the General Health Questionnaire and the Hospital Anxiety and Depression Scale

BackgroundWhile various measures of common mental disorders (CMD) have been found to be associated with mortality, a comparison of how different measures predict mortality may improve our understanding of the...

Relationship between dietary intake and the development of type 2 diabetes in a Chinese population: the Hong Kong Dietary Survey

To study the relationship between dietary intake and the development of type 2 diabetes among Chinese adults. A prospective cohort study. Dietary assessment was carried out using a validated FFQ. Principal component analysis was used to identify dietary patterns. Dietary glycaemic load and variety of snacks were also calculated. A hospital-based centre at the Queen Mary Hospital in Hong Kong SAR, China. A total of 1010 Chinese adults aged 25-74 years who participated in a territory-wide dietary and cardiovascular risk factor prevalence survey in 1995-1996 were followed up for 9-14 years for the development of diabetes. A total of 690 (68·3 %) individuals completed follow-up during 2005-2008 and seventy-four cases of diabetes were identified over the follow-up period. Four dietary patterns were identified ('more snacks and drinks', 'more vegetables, fruits and fish', 'more meat and milk products' and 'more refined grains'). After adjustment for age, sex, BMI, waist-to-hip ratio, smoking, alcohol intake, participation in exercise/sports and family history of diabetes, the more vegetables, fruits and fish pattern was associated with a 14 % lower risk (OR per 1 sd increase in score = 0·76; 95 % CI 0·58, 0·99), whereas the more meat and milk products pattern was associated with a 39 % greater risk of diabetes (OR per 1 sd increase in score = 1·39; 95 % CI 1·04, 1·84). Dietary glycaemic load, rice intake, snack intake and variety of snacks were not independently associated with diabetes. The more vegetables, fruits and fish pattern was associated with reduced risk and the more meat and milk products pattern was associated with an increased risk of diabetes.

Association between licensure examination scores and practice in primary care.

Standards for licensure are designed to provide assurance to the public of a physician's competence to practice. However, there has been little assessment of the relationship between examination scores and subsequent practice performance. To determine if there is a sustained relationship between certification examination scores and practice performance and if licensing examinations taken at the end of medical school are predictive of future practice in primary care. A total of 912 family physicians, who passed the Québec family medicine certification examination (QLEX) between 1990 and 1993 and entered practice. Linked databases were used to assess physicians' practice performance for 3.4 million patients in the universal health care system in Québec, Canada. Patients were seen during the follow-up period for the first 4 years (1993 cohort of physicians) to 7 years (1990 cohort of physicians) of practice from July 1 of the certification examination to December 31, 1996. Mammography screening rate, continuity of care index, disease-specific and symptom-relief prescribing rate, contraindicated prescribing rate, and consultation rate. Physicians achieving higher scores on both examinations had higher rates (rate increase per SD increase in score per 1000 persons per year) of mammography screening (beta for QLEX, 16.8 [95% confidence interval [CI], 8.7-24.9]; beta for Medical Council of Canada Qualifying Examination [MCCQE], 17.4 [95% CI, 10.6-24.1]) and consultation (beta for QLEX, 4.9 [95% CI, 2.1-7.8]; beta for MCCQE, 2.9 [95% CI, 0.4-5.4]). Higher subscores in diagnosis were predictive of higher rates in the difference between disease-specific and symptom-relief prescribing (beta for QLEX, 3.9 [95% CI, 0.9-7.0]; beta for MCCQE, 3.8 [95% CI, 0.3-7.3]). Higher scores of drug knowledge were predictive of a lower rate (relative risk per SD increase in score) of contraindicated prescribing for MCCQE (relative risk, 0.88; 95% CI, 0.77-1.00). Relationships between examination scores and practice performance were sustained through the first 4 to 7 years in practice. Scores achieved on certification examinations and licensure examinations taken at the end of medical school show a sustained relationship, over 4 to 7 years, with indices of preventive care and acute and chronic disease management in primary care practice.