Tertile Of Score Research Articles

Physical activity and sleep behaviour in women carrying BRCA1/2 mutations

The aim of the present study is to explore the potential association between sleep quality and physical activity (PA) in women carriers of BRCA1/2 mutations. 63 women completed the Pittsburgh Sleep Quality Index (PSQI) and Godin Shepard Leisure-Time Physical Activity Questionnaire (GSL-TPAQ) and were included in the present cross-sectional analysis. Globally, women showed a PSQI score of 7.0 ± 3.6 and a GSL-TPAQ score of 22.8 ± 18.3. Good sleepers (PSQI score ≤ 5) showed significantly higher PA levels compared to bad sleepers (PSQI score > 5). Women in the higher tertile of GSL-TPAQ total score (≥ 27 METs/week) have a prevalence ratio (PR) of being a good sleeper of 2.85 (1.25–6.52, 95% confidence intervals) compared to women in the lower tertile (≤ 11 METs/week). These results were consistent in BRCA1 and BRCA2 women. Considering each single question of PA intensity, the PR of being a good sleeper by unit of increase of MET/week was higher and significant in women engaged in strenuous and moderate intensity PA. These results suggests a direct association between PA and sleep quality in women carriers of BRCA mutations.

Higher dietary inflammatory index is associated with increased all-cause mortality in adults with chronic kidney disease.

BackgroundDiet property grounded on inflammatory potential, evaluated by the dietary inflammatory index (DII), has been proven to be connected with mortality, while studies of adults with chronic kidney disease (CKD) are scarce.ObjectiveThe purpose of this research was to evaluate the interrelationships between DII and all-cause mortality among adults with CKD.MethodsIn the National Health and Nutrition Examination Survey (NHANES) 2001–2006, we identified and evaluated data of 4,554 adults with CKD. DII scores were calculated from 24 h of dietary consumption at baseline. Vital status was followed through 31 December 2015. The association of all-cause mortality with DII score was assessed using the Kaplan–Meier curve and the Cox regression analysis.ResultsAfter an average follow-up of 132.103 months, a total of 1,246 (27.36%) deaths were recorded. The death rates in the DII tertile categories were 24.04, 26.81, and 31.23%, respectively. The Kaplan–Meier curve showed increased death risks for the high DII tertile as compared with the low DII tertile. After we adjusted for a broad range of possible confounders, the estimation between extreme tertiles of DII scores presented a positive and significant association with all-cause mortality [hazard ratio (HR): 1.21, 95% CI: 1.05–1.39].ConclusionOur results confirm the hypothesis that proinflammatory diets contribute to the increased all-cause mortality in adults with CKD.

Development of the cMIND Diet and Its Association with Cognitive Impairment in Older Chinese People.

Cognitive impairment commonly occurs among older people worldwide. Although the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet was associated with better cognitive function and lower risk of cognitive impairment, it could not be applied to older Chinese due to the traditional dietary characteristics in China. We aimed to develop the Chinese version of the MIND (cMIND) diet and verify its association with cognitive impairment among older Chinese individuals. A cross-sectional study. We included a total of 11,245 participants from the Chinese Longitudinal Healthy Longevity Study (CLHLS) follow-up survey in 2018. The mean age of the participants at study baseline was 84.06 (±11.46) years. We established the cMIND diet based on current evidence in the diet-cognition field, combined with Chinese dietary characteristics. The verification of its association with cognitive impairment was conducted using the data from the CLHLS follow-up survey. Adherence to the cMIND diet was assessed by the cMIND diet score, which was calculated from a food frequency questionnaire. Cognitive impairment was identified by the Mini-Mental State Examination. Instrumental activities of daily living (IADL) disability was defined according to the self-reported performance of eight activities. The cMIND diet comprised 11 brain-healthy food groups and 1 unhealthy food group. The median cMIND diet score of all participants was 4.5 (from a total of 12 points) and the prevalence of cognitive impairment was 15.2%. Compared with the lowest tertile, the highest tertile score was associated with lower odds of cognitive impairment (odds ratio (OR)=0.60, 95% confidence interval (CI): 0.51-0.72) and IADL disability (OR=0.86, 95% CI: 0.75-0.98) in the full-adjusted model. We developed the cMIND diet that was suitable for older Chinese individuals, and our results suggested that higher adherence to the cMIND diet was associated with reduced odds of cognitive impairment and IADL disability. In view of the limitations of cross-sectional design in the study, further research is clearly warranted.

Associations of Adherence to a Dietary Index Based on the EAT–Lancet Reference Diet with Nutritional, Anthropometric, and Ecological Sustainability Parameters: Results from the German DONALD Cohort Study

ABSTRACTBackgroundValidation of the EAT–Lancet reference diet (ELR-diet), recently proposed by the EAT–Lancet Commission, within the context of real-life studies is necessary to elucidate its feasibility, nutritional value, sustainability, and health effects.ObjectivesWe aimed to develop a dietary index (DI) score to measure adherence to the ELR-diet. We further aimed to study the association between the DI score and 1) nutritional characteristics, 2) indicators of ecological sustainability, and 3) anthropometric markers and biomarkers for cardiometabolic health.MethodsA DI score was constructed by comparing the categories defined by the ELR-diet with the dietary data of 2–5 sets of 3-d weighed dietary records from DONALD (Dortmund Nutritional and Anthropometric Longitudinal Designed) study participants (n = 298; ≥15 y of age). Prospective associations between the DI score and risk markers (anthropometric and cardiometabolic) in young adulthood (≥18 y old) were investigated using multivariate linear regression.ResultsAdherence to the DI score components was considerable (majority > 50%), but varied within the population (2%–100%). The highest tertile of the DI score was inversely associated with the intake of protein (tertile 3 compared with tertile 1: 13.5 compared with 14.5 energy %), added sugars (10.5 compared with 12.4 energy %), and cholesterol (100 compared with 116 mg/1000 kcal), but positively associated with fiber intake (10.0 compared with 8.82 g/1000 kcal) (all P < 0.05). The DI score was inversely associated with greenhouse-gas emissions (tertile 1 compared with tertile 3: 6.48 compared with 5.85 kg of carbon dioxide equivalents/2500 kcal; P < 0.001) and land use (8.24 compared with 7.16 m2 × y/2500 kcal; P < 0.001). Inverse associations between the DI score and anthropometric markers during young adulthood were observed (e.g., BMI: tertile 1 compared with tertile 3: 22.9 compared with 21.9 kg/m2; P = 0.03) (all P < 0.05). No associations between the DI score and cardiometabolic risk markers were found (all P ≥ 0.05).ConclusionsAdherence to the ELR-diet was associated with favorable nutritional characteristics and reduced environmental impact. Adherence to the DI score in adolescence was also beneficial with respect to anthropometric markers in early adulthood, although not for further cardiometabolic risk markers.

Association of interactions between tele-critical care and bedside with length of stay and mortality

Introduction Substantial variation exists in telemedicine critical care (Tele-CC) effectiveness, which may be explained by heterogeneity in Tele-CC implementation and utilization. Methods We studied inpatient intensive care unit (ICU) admissions within the Veterans Health Administration from January 2005 to September 2018. Tele-CC affiliation was based on a facility's Tele-CC go-live date. Tele-CC interaction was quantified as the monthly number of video activations, recorded in the eCaremanager® (Phillips) system, per patient days. Tele-CC affiliated facilities were propensity-score matched to facilities without Tele-CC by hospital volume and average modified APACHE scores. We examined the effect of Tele-CC affiliation and the quantity of video interactions between Tele-CC and bedside on hospital outcomes. Results Comparing Tele-CC affiliated and control facilities, affiliated patients were, on average, younger (66.8 years vs 67.8 years; p < 0.001) and more likely to be rural residents (11.3% vs 6.5%; p < 0.001). Stratifying the Tele-CC affiliated facilities, facilities with frequent interactions care for more rural and sicker patients relative to facilities with infrequent interactions. Adjusting for patient demographics, facilities in the top tertile of interactions and propensity score matched control facilities were assessed; patients in ICU's with Tele-CC access experienced shorter ICU-specific lengths of stay (RR = 0.39; 95% CI = [0.23, 0.65]). However, when facilities in the bottom tertile and propensity score matched control facilities were assessed, no significant differences were noted in ICU length of stay. Discussion Tele-CC interactions may occur more frequently for higher acuity patients. Increased Tele-CC interactions may improve health outcomes for the most acute and complex ICU cases.

Association between dietary intake networks identified through a Gaussian graphical model and the risk of cancer: a prospective cohort study.

In this study, we aimed to investigate the association between dietary communities identified by a Gaussian graphical model (GGM) and cancer risk. We performed GGM to identify the dietary communities in a Korean population. GGM-derived communities were then scored and investigated for their association with cancer incidence in the entire population as well as in the 1:1 age- and sex-matched subgroup using a Cox proportional hazards model. In the sensitivity analysis, GGM-derived communities were compared to dietary patterns (DPs) that were identified by principal component analysis (PCA) and reduced rank regression (RRR). During a median time to follow-up of 6.6years, 397 cancer cases were newly diagnosed. The GGM identified 17 and 16 dietary communities for the total and matched populations, respectively. For each one-unit increase in the standard deviation of the community-specific score of the community that was composed of dairy products and bread, there was a reduced risk of cancer according to the fully adjusted model (HR: 0.80, 95% CI: 0.66-0.96). In the matched population, the third tertile of the community-specific score of the community composed of poultry, seafood, bread, cakes and sweets, and meat by-products showed a significantly reduced risk of cancer compared to that of the lowest tertile in the fully adjusted model (HR: 0.66, 95% CI: 0.50-0.86, p-trend = 0.002). We found that the GGM-identified community composed of dairy products and bread showed a reduced risk of cancer. Further population-based prospective studies should be conducted to examine possible associations of dietary intake and specific cancer types.

Western-Style Diet, pks Island-Carrying Escherichia coli, and Colorectal Cancer: Analyses From Two Large Prospective Cohort Studies

Evidence supports a carcinogenic role of Escherichia coli carrying the pks island that encodes enzymes for colibactin biosynthesis. We hypothesized that the association of the Western-style diet (rich in red and processed meat) with colorectal cancer incidence might be stronger for tumors containing higher amounts of pks+E coli. Western diet score was calculated using food frequency questionnaire data obtained every 4 years during follow-up of 134,775 participants in 2 United States-wide prospective cohort studies. Using quantitative polymerase chain reaction, we measured pks+E coli DNA in 1175tumorsamong 3200 incident colorectal cancer cases that had occurred during the follow-up. We used the 3200 cases and inverse probability weighting (to adjust for selection bias due to tissue availability), integrated in multivariable-adjusted duplication-method Cox proportional hazards regression analyses. The association of the Western diet score with colorectal cancer incidence was stronger for tumors containing higher levels of pks+E coli (Pheterogeneity= .014). Multivariable-adjusted hazard ratios (with 95% confidence interval) for the highest (vs lowest) tertile of the Western diet score were 3.45 (1.53-7.78) (Ptrend= 0.001) for pks+E coli-high tumors, 1.22 (0.57-2.63) for pks+E coli-low tumors, and 1.10 (0.85-1.42) for pks+E coli-negative tumors. The pks+E coli level was associated with lower disease stage but not with tumor location, microsatellite instability, or BRAF, KRAS, or PIK3CA mutations. The Western-style diet is associated with a higher incidence of colorectal cancer containing abundant pks+E coli, supporting a potential link between diet, the intestinal microbiota, and colorectal carcinogenesis.

Clinical utility and prognostic implications of the 4S-AF scheme: Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry.

The 4S-AF classification scheme comprises of four domains (stroke risk [St], symptoms [Sy], severity of atrial fibrillation (AF) burden [Sb] and substrate [Su]), which has been recommended in the 2020 ESC guidelines to characterize and evaluate patients with AF. We aimed to determine whether the 4S-AF scheme would be useful for AF characterization and provides prognostic information in a large contemporary prospective Asian registry conducted by the Asia Pacific Heart Rhythm Society (APHRS). Among 4666 patients enrolled in APHRS registry, 3586 of them whose data about left atrial (LA) dimension and European Heart Rhythm Association (EHRA) symptom score were available have constituted as the study population. The 4S-AF score was calculated as the sum of each domain with a maximum score of 9. The clinical endpoint was defined as the 1-year composite risk of any thromboembolic event, ischaemic stroke, heart failure, acute coronary syndrome, significant coronary artery disease requiring coronary intervention and all-cause mortality. Based on the 4S-AF domains, 86.7% were 'non-low risk' for stroke; 94.3% had EHRA Class I-II, 48.5% were newly diagnosed or paroxysmal AF; and only 8.4% had no cardiovascular risk factors or LA enlargement. The risk of clinical events was higher in patients who were 'non-low risk' for stroke (aOR 2.175, 95% CI 1.060-4.461), with permanent AF (aOR 1.579, 95% CI 1.106-2.225) and increasing points for substrate (aORs 2.376-4.968 from score 2 to 4). When compared to the first tertile of 4S-AF score (0-3 points), patients in the second tertile (4-5 points) had approximately 2.5-fold increase in adverse events (OR 2.478, 95% CI 1.678-3.661, p < .001), while those in the third tertile (6-9 points), had a 3.5-fold increase (OR 3.484, 95% CI 2.322-5.226, p < .001), both without significant differences between the 5 participating countries (p for interaction > .05). If all 4S-AF domains were appropriately treated, this was associated with a lower risk of composite clinical outcomes (aOR 0.384, p < .001; p for interaction for different countries=.234). Categorization according to the 4S-AF scheme can be related to the risk of the composite adverse event rate in Asian AF patients, and appropriate treatments based on the 4S-AF scheme resulted in better clinical outcomes. These observations support the characterization and management according to the 4S-AF scheme in Asian patients.

Is there any association between adherence to the Mediterranean Diet and Dietary Total Antioxidant Capacity with Bacterial Vaginosis? Results from a Case–Control study

BackgroundBacterial vaginosis, BV, is a common inflammatory vaginal dysbiosis. The Mediterranean diet, MD, containing foods rich in antioxidant compounds, is shown to be beneficial for inflammatory conditions. This study aimed to investigate the association between MD adherence and dietary total antioxidant capacity (DTAC) with BV.MethodsThis case–control study was conducted on 143 BV-affected and 151 healthy individuals aged between 15 and 45 years. The Amsel criteria were used to detect newly diagnosed patients with BV by a gynecologist. The 168-item food frequency questionnaire (FFQ) was used to record participants' dietary intakes in the last year. The reported data in the FFQ was used to measure adherence to the MD by calculating the Medi-Lite score and to measure the DTAC by calculating ferric-reducing antioxidant power, FRAP, based on the related databases. Logistic regression models were used to determine the association between Medi-Lite and DTAC and BV odds.ResultsThe highest tertile of Medi-Lite score was associated with a reduced odds of BV in the crude model (Odds Ratio, OR: 0.49, 95% Confidence Interval, 95% CI 0.25, 0.96, P for trend: 0.023). This significant inverse association was not observed in the last model adjusted for age, body mass index (kg/m2), waist circumferences (cm), cigarette smoking, frequency of pregnancy, and physical activity (MET/h/d). In crude and adjusted odels, BV odds decreased in the highest tertile of vegetable (adjusted OR, aOR: 0.32, 95% CI 0.16, 0.63, P for trend: 0.001), fish (aOR: 0.46, 95% CI 0.25, 0.84, P for trend: 0.009), legumes (aOR: 0.26, 95% CI 0.14, 0.50, P for trend < 0.001), and meat (aOR: 0.29, 95% CI 0.15, 0.56, P for trend < 0.001) groups. There was no significant association between DTAC and BV odds.ConclusionsThe significant inverse association between the MD adherence and BV odds did not remain after modifying for confounders; besides, DTAC was not associated with BV odds. However, some of the MD components might be associated with a reduced odds of BV.

Relationship between communicative and critical health literacy, health information sources, and participation in health checkups among middle-aged Japanese community residents

We assessed the relationship between health literacy and participation in health checkups among middle-aged Japanese community residents. Additionally, we explored the health information sources related to participation in health checkups among those with low, medium, and high health literacy. This mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents with National Health Insurance (NHI), aged 40–64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3582 participants. Health literacy was measured by the Communicative and Critical Health Literacy (CCHL) scale, and participants were classified into three groups (low, medium, and high health literacy groups) by the tertiles of CCHL scale score. After adjusting for confounding factors, the multivariable-adjusted odds ratios for non-participation in health checkups were 1.20 (95% CI 1.01–1.43, p = 0.039) in the medium health literacy group and 1.47 (95% CI 1.20–1.80, p < 0.001) in the low health literacy group compared with the high health literacy group. Additionally, some health information sources were associated with participation in health checkups in the medium and high health literacy groups, whereas none of the health information sources were associated with participation in health checkups in the low health literacy group. We believe that it is important to develop materials and interventions aimed at low health literacy populations to promote participation in health checkups.

Strategies Associated with Retaining Participants in the Longitudinal National Alzheimer's Coordinating Center Uniform Data Set Study.

Background:Best approaches for retaining research participants in Alzheimer’s disease cohort studies are understudied.Objective:Using data from the National Alzheimer’s Coordinating Center Uniform Data Set, we evaluated the associations of unique strategies with participant retention across Alzheimer’s Disease Research Centers and explored potential effect modification by race, ethnicity and diagnostic group.Methods:We examined retention at the first follow-up visit among participants enrolled during 2015–2017. Structured surveys ascertained 95 retention tactics among 12 strategies. Strategy-specific summary scores were created based on the number of implemented tactics for each strategy and grouped into tertiles. Generalized estimating equations were constructed to evaluate associations between strategy scores and the odds of retention, controlling for age, sex, education, study partner type, marital status, visit length, battery length, diagnostic group, race and ethnicity. Separate models were stratified by race, ethnicity and diagnostic group. Effect modification was formally tested with interaction terms.Results:Among 5,715 total participants enrolled, 4,515 were Non-Hispanic White (79%), 335 were Hispanic/Latino (6%), 651 were Non-Hispanic Black (11%), and 214 were Non-Hispanic Asian (4%). Compared to the lowest tertile of scores, the highest tertile of scores involving improvement in study personnel and communication of study requirements and details were associated with 61% higher odds of retention in fully adjusted models (adjusted Odds Ratios [aOR] = 1.61, 95% Confidence Interval [CI] = 1.05–2.47 and aOR = 1.55, 95% CI = 1.03–2.35, respectively). We did not find evidence for effect modification.Conclusion:In the setting of limited resources, specific retention strategies may be more valuable than others.

Development of healthy lifestyle consciousness index for gynecological cancer patients

PurposeHealthy lifestyle is related to quality of life (QOL) after cancer diagnosis and prognosis. However, there are few reports on patients conscious of healthy lifestyle and patients requiring medical providers’ attention regarding healthy lifestyle. We aimed to develop a healthy lifestyle consciousness index (HLCI) for cancer patients and evaluated its validity in gynecological cancer patients.MethodsThe HLCI was designed to assess degree of healthy lifestyle consciousness, including items regarding “diet,” “exercise,” “body weight,” and “sleep.” Exploratory factor analysis was performed for dimensionality of the scale; Cronbach’s alpha was calculated to assess internal-consistency reliability. For criterion-based validity, we calculated proportions of stage III/IV gynecological malignancies in those with categorized HLCI scores based on tertiles. Concurrent validity was evaluated between HLCI and other quality of life (QOL) scales including European Organization for Research and Treatment of Cancer QLQ-C30 in limited patients.ResultsHLCI comprised five 10-point items (0–45); higher values implied improved healthy lifestyle consciousness. Data from 108 gynecological malignancy patients at Kyoto University Hospital were analyzed. The mean age of subjects was 55.8 years; 36.1% of them had uterine corpus cancer; 34.3% were at stage III/IV of gynecological malignancy. The factor analysis revealed HLCI was unidimensional; the reliability based on Cronbach’s alpha was satisfactory (0.88). The proportions of stage III/IV gynecological malignancies were 25.7%, 33.3%, and 44.4% in those with first (7–24 points), second (25–30 points), and third (31–46 points) tertiles of HLCI score, respectively. For patients with other QOL scales (n = 25), the mean scores of global health status of QLQ-C30 were 33.3, 50.0, and 83.3 for first, second, and third tertiles of HLCI score, respectively.ConclusionHLCI was successfully validated; thus, patients with advanced stages or higher QOL might have strong consciousness regarding healthy lifestyle. HLCI may be useful in precision care for improved lifestyles and QOL.

Effects of Dapagliflozin According to the Heart Failure Collaboratory Medical Therapy Score: Insights From DAPA-HF

BackgroundThe Heart Failure Collaboratory (HFC) has developed a score integrating classes and doses of guideline-directed medical therapies prescribed for patients with heart failure (HF) and reduced ejection fraction. One potential use of this score is to test whether new treatments demonstrate incremental benefits, even in patients receiving comprehensive guideline-directed medical therapy. ObjectivesThe authors investigated the efficacy of dapagliflozin according to a modified HFC score in the DAPA-HF (Dapagliflozin And Prevention of Adverse outcomes in Heart Failure) trial. MethodsIn DAPA-HF, 4,744 patients with HF and reduced ejection fraction were randomized to dapagliflozin or placebo. The modified HFC score accounted for race and electrocardiogram rhythm and rate, with a maximum possible score of 100%. The primary outcome was the composite of worsening HF or cardiovascular death. ResultsThe median modified HFC score was 50% (IQR: 27.5%-62.5%; range 0%-100%). Compared with the lowest tertile, the highest tertile of the treatment score was associated with a lower risk of worsening HF or cardiovascular death (tertile 1, reference; tertile 2, HR: 0.97 [95% CI: 0.82-1.14]; tertile 3, HR: 0.83 [95% CI: 0.70-0.99]). Dapagliflozin reduced the risk of worsening HF or cardiovascular death, irrespective of treatment score (the HRs for dapagliflozin vs placebo from tertile 1 to 3 were: 0.76 [95% CI: 0.61-0.94], 0.76 [95% CI: 0.60-0.97], and 0.71 [95% CI: 0.55-0.90]), respectively; Pinteraction = 0.89). Consistent benefits were observed for HF hospitalization, cardiovascular death, all-cause mortality, and improvement in the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ-TTS). ConclusionsDapagliflozin, compared with placebo, improved all outcomes examined, regardless of the modified HFC score. This score can be easily calculated in clinical trials and used to evaluate the incremental effects of new treatments. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124)

Association of Diet Quality Measured by Three A Priori-Defined Dietary Patterns With Gut Microbiota and Intestinal Permeability Among Obese Individuals

ObjectivesThe human gastrointestinal tract (GI) may play a critical role in the prevention of obesity and metabolic diseases. Considering the importance of a healthy diet for optimal health, this study examined associations of diet quality assessed by three a priori-defined dietary patterns (Healthy Eating Index 2010 [HEI-2010], Mediterranean Eating Pattern for Americans [MEPA], and Dietary Approaches to Stop Hypertension [DASH] with gut microbiota, short-chain fatty acids (SCFA) and intestinal permeability markers in adult obese participants. MethodsAnalyses utilized baseline data from 103 obese subjects (43.8 ± 11.3 years, body mass index ≥30 kg/m2, 72.8% females, 64.1% blacks) who participated in a probiotic/prebiotic supplement trial. Diet was assessed using a validated food frequency questionnaire. Associations of diet quality with outcome measures were assessed using partial correlation coefficient adjusting for relevant covariates. General linear models (GLM) were applied to compare covariate-adjusted means of outcomes for tertiles of respective dietary patterns scores. ResultsScores of HEI-2010 (r = 0.25, P = 0.02), MEPA (r = 0.24, P = 0.03) and DASH (r = 0.28, PP = 0.008) were positively associated with Blautia abundance. HEI-2010 score was positively associated butyrate and propionate to total SCFA ratio (r = 0.24, P = 0.048). Intestinal permeability marker, urinary 24-hr sucralose levels were inversely associated with HEI-2010 (r= –0.30, P = 0.009) and MEPA (r= –0.26, P = 0.02) score. The results were similar when GLM models were performed. No significant associations were observed between scores of dietary patterns and measures of microbial diversity. ConclusionsBlautia abundance and inversely associated with intestinal permeability markers such as urinary 24-h sucralose levels suggesting diet quality may have positive impact on the human GI community. Funding SourcesNo funding support.

1177-P: Mediterranean Diet Is Associated with a Better Estimated Renal Function in Overweight, but Not in Obese, Adults with Impaired Fasting Glucose

Background: Impaired fasting glucose (IFG) is a risk factor for renal function, whereas adherence to the Mediterranean diet may be protective. Methods: Cross-sectional study on 1016 overweight (OW) and 1297 obese (OB) adults (52 ± 12 yrs, 55% women) with IFG (s-glucose: 100-125 mg/dl) . Anthropometry, fat-free mass by BIA, s-creatinine, blood pressure, marital status, education, familiarity for diabetes and CVD, smoking and physical activity were evaluated. The 14-item MEDiterranean Diet Adherence Screener (MEDAS, score: 0-14 points) was used to assess Mediterranean diet. Glomerular filtration rate (eGFR) was estimated by CKD-EPI formula. Normal renal function was defined as eGFR ranged 90-140 ml/min/1.73m2, so that both cases of loss of renal function and cases of glomerular hyperfiltration were considered at risk of renal damage. Logistic regression stratified for BMI class and adjusted for above confounders was fitted to assess association of Mediterranean diet with normal renal function. Results: The prevalence of normal renal function was 55% (60% in OW, 52% in OB) . Compared to the first tertile, the highest tertile of MEDAS score was associated to higher odds being normal renal function in OW (OR 1.48, 95%CI 1.07, 2.04, Ptrend=0.014) but not in OB patients. Conclusion: Mediterranean diet is associated with a better renal function in OW patients with IFG. Disclosure A.Leone: None. R.De amicis: None. A.Foppiani: None. S.Bertoli: None. A.Battezzati: None.

Low-Carbohydrate Diets, but Not Low-Fat Diets, Increase Non-alcoholic Fatty Liver Disease Risk in the Framingham Heart Study

ObjectivesNonalcoholic fatty liver disease (NAFLD) is a highly prevalent disease associated with morbidity and mortality. NAFLD prevention focuses on weight loss; however, information on the long-term effects of low-fat diets (LFD) or low-carbohydrate diets (LCD), two popular strategies for weight loss, on NAFLD risk are not known. We examined the prospective association of LFD and LCD with NAFLD risk in a US community setting.MethodsWe included participants from the Framingham Heart Study second and third-generation cohorts. Liver fat was assessed on computed tomography scan using the average liver fat attenuation referenced to a radiopaque phantom to create the liver phantom ratio (LPR) at baseline and after 6 years (median). Incident NAFLD was defined as LPR ≤ 0.33 on the follow-up CT scan after excluding baseline NAFLD. We quantified baseline adherence to LFD and LCD using scores that consider carbohydrate, fat, and protein energy percentages derived from food-frequency questionnaires. Modified poison regression models were used to compute NAFLD risk ratios (RR) and confidence intervals (CI) associated with score tertiles adjusting for age, sex, education, and lifestyle confounders, including baseline BMI and BMI change.ResultsOver 6 years, 18.6% of participants (mean age 51 years, 38% women) developed NAFLD. Those with a higher adherence to LCD (vs. lower) had lower carbohydrate, higher fat, and slightly higher protein intakes; their diets included less fiber and dairy and more meat products. Those with higher LFD scores (vs. lower) had the opposite dietary composition except protein intake was similar. Women with the highest adherence to LCD (vs. lowest) had an 89% increased risk of developing NAFLD (95% CI: 1.16–3.08) after adjusting for sociodemographic and lifestyle factors. No associations were found in men. Further adjustment for BMI but not BMI change slightly attenuated the results. Participants who had hypertension and followed an LCD were at highest risk of developing NAFLD. A LFD was not associated with NAFLD.ConclusionsIn our study, higher adherence to LCD associated with an increased risk for incident NAFLD among women. Additional studies are needed to determine the optimal diet to prevent NAFLD.Funding SourcesNational Institute of Diabetes and Digestive and Kidney Diseases.

The dietary and lifestyle indices of insulin resistance are associated with increased risk of cardiovascular diseases: A prospective study among an Iranian adult population

Background and aimsPrevious studies have introduced insulin resistance (IR) as a major risk factor for poor cardiovascular diseases (CVDs) outcomes. Diet, body weight, and physical activity are three key pillars of lifestyle that can significantly impact the IR status. We aimed to assess the possible link between the empirical dietary index for IR (EDIR) and the empirical lifestyle index for IR (ELIR) with the risk of chronic heart disease (CHD) and CVDs. Methods and resultsThis study was conducted on 4980 participants aged ≥30 years (follow-up rate: 99.85%). Dietary intake data was collected using a validated food frequency questionnaire. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals (HRs and 95% CIs) of CVDs and CHD across tertiles of EDIR and ELIR scores. In the final model, after adjusting for all potential confounding variables, participants in the highest tertile of EDIR had a higher risk of CVD (HR:1.36, 95%CI:1.03–1.80, P-trend = 0.016) and CHD (HR:1.36, 95% CI:1.01–1.83, P-trend = 0.023) compared to the lowest tertile. Also, participants with a higher score of ELIR had a higher risk of CVD (HR: 1.64, 95%CI:1.24–2.16, P-trend=<0.001) and CHD (HR: 1.72, 95%CI:1.28–2.32, P-trend=<0.001). ConclusionA greater adherence to the lifestyle and diet with a higher EDIR and ELIR may be associated with an increased risk of CVD and CHD outcomes in the adult population.

A Positive Association between the Atherogenic Index of Plasma and White Matter Hyperintensity.

BackgroundWhite matter hyperintensity (WMH) is a risk factor for dementia and ischemic stroke. The atherogenic index of plasma (AIP) is a simple and cost-effective marker for the prediction of various vascular diseases. In this study, we evaluated the relationship between AIP and WMH in adults without cerebrovascular accidents.MethodsWe analyzed the data of 281 adults, aged ≥26 years, who underwent brain magnetic resonance imaging (MRI) at the health promotion center of an education hospital between January 2014 and December 2018. Participants were divided into three categories according to tertiles of the AIP scores (T1: <0.20; T2: 0.20–0.48; and T3: >0.48). WMH was defined as a modified Fazekas scale score of 1–3 on brain MRI. A cubic spline curve was used to determine the linearity of the relationship between AIP and WMH. Multiple logistic regression analysis was used to evaluate the relationship between the AIP and WMH.ResultsThe prevalence of WMH was 45.7% in T1, 57.0% in T2, and 66.0% in T3 (T3 vs. T1, P for post-hoc analysis=0.005). The increased odds of WMH were associated with increased AIP. The odds ratio (OR) with a 95% confidence interval (CI) for WMH of T2 and T3 compared with T1 were 1.57 (0.88–2.80) and 2.30 (1.28–4.14), respectively. After adjusting for confounding variables, the OR with a 95% CI for WMH in the T2 and T3 groups vs. the referent T1 were 1.55 (0.76–3.13) and 2.27 (1.06–4.84), respectively.ConclusionAIP is independently and positively associated with WMH in a healthy population.

The Environmental Footprint Associated With the Mediterranean Diet, EAT-Lancet Diet, and the Sustainable Healthy Diet Index: A Population-Based Study.

Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020.MethodsA group of 525 participants were recruited via social media, email, and phone. Demographic characteristics, quality of life, and answers to the SHED-index questionnaire were obtained. Dietary assessment was performed using the 116-item Food Frequency Questionnaire (FFQ), which was developed for the Israeli population. Adherence to the MED was calculated using a 9-point score. Adherence to the EAT-Lancet reference diet was assessed through the consumption of 14 food components. The environmental pressure of these dietary patterns was determined based on the “footprint family indicators,” which include land, water, and carbon footprints per unit of agricultural and food products. We assigned values for each food comprising the FFQ and calculated the environmental load for each dietary pattern. Statistical analyses were performed using the R package version 4.1.1 to compare environmental footprint values according to tertiles of the MED score, EAT-Lancet score, and SHED score.ResultsThe participants (n = 525) were 49% women, educated (82% had academic education), and physically active, and only 13% were smokers. The highest tertiles of adherence to the MED, adherence to the EAT-Lancet reference diet, and the SHED index were associated with the lowest GHG emissions and land use, as well as higher water use. Meat consumption contributed the most to land use, while dairy contributed the most to GHG emissions, and fruits contributed the most to water use.ConclusionsOur analysis reveals that animal protein is the highest contributor to GHG emissions and land use, while fruits and vegetables contribute the most to water consumption. Nevertheless, most of the fruits and vegetables are grown using treated wastewater, which reduces environmental pressure. Given these findings, we suggest that MED and EAT-Lancet dietary patterns should be included in national dietary guidelines.

Physical activity patterns, genetic susceptibility, and risk of hip/knee osteoarthritis: a prospective cohort study based on the UK Biobank

The effect of physical activity on hip/knee osteoarthritis (OA) and how it varies by genetic susceptibility to OA remains inconclusive. In a cohort study of UK Biobank, 436,166 OA-free participants were recruited in 2006-2010 and followed for knee/hip OA until the end of 2020. 28 physical activity-related items were collected at baseline. Cox regression was used to estimate associations between physical activity behaviors, as well as major activity patterns (i.e., significant principal components[PCs] identified by principal component analysis), and risk of OA, adjusting for multiple confounders. We further stratified the analyses by polygenic risk score (PRS) for OA to examine the impact of genetic susceptibility to OA on the studied association. During a mean follow-up of 11.15 years, 13,227 hip and 21,119 knee OA cases were identified. 19, out of 28, studied items showed associations with increased OA risk. Compared with low adherence group(<1st tertile of PC score for each pattern), individuals with high adherence to five identified patterns were associated with increased risk of OA. The moderate adherence to "strenuous sports"(HR=0.93, 95%CI: 0.89-0.97) and "walking for pleasure"(HR=0.93, 95%CI: 0.89-0.98) patterns was associated with reduced OA. Similar risk patterns were obtained in the stratified analysis by PRS levels for OA. High intensity of most activity patterns were associated with increased OA. However, a protective effect was suggested for moderate adherence to patterns of "strenuous sports" and "walking for pleasure" that consistent across different genetic susceptibilities, underscoring the potential benefits of moderate-intensity physical activity on OA.