White Caucasians Research Articles

Vitamin D status and dietary intake in young university students in the UK

PurposeVitamin D deficiency is prevalent worldwide. This paper aims to investigate the vitamin D status and dietary intake in young university students.Design/methodology/approachForty-one healthy students aged 18–29 years from Coventry University UK were recruited during January-February 2019, including white Caucasians (n = 18), African-Caribbeans (n = 14) and Asians (n = 9). Plasma 25(OH)D concentrations were measured and dietary vitamin D intake was determined. Chi-square and simple linear regression were used to analyse the data.FindingsThe plasma 25(OH)D concentrations were (36.0 ± 22.2) nmol/L in all subjects, (46.5 ± 25.3) nmol/L in white Caucasians, (22.6 ± 7.4) nmol/L in African-Caribbeans and (37.4 ± 21.7 nmol/L) in Asians. The majority (85.7%) of African-Caribbeans were vitamin D deficient compared with 22.2% of white Caucasians and 33.3% of Asians (p = 0.001). Overweight/obese subjects showed a significant higher proportion of vitamin D deficiency (65%) than normal weight subjects (28.6%) (p = 0.04). The average dietary vitamin D intake in all subjects was (4.6 ± 3.9) µg/day. Only 12.1% of the subjects met the recommended dietary vitamin D intake of 10 µg/day. Dietary vitamin D intake (p = 0.04) and ethnicity (p = 0.01) were significant predictors of 25(OH)D levels and accounted for 13% and 18.5% of 25(OH)D variance, respectively.Research limitations/implicationsThis small-scale study showed an alarmingly high prevalence of vitamin D deficiency among subjects from African-Caribbean origin during wintertime. Education programs and campaigns are urgently needed to fight the vitamin D deficiency in this population.Originality/valueThe targeted population were in a critical period of transition from adolescence toward adulthood involving in changes in behaviours and nutrition.

Increased classical monocyte subsets in South Asians compared to White Caucasians at risk for coronary atherosclerosis

Abstract Background South Asians (SA) have an increased prevalence of coronary artery disease (CAD) and myocardial infarction compared with age- and sex-adjusted White Caucasians (WC). The mechanism for this increased risk is poorly understood. While classical CD14++CD16- monocytes act as independent predictors of cardiovascular disease, differences in the distribution of monocyte subsets between SA and WC have not been established. Purpose We aimed to determine if differences exist in monocyte subsets between SA and WC at risk for CAD. Methods Our cohort consisted of 119 consecutively enrolled patients (59 SA, 60 WC) at intermediate or higher risk for CAD by the INTERHEART score using self-reported history and physical exam. A single blood sample was collected prospectively for the purpose of monocyte analysis. Flow cytometry using dual colour fluorescence (CD14, CD16) within the monocyte gate was used to identify monocyte subsets (classical, intermediate and non-classical) by staff blinded to the individuals' characteristics. Variables were compared using Mann-Whitney U test and Chi-squared test, as appropriate. Eta coefficient was calculated to analyze the relationship between ethnicity and proportion of monocyte subsets. Eta squared values were calculated to assess the impact of ethnicity on monocyte subset proportions. Results The SA group consisted of 64% males with a mean age of 54 (± 9), while the WC group consisted of 55% males with a mean age of 59 (± 7). Both groups had similar body mass index, rates of hypertension, dyslipidemia and family history of premature CAD. Compared to WC, SA had higher prevalence of diabetes (36% vs. 13%, p=0.005) and hemoglobin A1C levels (6.0±1.1% vs. 5.6±0.6%, p<0.001). SA patients had a higher proportion (85.3±10.7% vs. 81.4±11.0%, p=0.009) and total level (449.0±180.4 vs. 388±127.4, p=0.010) of classical CD14++CD16- monocytes compared to WC. There was no difference between the two groups in the proportion of intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes. There was no association between diabetes and the proportion of monocyte subsets. Ethnicity had a moderate association with the proportion of classical CD14++CD16- monocytes (Eta coefficient = 0.525) with a large effect size (Eta squared = 27.5%). The association of ethnicity with intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes was either weak or negligible with minimal to no effect size. Conclusion In patients with substantive risk for CAD, SA had a significantly higher proportion and level of classical CD14++CD16- monocytes compared to WC. Our findings provide a novel insight into the potential mechanism of increased CAD susceptibility amongst SA compared to WC. Future studies are needed to determine whether these ethnic differences in the distribution of monocyte subsets can predict susceptibility to developing CAD and suffering atherothrombotic events. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Academic Practice Plan grant at the University of British Columbia

MONOCYTE SUBSETS HETEROGENEITY AND CORONARY ATHEROSCLEROSIS IN SOUTH ASIANS COMPARED TO WHITE CAUCASIANS

BACKGROUND South Asians (SAs) have an increased prevalence of coronary artery disease (CAD) and myocardial infarction compared with age- and sex-adjusted White Caucasians (WCs). The mechanism for this increased risk is poorly understood. While classical CD14++CD16- monocytes act as independent predictors of cardiovascular disease, differences in the distribution of monocyte subsets between SA and WC have not been established. We aimed to determine if differences exist in monocyte subsets between SAs and WCs at risk for CAD. METHODS AND RESULTS 119 consecutive patients (59 SA, 60 WC) of at least intermediate CAD risk by the INTERHEART score were prospectively enrolled. Patients with history of malignancy, age > 70, GFR < 30 or on dialysis were excluded. A single blood sample was collected for monocyte analysis. Flow cytometry using dual colour fluorescence (CD14, CD16) within the monocyte gate was used to identify monocyte subsets (classical, intermediate, and non-classical) by staff blinded to the individuals’ characteristics. The SA group consisted of 64% males with a mean age of 54 (+/- 9), while the WC group consisted of 55% males with a mean age of 59 (+/- 7). Both groups had similar body mass index, rates of hypertension, dyslipidemia and family history of premature CAD. Compared to WCs, SAs had higher prevalence of diabetes (36% vs. 13%, p = 0.005) and hemoglobin A1C levels (6.0 +/- 1.1% vs. 5.6 +/- 0.6%, p < 0.001). SA patients had a higher proportion (85.3 +/- 10.7% vs. 81.4 +/- 11.0%, p = 0.009) and total level (449.0 +/- 180.4 vs. 388 +/- 127.4, p = 0.010) of classical CD14++CD16- monocytes compared to WCs. There was no difference between the two groups in the proportion of intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes (see Figure 1). There was no association between diabetes and the proportion of monocyte subsets. Ethnicity had a moderate association with the proportion of classical CD14++CD16- monocytes (Eta coefficient = 0.525) with a large effect size (Eta squared = 27.5%). The association of ethnicity with intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes was either weak or negligible with minimal to no effect size (see Table 1). CONCLUSION In patients with substantive risk for CAD, SAs had a significantly higher proportion and level of classical CD14++CD16- monocytes compared to WCs. Our findings provide a novel insight into the potential mechanism of increased CAD susceptibility amongst SAs compared to WCs. South Asians (SAs) have an increased prevalence of coronary artery disease (CAD) and myocardial infarction compared with age- and sex-adjusted White Caucasians (WCs). The mechanism for this increased risk is poorly understood. While classical CD14++CD16- monocytes act as independent predictors of cardiovascular disease, differences in the distribution of monocyte subsets between SA and WC have not been established. We aimed to determine if differences exist in monocyte subsets between SAs and WCs at risk for CAD. 119 consecutive patients (59 SA, 60 WC) of at least intermediate CAD risk by the INTERHEART score were prospectively enrolled. Patients with history of malignancy, age > 70, GFR < 30 or on dialysis were excluded. A single blood sample was collected for monocyte analysis. Flow cytometry using dual colour fluorescence (CD14, CD16) within the monocyte gate was used to identify monocyte subsets (classical, intermediate, and non-classical) by staff blinded to the individuals’ characteristics. The SA group consisted of 64% males with a mean age of 54 (+/- 9), while the WC group consisted of 55% males with a mean age of 59 (+/- 7). Both groups had similar body mass index, rates of hypertension, dyslipidemia and family history of premature CAD. Compared to WCs, SAs had higher prevalence of diabetes (36% vs. 13%, p = 0.005) and hemoglobin A1C levels (6.0 +/- 1.1% vs. 5.6 +/- 0.6%, p < 0.001). SA patients had a higher proportion (85.3 +/- 10.7% vs. 81.4 +/- 11.0%, p = 0.009) and total level (449.0 +/- 180.4 vs. 388 +/- 127.4, p = 0.010) of classical CD14++CD16- monocytes compared to WCs. There was no difference between the two groups in the proportion of intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes (see Figure 1). There was no association between diabetes and the proportion of monocyte subsets. Ethnicity had a moderate association with the proportion of classical CD14++CD16- monocytes (Eta coefficient = 0.525) with a large effect size (Eta squared = 27.5%). The association of ethnicity with intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes was either weak or negligible with minimal to no effect size (see Table 1). In patients with substantive risk for CAD, SAs had a significantly higher proportion and level of classical CD14++CD16- monocytes compared to WCs. Our findings provide a novel insight into the potential mechanism of increased CAD susceptibility amongst SAs compared to WCs.

7Demographics of postural orthostatic tachycardia syndrome in adult population

Abstract Background Postural Orthostatic Tachycardia Syndrome (POTS) is a dysautonomia of unclear etiology. POTS is defined as a form of orthostatic intolerance characterized by an increase in heart rate ≥ 30 bpm or to a heart rate ≥120 bpm upon standing. The clinical manifestations include dizziness, palpitations fatigue, anxiety, nausea and fainting. There is a paucity of data available on adult population. This study aims to identify and evaluate demographic features of adult patients with POTS in a large tertiary specialty clinic. Methods 447 patients diagnosed with POTS between 8/21/2018 and 8/20/2019 were randomly selected from our electronic records, and clinical data obtained during initial outpatient evaluation was reviewed retrospectively for race, gender and age. Results Out of 447 patients, 407 (91%) are female and 40 (9%) are male. Amongst them, 417 (93%) patients are White Caucasian of which 381 (91%) are female and 36 (9%) are male; 12 (3%) are Black/African-American of which 11 (92%) are female and 1 (8%) is male; 10 (2%) are Hispanic of which 100% are females; 4 (1%) are Asian of which 2 (50%) are females and 2 (50%) are males and 4 from other races of which 3 (75%) were female and 1 (25%) was male. Patients had a mean age of 32.9 with a standard deviation of 11.96. Conclusions POTS predominates in females, middle age population, and may be heavily prevalent in White Caucasians. Key messages Further clinical studies on more geographically spread populations are encouraged to support our findings on racial prevalen

1030-P: Cardiorenal Complications in Young-Onset T2DM Compared between White Caucasian and African American in the USA

Aim: Complex associations between T2DM, CKD and HF challenge treatment strategies and results in significant life years loss. Risk of CKD and HF in young- and usual-onset T2DM among White Caucasian (WC) and African American (AA) were explored.Methods: From nationally representative EMRs of USA, 1491672 WC and 31133 AA diagnosed with T2DM from 2000-2018 within age 18-39 /40-49/50-59/ 60-69 yrs were identified. The restricted mean time (RMT) to CKD and HF in AA and WC were compared, adjusting for anthropometric and time-varying disease confounders.Results: At T2DM Dx, 10 /12% and 2 /4% of WC /AA had existing CKD and HF; 48 /57% and 39 /32% had hypertension and dyslipidaemia. With mean 5 yrs follow-up, 95% CIs of CKD+HF incidence rates/1000PY were: (23-24) /(37-38) /(53-54) /(82-83) in 18-39 /40-49 /50-59/ 60-69 yrs grps for WC and (30-31) /(47-49) /(66-68) /(93-95) for AA.Compared to WC, AA had significantly higher risk of CKD and HF across all age groups (HR CI range: 1.1-2.4). In AA/WC aged 18-39 yrs, RMT (CI) in yrs to CKD [8.3 (7.8-8.7) /8.9 (8.5-9.2)] and HF [9.4 (8.6-10.3) /11.4 (9.8-12.9)] was on average only 3.2 /3.2 yrs and 2.7 /3.3 longer compared to those aged 60-69 yrs at Dx (Fig).Conclusion: Developing cardio-renal complications within 10 yrs of young-onset T2DM and significant higher risk among AA compared to WC call for more intense prevention strategies in young-onset population, particularly in AA.View largeDownload slideView largeDownload slide DisclosureS. K. Paul: Advisory Panel; Self; Sanofi, Consultant; Self; Roche Pharma. O. Montvida: None.

Assessing Calcium and Magnesium Nutritional Status With the Hair Median Derivatives Bioassay

ObjectivesShort-term biological indicator of urinary Mg and Ca excretion helps us to assess human body Mg and Ca nutritional status. In this study, we used the long-term biological indicator tissue of hair to assess Mg and Ca human body nutritional status. MethodsHair Mg and Ca were analyzed in 1073 healthy white adult Caucasians [734 women (♀) and 339 men (♂)] consuming common mid-European diet, with the ICP MS. The log transformed data on hair magnesium and calcium were analyzed with median derivatives bioassay. ResultsThe median values (μg·g–1) were ♀Mg 137.2 and ♂Mg 47.1, and ♀Ca 1721.4 and ♂Ca 492.0, respectively. The linear (adequate) reference ranges of the sigmoid saturation curve for magnesium were ♀Mg 29.7–270.6 and ♂Mg 20.5–90.2, whereas these ranges for calcium were ♀Ca 487.7–4426.8 and ♂Ca 261.1–816.4. The magnesium to calcium (Mg/Ca) ratio in women appears fairly constant along the sigmoid linear segment range (about 0.067), and in difference to the constantly increasing Mg/Ca ratio in men - from 0.078 at the start of the linear segment to 0.096 at the median and 0.1105 before leveling at the top of the curve. ConclusionsWomen tend to accumulate much more Ca in their hair than men. The results suggest how hair Mg concentration should not be below 29.7 and 20.5 or above 270.6 and 90.2 μg·g–1 in women and men, respectively. Similarly, Ca hair concentrations should be not below 487.7 and 261.1 and higher than 4456.8 and 816.4 in women and men, respectively. The possible health effects of the observed sex related metabolic difference between men and women remains to be elucidated. Funding SourcesThe authors received no specific funding for this work.

Type 2 diabetes in South Asians compared to Europeans: Higher risk and earlier development of major cardiovascular events irrespective of the presence and degree of retinopathy. Results from The HinDu The Hague Diabetes Study.

IntroductionSouth Asians with diabetes have more severe diabetic retinopathy (DR) and cardiovascular complications than white Caucasians. However, how big this gap is and the relation with the severity of DR has not been studied. Here, we quantify the difference in time from diabetes diagnosis until a first non‐fatal Major Adverse Cardiovascular Event (TUF MACE) in different DR groups in South Asians and Europeans.Methods3831 adults with type 2 diabetes, 1358 South Asians and 2473 Europeans, treated in our diabetes clinic between 2006 and 2017 were included. Data on risk factors, diabetes duration, age of diagnosis and diabetes complications were collected from the diabetes‐specific database and analysed using descriptive statistics and Cox regression. DR was graded in 3 categories, and non‐fatal MACE was pre‐specified.ResultsPrevalence of non‐fatal MACE was the same when DR was absent, increased with increasing severity of DR in both ethnic groups, but was more frequent in South Asians with DR (mild: 50 vs. 42% and severe 62 vs. 46%. Classic risk factors only differed in relation to smoking habits, which were significantly lower in South Asians.After correction for classic risk factors and age at diabetes diagnosis TUF MACE was significantly shorter in South Asians, an effect also seen in the no‐DR group (4.1 yrs. HR 1.5, 95% CI 1.3–1.8 and 7.4 yrs. earlier, HR 2.0, 95% CI 1.6–2.6 for no‐DR and severe DR, respectively).ConclusionsWhen adjusted for age at diabetes diagnosis, we show that time until first non‐fatal MACE in South Asians is significantly shorter compared to Europeans and increases from no‐ to severe DR.

Experiences of Outpatient Clinics and Opinions of Telehealth by Caucasian and South Asian Patients' With Celiac Disease.

Outpatient clinics are an important part of chronic disease management, including that of celiac disease. During the coronavirus disease 2019 (COVID-19) global pandemic, telephone and online video consultations with health care professionals have substantially increased. This study aimed to explore the experience and opinions of adults, with celiac disease, toward face-to-face clinic appointments and alternatives, such as telehealth. Semistructured qualitative interviews with 37 patients were undertaken (75% White Caucasians, 25% South Asians; 29 patients were not adhering to the gluten-free diet). Interviews were recorded, transcribed, and analyzed by NVivo. Frequently reported issues with face-to-face appointments included travel and car parking costs, needing to take time off work, and frequent changes to appointment time. In addition, South Asian patients highlighted issues with linguistics barriers. Telephone consultations were considered acceptable and practical by the majority of patients based on ease and convenience. Online video consultations were favored by just 9 patients, however it is acknowledged that since the COVID-19 pandemic, there has been a greater exposure to this type of technology. These patient experiences can inform health care service development and are not biased by external health concerns connected with in-person visits during the pandemic.

Flares in patients with systemic lupus erythematosus.

ObjectiveSLE is characterized by relapses and remissions. We aimed to describe the frequency, type and time to flare in a cohort of SLE patients.MethodsSLE patients with one or more ‘A’ or ‘B’ BILAG-2004 systems meeting flare criteria (‘new’ or ‘worse’ items) and requiring an increase in immunosuppression were recruited from nine UK centres and assessed at baseline and monthly for 9 months. Subsequent flares were defined as: severe (any ‘A’ irrespective of number of ‘B’ flares), moderate (two or more ‘B’ without any ‘A’ flares) and mild (one ‘B’).ResultsOf the 100 patients, 94% were female, 61% White Caucasians, mean age (s.d.) was 40.7 years (12.7) and mean disease duration (s.d.) was 9.3 years (8.1). A total of 195 flares re-occurred in 76 patients over 781 monthly assessments (flare rate of 0.25/patient-month). There were 37 severe flares, 32 moderate flares and 126 mild flares. By 1 month, 22% had a mild/moderate/severe flare and 22% had a severe flare by 7 months. The median time to any ‘A’ or ‘B’ flare was 4 months. Severe/moderate flares tended to be in the system(s) affected at baseline, whereas mild flares could affect any system.Conclusion. In a population with active SLE we observed an ongoing rate of flares from early in the follow-up period with moderate–severe flares being due to an inability to fully control the disease. This real-world population study demonstrates the limitations of current treatments and provides a useful reference population from which to inform future clinical trial design.

Unique pattern of COVID-19 infection in the State of Hawai‘i

This is a brief report on an unusual observation regarding COVID-19 cases. The State of Hawaii is one of the most remote of the Pacific islands and the population is approximately 1.4 million. The racial and ethnic diversity is very high. For example, white Caucasians comprise ∼25%, Asians including Japanese, Chinese, and other Asians account for ∼30%, Hawaiians for 20%, and Pacific Islanders mostly from Micronesia and Samoa comprise ∼4%. We discovered that the COVID-19 rate in the latter group was up to 10 times that in all of the other groups combined and they accounted for almost 30% of cases. Moreover, we are unaware of COVID-19 transmission from Pacific Islanders to islanders with other ethnicities. Thus, there is an epidemic within the epidemic in Hawai‘i.

Association of Cardiometabolic Multimorbidity and Depression With Cardiovascular Events in Early-Onset Adult Type 2 Diabetes: A Multiethnic Study in the U.S.

To evaluate the temporal patterns of cardiometabolic multimorbidity (CM) and depression in White Caucasians (WCs) and African Americans (AAs) with early-onset type 2 diabetes and their impact on long-term atherosclerotic cardiovascular disease (ASCVD). From U.S. electronic medical records, 101,104 AA and 505,336 WC subjects with type 2 diabetes diagnosed between 2000 and 2017 were identified (mean follow-up 5.3 years). Among those without ASCVD at diagnosis, risk of ASCVD and three-point major adverse cardiovascular events (MACE-3) (heart failure, myocardial infarction, or stroke) was evaluated between ethnicities by age-groups. The proportion of patients diagnosed at <50 years of age increased during 2012-2017 (AA 34-38%, WC 26-29%). Depression prevalence increased during 2000-2017 (AA 15-23%, WC 20-34%), with an increasing trend for CM at diagnosis in both groups. Compared with WC, the adjusted MACE-3 risk was significantly higher in AA across all age-groups, more pronounced in the 18-39-year age-group (hazard ratio 95% CI 1.42, 1.88), and in patients with and without depression. AAs had a 17% (1.05, 1.31) significantly higher adjusted ASCVD risk in the 18-39-year age-group only. Depression was independently associated with ASCVD and MACE-3 risk in both ethnic groups across all age-groups. Other comorbidities were independently associated with ASCVD and MACE-3 risk only among WCs. AAs have higher cardiovascular risk compared with WCs, particularly in early-onset type 2 diabetes. CM and depression at diabetes diagnosis have been increasing over the past two decades in both ethnic groups. Strategies for screening and optimal management of CM and depression, particularly in early-onset type 2 diabetes, may result in a lower cardiovascular risk.

SUN-605 Mediastino-Abdominal Lipomatosis: Deep Accumulation of Fat Mimicking a Respiratory Disease

Introduction: Multiple systemic lipomatosis (MSL) is a rare disorder with unknown etiology. It is characterized by the massive development of non-encapsulated lipomas in subcutaneous tissues. Lipomatosis of the face, head, neck, extremities, abdomen, and pelvis have been reported in the literature. Case: We report a case of a 65 years old female (BMI: 34 kg/m2) with past medical history of hypertension, hyperlipidemia(DLD) diabetes mellitus type 2 and sleep apnea that was brought into emergency room (ER) for worsening shortness of breath. In the ER, she was having an oxygen saturation of 75% and required intubation. The patient was afebrile, with a BP of 120/75 mm Hg and a heart rate of 70/minute. Trans-thoracic echocardiogram revealed normal ejection fraction and normal pulmonary pressure with no wall motion abnormality. CXR showed no infiltration or consolidation. CT angiogram (CTA) ruled out pulmonary embolism but it was notable for large deposits of fat involving the abdomen and thorax, with invasion into the mediastinum and the space between the liver and diaphragm. Mesenteric fat was increased. Tissue was biopsied, which confirmed the diagnosis of fatty invasion. Discussion: Abdominal lipomatosis is characterized by massive enlargement of the abdomen due to intraperitoneal and retroperitoneal fatty deposits. Phenotypically patients can appear to be thin or obese, however, it is more common in the overweight population like our patient. Mediastinal lipomatosis is a benign cause of mediastinal widening, however patients can develop respiratory symptoms like exertional dyspnea due to compression of airways. MSL affects white caucasian between 25-60 years old and it is associated with DLD, impaired glucose tolerance, hyperuricemia, macrocytic anemia, and peripheral neuropathy. The pathophysiology is not fully understood, some theories stated that it is related to defective lipid mobilization in lipomatocytes, other suggested disorder in the mitochondria of brown fat. Conclusion: CT and MRI of the abdomen and chest are very helpful in the diagnosis of MSL but a tissue biopsy is what makes the final diagnosis. There is no definitive treatment; the recommendations are a healthy lifestyle including a low-fat diet, abstinence from alcohol and exercise. In severe cases, surgery is recommended.

Determining the Impact of the Opioid Crisis on a Tertiary-Care Hospital in Central New York to Identify Critical Areas of Intervention in the Local Community.

Background Central New York has been afflicted by the heroin epidemic with an increase in overdose deaths involving opioids. Objective The objective of the study was to understand the epidemiology of hospitalizations related to a diagnosis of opioid use (OU). Design The study was designed as a retrospective analysis of hospitalized patients admitted from January 1, 2008, to December 30, 2018, using ICD-9 and 10 codes for heroin or opiate use, overdose, or poisoning. Setting. The study was conducted in a tertiary-care and teaching hospital located in Central New York. Patients. Hospitalized patients were included as study participants. Results Opioid use-related admissions increased from .05/100 hospital admissions in 2008 to a peak of 2.9/100 in 2018, a 58-fold increase. There were 49 deaths over the 11-year period for an overall case fatality of 1.2 per 100 OU admissions. The median age for all years was 40 years (SD of 13.7 years), and admissions were largely white caucasians (67.0% of all admissions). The mean length of stay was 8.55 days (SD 12 days), with a range of 1 to 153 days. The most frequent discharge diagnosis was due to infections (15.0% of discharge diagnoses) followed by trauma (5.8% of discharge diagnoses). Methicillin-resistant Staphylococcus aureus was more common in patients with OU (58.1%) than in patients with non-OU (43%) (p < 0.0001 by chi-square with Yates' correction). Spatial analysis was performed by zip code and demonstrated regional hotspots for OU-related admissions. Limitations. The limitations of this study are its retrospective nature and largely numerator-based analysis. The use of ICD codes underrepresents the true burden due to underreporting and failure to code appropriately. This study focuses on patients who are hospitalized for a medical reason with a secondary diagnosis of opioid use and does not include patients who present to the emergency room with an overdose underrepresenting the true burden of the problem. Conclusions Our results demonstrate the impact of the opioid epidemic in one tertiary-care center and the need to prepare for the costs and resources to address addiction care for this population.

Intake of B vitamins in UK dwelling South Asian and White Caucasian women: Results from the D-FINES study

AbstractAdequate intakes of the B vitamins are essential for health; however there is a lack of data concerning B vitamin intakes in UK dwelling South Asian (SA) groups. We aimed to investigate whether UK SA women meet the LRNI for B vitamins, and whether their intake differs from same-age White Caucasian (WC) women. We used summer 2006 dietary intake data from the Food Standards Agency (FSA) funded D-FINES study (Vitamin D, Food Intake, Nutrition and Exposure to Sunlight in Southern England, project N05064). After removal of over- and under-reporters (energy: BMR ratio &lt; 1 or &gt; 1.6) there were n = 29 SA and n = 146 WC subjects. The two groups did not differ significantly in age and BMI. Overall mean (SD) for age was 50.6 (13.6) years and for BMI was 26.8 (4.8). In SA, 41% were Bangladeshi or Pakistani, 28% were Indian and 31% were of other ethnicity. Independent T-tests, using log transformed data, showed no statistically significant differences for any B vitamin (Bonferroni revised p value: &lt; 0.008). Results were as follows, giving median (IQR): Thiamine (mg) 1.5 (0.5) SA vs 1.4 (0.5) WC; (P = 0.8); Riboflavin (mg) 1.3 (0.5) SA vs. 1.5 (0.6) WC (P = 0.08); Niacin (mg) 30.7 (13.7) SA vs 33.3 (9.8) WC (P = 0.4); B6 (mg) 1.7 (0.5) SA vs 1.9 (0.7) WC (P = 0.2); B12 (micrograms) 2.8 (0.05) SA vs 3.6 (2.5) WC (P = 0.02); Folate (micrograms) 213 (93) SA vs 231 (82) WC (P = 0.8). In terms of percentages below the LRNI: Thiamine 0% SA and 0.7% (n = 1) WC; Riboflavin 0% SA and 1.4% (n = 2) WC; B12 10% (n = 3) SA and 0% WC. For Niacin, B6 and Folate no women in either group were below the LRNI. Overall, there were no ethnic differences in B vitamin intake by ethnicity. There was a trend for a slightly lower B12 intake in SA but this did not reach statistical significance after adjustment for multiple testing. It is of concern that 10% of SA did not meet the LRNI for B12. Of this 10%, the majority were not vegetarian or vegan. The sample size for SA was very small and further research is now required in a larger sample to confirm this finding. The D-FINES study was funded by the UK FSA (N05064). The views expressed are those of the authors alone.

Higher Plasma Sclerostin and Lower Wnt Signaling Gene Expression in White Adipose Tissue of Prediabetic South Asian Men Compared with White Caucasian Men.

BackgroundSouth Asians generally have an unfavourable metabolic phenotype compared with white Caucasians, including central obesity and insulin resistance. The Wnt protein family interacts with insulin signaling, and impaired Wnt signaling is associated with adiposity and type 2 diabetes mellitus. We aimed to investigate Wnt signaling in relation to insulin signaling in South Asians compared with white Caucasians.MethodsTen Dutch South Asian men with prediabetes and overweight or obesity and 10 matched Dutch white Caucasians were included. Blood samples were assayed for the Wnt inhibitor sclerostin. Subcutaneous white adipose tissue (WAT) and skeletal muscle biopsies were assayed for Wnt and insulin signaling gene expression with quantitative reverse transcription polymerase chain reaction (Clinicaltrials.gov NCT02291458).ResultsPlasma sclerostin was markedly higher in South Asians compared with white Caucasians (+65%, P<0.01). Additionally, expression of multiple Wnt signaling genes and key insulin signaling genes were lower in WAT in South Asians compared with white Caucasians. Moreover, in WAT in both ethnicities, Wnt signaling gene expression strongly positively correlated with insulin signaling gene expression. In skeletal muscle, WNT10B expression in South Asians was lower, but expression of other Wnt signaling and insulin signaling genes was comparable between ethnicities. Wnt and insulin signaling gene expression also positively correlated in skeletal muscle, albeit less pronounced.ConclusionSouth Asian men with overweight or obesity and prediabetes have higher plasma sclerostin and lower Wnt signaling gene expression in WAT compared with white Caucasians. We interpret that reduced Wnt signaling could contribute to impaired insulin signaling in South Asians.

LDL aggregation susceptibility is higher in healthy South Asian compared with white Caucasian men

South Asians are more prone to develop atherosclerotic cardiovascular disease (ASCVD) compared with white Caucasians, which is not fully explained by classical risk factors. We recently reported that the presence of aggregation-prone low-density lipoprotein (LDL) in the circulation is associated with increased ASCVD mortality. We hypothesized that LDL of South Asians is more prone to aggregate, which may be explained by differences in their LDL lipid composition. In this cross-sectional hypothesis-generating study, LDL was isolated from plasma of healthy South Asians (n=12) and age- and BMI-matched white Caucasians (n=12), and its aggregation susceptibility and lipid composition were analyzed. LDL from South Asians was markedly more prone to aggregate compared with white Caucasians. Among all measured lipids, sphingomyelin 24:0 and triacylglycerol 56:8 showed the highest positive correlation with LDL aggregation. In addition, LDL from South Asians was enriched in arachidonic acid containing phosphatidylcholine 38:4 and had less phosphatidylcholines and cholesteryl esters containing monounsaturated fatty acids. Interestingly, body fat percentage, which was higher in South Asians (+26%), positively correlated with LDL aggregation and highly positively correlated with triacylglycerol 56:8, sphingomyelin 24:0, and total sphingomyelin. LDL aggregation susceptibility is higher in healthy young South Asians compared with white Caucasians. This may be partly explained by the higher body fat percentage of South Asians, leading to sphingomyelin enrichment of LDL. We anticipate that the presence of sphingomyelin-rich, aggregation-prone LDL particles in young South Asians may increase LDL accumulation in the arterial wall and thereby contribute to their increased risk of developing ASCVD later in life.

SAT-187 EPIDEMIOLOGY 0F CHRONIC TUBULO-INTERSTITIAL NEPHRITIS IN A NEPHROLOGY SERVICE IN SRI LANKA- ARE THESE CKDu ALL?

Epidemic chronic kidney disease (CKD) from agricultural communities in many regions of the world has been termed CKD of unknown cause (CKDu) and has been widely recognized as an idiopathic chronic tubulo-interstitial nephritis (iCTIN). This unique CKD which affects people of a similar social stratum and environment, appeared from agricultural communities in these regions around the same period of time, and has very similar clinical and biochemical features. Attempted case definitions of CKDu from Sri Lanka and Central America only narrow it down to a non-proteinuric CKD. CTIN from any cause would fit into these case definitions. In all renal biopsy registries in the world there have been iCTIN, ranging from 11-30%, even before the emergent epidemic of CKDu. In one case series from Texas in 1990, 25% of CTIN were idiopathic and in another series published in 2001, the incidence of iCTIN among Indo-Asians in a London hospital was seven times that of white Caucasians. Obviously, all these cannot be termed CKDu. A retrospective study was conducted in those who underwent renal biopsies at Sri Jayewardenepura General Hospital, Sri Lanka, situated in the non-endemic region for CKDu, but gets many referrals from the endemic area. All case records of patients who underwent renal biopsies during the period March 2016-March 2018 were analyzed. 1218 patients with CKD were treated during this period. 297 underwent a renal biopsy. 77/297 (26%) had primary CTIN. 13/77 (17%) had identifiable causes of CTIN, while the rest-64/77(83%) - were idiopathic. 24/64 (38%) were from known endemic agricultural areas. 14 of 40 from non-endemic areas (35%) were from areas with high agricultural activity. Hence, 26 of the cohort of 64 iCTIN (40%) were from urban or semi-urban areas with neither significant agricultural activity nor occupational exposure to heat stress. Idiopathic CTIN of unknown cause was a recognized biopsy diagnosis even before the CKDu epidemic. The epidemic CKDu which appeared from agricultural communities in Sri Lanka, Central America and India are likely to have similar, if not the same etiology due to the simultaneity of their emergence, and the similar demographic, clinical, biochemical and pathological features. The name CKDu confusingly mixes up all patients with undiagnosed CTIN hence the name CINAC (chronic interstitial nephritis of agricultural communities) is more appropriate to identify the global epidemic CKD identified since the 1990s.

Evidence-Based Psychosocial Interventions for Ethnic Minority Youth: The 10-Year Update

This is the official update on the status of evidence-based psychosocial interventions for ethnic minority youth. Compared to a decade ago, there has been expansion of well-designed intervention studies, growth in the number (not type) of interventions meeting evidence-based criteria, and greater focus on testing ethnicity/race moderator effects. In terms of standard of evidence, 4 psychosocial interventions are now well-established and 10 are probably efficacious or possibly efficacious, with most protocols drawing on cognitive and behavioral change procedures and/or family systems models. Yet the research literature remains mostly focused on testing interventions with European Americans (White Caucasians), and little to no progress has been made in testing the effects of interventions with Asian American or Native American youth. Knowledge of the effects of cultural tailoring on program engagement, outcomes, and mechanisms of change remains scant.

Does parasocial interaction with weight loss vloggers affect compliance? The role of vlogger characteristics, consumer readiness, and health consciousness

Drawing on the notion of parasocial interaction (PSI) and the social comparison theory, this experimental research examines how nutritionist video bloggers (vloggers) influence consumer compliance intentions toward healthy, weight-loss diets. Drawing on two samples (Mexican Americans and White Caucasians) and using structural equation modeling and mediation analysis, this research highlights vloggers’ credibility and physical attractiveness, but not homophily, as salient source characteristics that influence PSI, which in turn reinforces compliance intention. Moreover, consumer readiness, consisting of role clarity, ability, and motivation, serves as a partial mediator of the PSI–compliance intention relationship. Lastly, consumer health consciousness emerged as a significant moderator of the PSI–compliance intention relationship among White Caucasians, but not among Mexican Americans. The findings and their implications are discussed.

Estimation and Comparison of the Duration of the Pubertal Peak in Skeletal Class II and Class I Subjects Using the Cervical Vertebrae Maturation Index Method

The purpose of this study is to estimate and compare the duration of the pubertal peak in skeletal class II and class I subjects and to detect any difference between boys and girls or between hypo-, normo-, and hyperdivergent subjects for skeletal maturation indicator (CVM) in white Caucasians. 346 subjects were selected from 3,119 examined files. Pretreatment lateral cephalometric records were hand-traced and divided following the anteroposterior skeletal relationship, the gender, the vertical pattern, and the skeletal maturation. The duration of the pubertal peak was calculated based on the chronological age interval according to each group. The age of onset of the active growth and the duration of the pubertal peak were compared between the different groups studied. Pubertal peak had a mean duration of 13 months in skeletal class I subjects, 19 months in skeletal class II subjects, 15 months in girls, 20 months in boys, 13 months in normodivergent and hypodivergent subjects, whereas in hyperdivergent subjects, it lasted 18 months. The growth interval corresponding to the pubertal growth spurt (CS3-CS4) was (1) significant between skeletal class I and class II subjects, (2) longer in boys, and (3) longer in hyperdivergent subjects. Orthodontic treatments can start earlier for girls in class I or class II relationship and for hyperdivergent subjects as well. Furthermore, boys and subjects in class II skeletal relationship have a significantly longer duration of the pubertal peak and consequently a much efficient orthopedic and orthodontic treatment.