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Abstract P3116: Household Food Insecurity and Adiposity Changes Among Adolescents: A Longitudinal Study of Gender-Specific Outcomes in the Greater Baton Rouge Area
Background: Food insecurity has been consistently linked with obesity in adults, but research findings have been less conclusive among adolescents. Previous studies have suggested that food insecurity places adolescents at a higher risk for adverse health outcomes, with obesity being a significant concern. Objective: To examine the relationship between baseline household food insecurity and adiposity changes over two years among Louisiana adolescents aged 10 to 16 in the Baton Rouge, Louisiana metropolitan area. Methods: Multilevel longitudinal data were collected from June 2016 to August 2018 during baseline and follow-up assessments conducted within the Translational Investigation of Growth and Everyday Routines in Kids study. Adolescent adiposity and body composition data were obtained using body imaging (i.e., dual-energy X-ray absorptiometry and abdominal magnetic resonance imaging) and anthropometric measures at baseline and follow-up. Multivariable multilevel linear regression models, adjusted for demographic and physiological variables, assessed the relationship between baseline household food security status and changes in adiposity outcomes. Results: The analytic sample consisted of 216 adolescents with a mean age of 12.9±1.9; 47.7% were male, 40.7% identified as African American or Hispanic, and 38.4% had obesity at baseline. Twenty-two percent of the sample reported food insecurity at baseline. Compared to food-secure adolescents, food-insecure adolescents experienced significantly larger increases in all adiposity measures between baseline and follow-up (percentage of the 95th BMI percentile: b=7.3, p<0.01; waist circumference: b=3.9, p<0.05; total body fat percentage: b=3.2, p<0.01; and abdominal visceral adipose tissue: b=0.2, p<0.01). Similar results were found among girls; however, among boys, only change in abdominal visceral adipose tissue was higher in food insecure vs food secure boys (b=0.2, p<0.05). Conclusion: This study provides support for the longitudinal association between household food insecurity and increased adiposity in adolescents, with notable gender differences. The main findings show household food insecurity is associated with greater changes in adiposity among girls than boys. These findings underscore the importance of addressing food insecurity as part of comprehensive obesity prevention strategies. Moreover, they highlight the need for gender-specific approaches in tackling this complex public health issue.
Abstract P1116: The DASH Dietary Pattern and Risk of Cardiovascular Disease Mortality During 1988-2019 in US Adults: A Population-Based Cohort Study
Introduction: The Dietary Approaches to Stop Hypertension (DASH) diet reduces cardiovascular disease (CVD) risk factors in clinical trials and has been associated with reduced CVD risk. However, evidence on reduced CVD mortality outcomes has yet to be observed in the National Health and Nutrition Examination Survey (NHANES), a representative sample of the US population, possibly due to an insufficient follow-up in early analyses and a limited dietary exposure assessment. Objective: To examine the association between the DASH dietary pattern and CVD mortality with a longer follow-up using a food-based score and a more robust dietary exposure assessment. Methods: A total of 13,586 nonpregnant adults without a history of CVD were included from NHANES (1988-1994). Diet was assessed by a 24-hour dietary recall supplemented with a food frequency questionnaire at baseline using the DASH-style diet adherence score (DASH score) with positive points for servings of fruits, vegetables, nuts and legumes, whole grains, and low-fat dairy products, and negative points for total dietary sodium, servings of red and processed meats, and sweetened beverages (range, 8-40 points). Mortality data were obtained from National Death Index records until 31 December 2019. Weighted Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). The primary outcome was CVD-mortality. Other mortality outcomes included coronary heart disease (CHD), stroke, and all-cause mortality. Results: During a mean follow-up of 23-years, 1,751 CVD deaths, including 1,416 CHD, 335 stroke deaths and 5,202 all-cause deaths were documented over 311,826 person-years. After multivariable adjustments comparing the highest to lowest tertiles of the DASH score, participants with higher DASH scores were associated with 24% (HR: 0.76 [95% CI: 0.61, 0.94]), 25% (0.75 [0.60, 0.95]) and 19% (0.82 [0.71, 0.94]) lower risk of CVD, CHD, and all-cause mortality, respectively. There was no association with stroke mortality (0.80 [0.48, 1.38]). An increase in DASH score by 10-points was associated with a 20% (0.80 [0.70, 0.93]), 23% (0.77 [0.65, 0.90]), and 18% (0.82 [0.75, 0.90]) lower risk of CVD, CHD, and all-cause mortality, respectively. Conclusion: Among US adults, greater adherence to a food-based DASH score was inversely associated with CVD, CHD, and all-cause mortality.
Abstract P3127: Loneliness and Social Isolation from Reduced Activities Increase Ischemic Heart Disease Risk via Metabolic and Behavioral Mediators: Evidence from Mendelian Randomization Study
Introduction: Observational studies have linked loneliness or social isolation (SI) to ischemic heart disease (IHD), but results are inconsistent. Moreover, modifiable risk factors mediating the causal effects remain unclear. Hypothesis: loneliness and SI causally increase IHD risk, with metabolic and behavioral factors acting as key mediators. Methods: Using genetic instruments derived from summary-level Genome-Wide Association Studies data of European ancestry, we performed a bidirectional two-sample Mendelian Randomization (MR) study to estimate causal effects between loneliness (N=487,647) or SI and IHD (60,801 cases and 123,504 controls). SI traits included living alone (N=459,988), fewer social activities (N=459,830), and fewer contact with friends or family (N=461,369). Five subtypes of social activities were further analyzed, including sports club or gym, pub or social club, religious group, adult education class, or other group activities. Subsequently, a network MR study was conducted to evaluate the potential mediating effects of 20 candidate mediators and calculate their mediated proportions. Results: Loneliness was causally associated with IHD (OR 2.129; 95% CI, 1.380 to 3.285), mediated by body fat percentage, waist-hip ratio, total cholesterol and LDL-C. Regarding SI traits, fewer social activities increased IHD risk (OR, 1.815; 95%CI, 1.189 to 2.772), and only sports club or gym had protected against IHD (OR, 0.333; 95%CI, 0.204 to 0.542). No evidence showed causality between living alone or contact frequency and IHD. Smoking cessation, HDL-C, triglycerides, hypertension and fasting insulin mediated the causal pathway from fewer social activities to IHD. Moreover, no evidence indicated the reverse causality of IHD with loneliness or SI. Results were robust in sensitivity analyses. Conclusions: More attention should be paid to individuals who feel lonely or have fewer social activities for prevention of IHD, with several modifiable mediators as prioritized targets.
Porphyromonas gingivalis outer membrane vesicles alter cortical neurons and Tau phosphorylation in the embryonic mouse brain
Porphyromonas gingivalis (Pg) is an oral bacterial pathogen that has been associated with systemic inflammation and adverse pregnancy outcomes such as low birth weight and pre-term birth. Pg drives these sequelae through virulence factors decorating the outer membrane that are present on non-replicative outer membrane vesicles (OMV) that are suspected to be transmitted systemically. Given that Pg abundance can increase during pregnancy, it is not well known whether Pg-OMV can have deleterious effects on the brain of the developing fetus. We tested this possibility by treating pregnant C57/Bl6 mice with PBS (control) and OMV from ATCC 33277 by tail vein injection every other day from gestational age 3 to 17. At gestational age 18.5, we measured dam and pup weights and collected pup brains to quantify changes in inflammation, cortical neuron density, and Tau phosphorylated at Thr231. Dam and pup weights were not altered by Pg-OMV exposure, but pup brain weight was significantly decreased in the Pg-OMV treatment group. We found a significant increase of Iba-1, indicative of microglia activation, although the overall levels of IL-1β, IL-6, TNFα, IL-4, IL-10, and TGFβ mRNA transcripts were not different between the treatment groups. Differences in IL-1β, IL-6, and TNFα concentrations by ELISA showed IL-6 was significantly lower in Pg-OMV brains. Cortical neuron density was modified by treatment with Pg-OMV as immunofluorescence showed significant decreases in Cux1 and SatB2. Overall p-Tau Thr231 was increased in the brains of pups whose mothers were exposed to Pg-OMV. Together these results demonstrate that Pg-OMV can significantly modify the embryonic brain and suggests that Pg may impact offspring development via multiple mechanisms.
Abstract P3151: Association Between Life’s Essential 8 and Cardiovascular Disease by Depression Status
Cardiovascular health (CVH), as measured by the American Heart Association's Life’s Essential 8 (LE8) metrics, plays a vital role in determining cardiovascular disease (CVD) risk. Depression is also known to have adverse effects on CVD outcomes and may further complicate this relationship. Thus, this study assesses the relationship between LE8 and CVD overall, and by depression status. We hypothesize that higher LE8 scores are associated with lower odds of CVD, and that depression status may modify this relationship. This cross-sectional study employed secondary data analysis using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, with an analytic sample size of 14,848 participants (age ≥ 20 years). Multivariable logistic regression analyses, incorporating survey weights, for CVD outcome (i.e., stroke, heart attack, angina, coronary heart disease, heart failure) were performed as a function of LE8 scores (high/moderate/low CVH) while adjusting for potential confounders. We also assessed for effect measure modification (EMM) by depression status using the PHQ-9 scores by including product terms between LE8 scores and depression in the adjusted model. The adjusted odds ratios (OR) for CVD among participants with high and moderate compared to low LE8 scores were 0.38 (95% CI: 0.19-0.75) and 0.52 (95% CI: 0.42-0.63), respectively. EMM assessment by depression status indicated strong negative associations between higher LE8 scores and CVD in both groups. Specifically, the adjusted ORs were 0.42 (95% CI: 0.21-0.83) for those reporting no depression and 0.06 (95% CI: 0.01-0.60) for those with depression. We found a clear negative relationship between LE8 scores and CVD, with higher LE8 scores associated with lower odds of CVD compared to the lower LE8 scores group. This protective relationship was particularly profound among individuals with higher levels of depressive symptoms. These findings highlight the importance of promoting CVH to mitigate the adverse effects of depression on CVD outcomes. Additional prospective studies should be conducted to establish the temporality of these associations between LE8 scores and CVD outcomes among individuals with depression.
Abstract 007: Associations of Accelerometer Measures of Physical Activity and Sedentary Behavior with Alzheimer’s Disease Related Dementias and Vascular Dementias Classified Using Medicare Claims Data Among Older Black, Hispanic and White Women: The Objective Physical Activity and Cardiovascular Health Study
Introduction: Higher amounts of physical activity (PA) have been shown to be associated with lower risk of Alzheimer’s disease related dementias (ADRD), however few studies have prospectively examined accelerometer measures of PA and sitting with ADRD and specifically vascular dementias (VD) among older diverse women. Methods: Older postmenopausal women (n=5417; mean age=78 ± 7 years; 33% Black, 17% Hispanic) in the Objective Physical Activity and Cardiovascular Health Study without prior ADRD wore accelerometers for 7 days in May 2012-April 2014 and were followed through December 31, 2021. Incident ADRD was classified using Medicare Claims data, allowing for identification of events among older Black, Hispanic or Latina, and White women. Multivariable Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) for total PA, light PA (LPA), moderate-to-vigorous intensity PA (MVPA), steps/day, total sitting time, and mean sitting bout duration (MSBD) with ADRD and VD adjusting for age, race and ethnicity, education, alcohol, smoking, hypertension, diabetes, physical functioning, and body mass index (BMI). We additionally carried out stratified analysis across covariates. Results: There were 1143 ADRD events, including 187 VD events, during a median follow-up of 8.6 years. The HR (95% CI; P-trend) for ADRD and VD for each 1 standard deviation (SD) increment was 0.83 (0.69-1.00; 0.04) and 0.77 (0.48-1.25; 0.70) for total PA (SD=90 minutes/day), 0.58 (0.48-0.71; <0.001) and 0.61 (0.38-0.99; 0.02) for MVPA (SD=34 minutes/day), 0.53 (0.43-0.65; <0.001) and 0.57 (0.34-0.97; 0.01) for steps/day (SD=2051 steps/day), and 1.15 (0.95-1.38; 0.03) and 0.84 (0.52-1.37; 0.72) total sitting time (SD=102 minutes/day). Associations for steps with ADRD were similar among Black (HR=0.69, 95% CI=0.57-0.85), White (HR=0.70, 95% CI=0.61-0.81) and Hispanic or Latina women (HR=0.80, 95% CI=0.63-1.01, P-interaction=0.32). LPA and MSBD were not associated with ADRD or VD. Conclusions: Higher MVPA and steps/day were associated with lower ADRD and VD risk while higher total sitting time was associated with higher ADRD risk, supporting interventions aimed at increasing PA and reducing SB for ADRD prevention in diverse populations.
Abstract P3141: Psychological Health and Life’s Essential 8 Cardiovascular Health Risk among Women of Reproductive Age
Introduction: Few studies have explored how stress, anxiety, and depression impact cardiovascular health among women of reproductive age. This study examines the relationship between psychological health and cardiovascular risk factors among community-enrolled participants and those from the American Heart Association’s Research Goes Red (RGR) registry. Methods: We conducted a cross-sectional analysis of participants from the RGR Registry and the SAFE HEART study who completed cardiovascular and psychological health questionnaires. Psychological health risk was assessed using the Perceived Stress Scale (high stress, ≥8), Generalized Anxiety Disorder scale (high anxiety, ≥3), and Patient Health Questionnaire (high depression, ≥3). Dependent variables included Life’s Essential 8 cardiovascular health metrics: self-reported hypertension, diabetes, hyperlipidemia, overweight/obesity (≥25 kg/m2), poor diet (less than 5 servings of fruits/vegetables), low physical activity (<150 minutes/week, moderate), inadequate sleep (<7 or >9 hours), and smoking (current or history of 100 cigarettes). Logistic regression models were used to assess associations between psychological health and cardiovascular outcomes, adjusting for social risk covariates. Results: In this cross-sectional study of 457 women aged 18-44 the mean age was 30 years ± 5.7, with 45.51% Black adults, 87.30% had at least college education, 66.52% were married or living with a partner and 71.12% were employed. After adjusting for covariates, high stress was associated with increased odds of hypertension (adjusted odds ratio [aOR] = 2.08, 95% CI: 1.29-3.36), hyperlipidemia (aOR = 2.78, 95% CI: 1.74-4.46), smoking (aOR = 2.21, 95% CI: 1.40-3.60) and lower odds of poor diet (aOR = 0.62, 95% CI: 0.38-0.98). High depression was similarly associated with hypertension (aOR = 1.97, 95% CI: 1.20-3.25), hyperlipidemia (aOR = 2.49, 95% CI: 1.52-4.06), smoking (aOR = 4.61, 95% CI: 2.75-7.74), overweight/obesity (aOR = 2.41, 95% CI: 1.40-4.16), low physical activity (aOR = 2.45, 95% CI: 1.42-4.22), and poor diet (aOR = 3.13, 95% CI: 1.75-5.61). High anxiety was also associated with hyperlipidemia (aOR = 2.09, 95% CI: 1.30-3.39) and smoking (aOR = 1.79, 95% CI: 1.08-2.96). Conclusion: We found significant associations between psychological health and cardiovascular risk factors among women of reproductive age. Interventions to improve psychological health may improve cardiovascular health and prevent adverse pregnancy outcomes.
STEM ability perceptions, basic needs satisfaction, and intrinsic motivation in adolescents: The role of inclusive perceptions in self-determination
Current work suggests that basic psychological needs are related to higher intrinsic motivation, which in turn, can promote more positive academic outcomes. However, few studies have examined how perceptions around one’s abilities in science, engineering, technology, and math (STEM) are related to intrinsic motivation and what role needs satisfaction plays in this association. This study assessed adolescents’ (N = 285, 56.1% female, Mage = 15.76 years, SD = 1.24) STEM ability perceptions, basic needs satisfaction, and intrinsic motivation. A path analysis was used to examine the association between STEM ability perceptions, basic needs satisfaction, and intrinsic motivation in adolescents. Inclusive perceptions of the STEM abilities of historically underrepresented groups (i.e., girls and minoritized ethnicities) were positively associated with basic needs satisfaction and basic needs satisfaction was positively associated with intrinsic motivation. There was also a positive indirect effect from inclusive perceptions of STEM abilities to intrinsic motivation through basic needs satisfaction. These findings suggest that schools should focus on promoting inclusive perceptions in order to bolster adolescents’ basic needs satisfaction, which could have carry-on effects on intrinsic motivation.
Abstract P3160: The Effect of Early-Life Area-Level Socioeconomic Deprivation on Cognitive Function in Middle-Aged Adults: Findings from the Bogalusa Heart Study
Background: Area-level socioeconomic deprivation is linked to cognitive impairment in older adults, but its impact from middle age is unclear. Evidence on the early-life deprivation effect on midlife cognitive function (CF) is limited. Objective: To investigate the effect of early-life Area Deprivation Index (ADI), on CF in middle-aged adults Methods: We assessed the association between early-life ADI and midlife CF in 1,099 subjects from the Bogalusa Heart Study (58.0% Whites, 42.0% Blacks, mean age at ADI: 12.6±5.9, mean age at CF: 48.7±5.0). Census data for 17 block-group variables were collected, including education, poverty, income, employment, and housing. Home ownership was excluded due to a factor loading below 0.3, leaving 16 variables for ADI calculation through factor analysis. The ADI was divided into quintiles, with the 1st quintile as the least deprived and 5th as most. CF was assessed through tests measuring episodic memory, working memory, attention, graphomotor information processing speed (GIPS), and global CF. Associations between ADI and CF were evaluated using a generalized estimation equation, adjusting for age at first exam, sex, race, year, and education. Interaction terms of race and education with ADI quintiles were tested. Results: The independent t-test showed Blacks had a higher ADI than Whites, indicating greater deprivation (0.81±0.58 vs. –0.60±0.80, p <0.001). Global CF decreased in the 5th ADI quintile compared to the 1st (β=–0.002 standardized unit [SE: 0.001], p =0.001), with a downward trend across quintiles ( p =0.002). Episodic memory, working memory, attention, and GIPS also decreased as the quintile of ADI increased ( p <0.001). Interaction terms with education showed significant negative effect on CF among high school graduates (1 st vs. 4 th quintile: β=–0.004 [SE: 0.002]), and those with education beyond high school (1 st vs. 5 th quintile: β=–0.004 [SE: 0.002]), but not among less than high school (1 st vs. 5 th quintile: β=–0.003 [SE: 0.001]; p for interaction: 0.011). Interactions between ADI quintiles and race were not significant. Conclusion: Higher early-life ADI was associated with lower midlife CF, with a decline observed in CF in the most deprived quintile, although effect sizes were modest. The strongest negative impact was observed among those with high school education or higher. Keywords area deprivation index; cognition; middle-aged adults
Abstract P2093: Chronic Kidney Disease Severity and Incident Cognitive Impairment in Patients with Chronic Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort
Background: Patients with chronic kidney disease (CKD) face a disproportionate burden of dementia compared to the general population. However, prospective associations between kidney function and cognitive impairment remain inconsistent and have not been exclusively evaluated in CKD. Methods: This analysis included 4,261 CKD patients from the Chronic Renal Insufficiency Cohort (CRIC). CKD severity was defined using standard estimated glomerular filtration rate (eGFR) and urinary protein to creatinine ratio (UPCR) thresholds. Global cognition and domains of verbal memory, attention/processing speed, and executive function were assessed longitudinally using the modified mini-mental status examination (3MS), Buschke Selective Reminding test, Trail Making Test A (TMTA), and Trail Making Test B (TMTB), respectively. For each test, impairment was defined as a score at least one standard deviation (SD) worse than the cohort mean at baseline. Cox proportional hazard models assessed associations between baseline CKD severity and time-to-cognitive impairment, adjusting for demographic and lifestyle risk factors, clinical measures, medications, and baseline cognition. Restricted cubic splines evaluated non-linear relations of both eGFR and UPCR with cognitive impairment. Results: Among CRIC participants with a mean age 59.6 years and median follow-up of 14.7 years, we observed significant, dose-response associations between increasing CKD severity, based on both eGFR and UPCR, and incident global cognitive impairment. Compared to those with stage G2 CKD (eGFR=60-89), patients with stage G4/G5 CKD (eGFR<30) had a 36% increased risk of cognitive impairment (HR=1.36; 95% CI=1.00, 1.86; P linear =0.03). Similarly, patients with UPCR>500 mg/g had a 26% increased risk compared to those with UPCR<150 mg/g (HR=1.26; 95% CI=0.99, 1.59; P linear =0.04). Increased CKD severity based on eGFR was significantly associated with attention impairment (G4/G5 vs. G2 HR=1.49; 95% CI=1.03, 2.14; P linear =0.04). Spline analyses revealed linear relationships between declining eGFR and impairment in global cognition (P=0.007) and attention (P=0.005), and between increasing UPCR and impairment in attention (P=0.015) and executive function (P=0.036; Figure ). No evidence of non-linear relationships were observed. Conclusion: More severe CKD, reflected by lower eGFR and higher UPCR, was prospectively associated with impairment in global cognition and specific cognitive domains.
Abstract 047: Plasma metabolic signatures of healthy diets and healthspan: an integrative analysis of metabolomics and genetics among 12,478 US adults with 32 years of follow-up
Background: Extending the healthspan – years of lived without disease – is a public health priority. Healthy diets have been linked to lower chronic disease risk, but the underlying mechanisms are largely unknown. We have previously identified plasma multi-metabolite signatures that measure intakes and metabolic responses to different dietary patterns. Hypothesis: Plasma metabolic signatures of heathy diets are associated with longer healthspan. Methods: We studied 12,478 participants from Nurses’ Health Studies and Health Professional Follow-up Study who were free of baseline chronic diseases. Diet was assessed by a food frequency questionnaire and indices for 3 recommendation-based, 3 plant-based, and 2 mechanism-based diets, were calculated. Plasma metabolome was profiled by liquid chromatography-mass spectrometry. Metabolic signatures for 8 dietary patterns, each based on 38-66 metabolites, were derived using elastic net model from our prior study. A polygenetic risk score (PRS) of shortened healthspan was calculated based on a published genome-wide association study using LDpred2. Cox regression was used to test associations with healthspan, which ended at the time of first onset of any of 11 major chronic diseases including cardiovascular disease. Results: During up to 32.4 years of follow-up, 6,021 individuals developed at least one chronic disease within an average of 23.8 years. In multivariable analyses, per standard deviation (SD) increase in metabolic signatures of all 5 examined healthful diets (e.g., Mediterranean diet) were associated with a lower risk of shortened healthspan (hazard ratio [HR]: 0.83-0.88; P < 6e-8), whereas signatures of 3 unhealthful diets (e.g., proinflammatory diet) were associated with a higher risk of shortened healthspan (HR: 1.08-1.26; P < 1e-3) ( Fig. A ). These associations persisted after adjusting for their corresponding dietary indices. While the derived PRS significantly predicted the genetic risk for any chronic diseases ( Fig. B ), the associations between metabolic signatures of diets and healthspan were not modified by such a genetic burden ( P-interaction >0.05; Fig. C ). Conclusions Plasma metabolic signatures that reflect intakes and metabolic responses to heathy diets are associated with longer healthspan, regardless of genetic burden for chronic diseases.
LLM-FMS: A fine-grained dataset for functional movement screen action quality assessment
The Functional Movement Screen (FMS) is a critical tool for assessing an individual’s basic motor abilities, aiming to prevent sports injuries. However, current automated FMS evaluation is based on deep learning methods, and the evaluation of actions is limited to rank scoring, which lacks fine-grained feedback suggestions and has poor interpretability. This limitation prevents the effective application of automated FMS evaluation for injury prevention and rehabilitation. We develop a fine-grained, hierarchical FMS dataset, LLM-FMS, derived from FMS videos and enriched with detailed, hierarchical action annotations. This dataset comprises 1812 action keyframe images from 45 subjects, encompassing 15 action representations of seven FMS actions. Each action includes a score, scoring criteria, and weight data for body parts. To our extensive knowledge, LLM-FMS is the first fine-grained fitness action dataset for action evaluation task. Additionally, a novel framework for action quality assessment based on large language models (LLMs) is proposed, designed to enhance the interpretability of FMS evaluations. Our method integrates expert rules, utilizes RTMPose to extract key skeletal-level action features from key frames, and inputs prompts into the LLM, enabling it to infer scores and provide detailed rationales. Experimental results demonstrate that our approach significantly outperforms existing methods while offering superior interpretability. Experimental results demonstrate that our approach outperforms existing methods in terms of accuracy and interpretability, with a substantial increase in the clarity and detail of the rationales provided. These findings highlight the potential of our framework for fine-grained action quality assessment with the aid of LLMs.
Abstract P3169: Significant Social Determinants of Health Disparities Exist Between Rural and Non-rural Residents with Elevated Blood Pressure: Findings from the LINKED-BP Study
Background: Rural populations face multiple challenges related to social determinants of health (SDOH). However, the extent of these disparities between rural and non-rural residing people with elevated blood pressure or untreated stage 1 hypertension is not well described. Further understanding of these disparities in the context of a hypertension prevention program focused on addressing SDOH that may contribute to the development of hypertension may inform targeted interventions. Objective: To examine differences in SDOH between rural and non-rural residents with elevated blood pressure or untreated stage 1 hypertension and identify areas for targeted interventions within the context of a blood pressure management program. Methods: This cross-sectional study analyzed baseline data from the LINKED-BP (Home Blood Pressure Telemonitoring Linked with Community Health Workers to Improve Blood Pressure) Program. SDOH were assessed using standardized questionnaires covering education, income, housing, food security, transportation, utilities, and social support. Rurality was determined based on zip code. Chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables were used for comparisons between rural and non-rural groups. Results: The study included 308 adults (127 rural, 181 non-rural) with known ZIP codes. People residing in rural areas had lower educational attainment (25.2% vs 1.1% with less than high school education, P<0.001) and lower income (40.2% vs 6.1% earning ≤$39,999 annually, P<0.001) compared to non-rural residents. Food insecurity (24.4% vs 5.0%, P<0.001) and transportation needs (19.7% vs 3.9%, P<0.001) were more prevalent in rural areas. Housing insecurity was higher in rural areas but was not statistically significant (5.5% vs 1.7%, P=0.060). No differences were found in housing conditions, utility needs, or social/emotional support. Conclusions: Significant SDOH disparities exist between rural and non-rural populations particularly in education, income, food security, and transportation access. These findings highlight potential challenges in implementing home blood pressure telemonitoring programs in rural areas. Targeted interventions addressing these SDOH factors could enhance the effectiveness of blood pressure management programs in rural communities. Future research should explore whether proactively addressing SDOH disparities in rural communities prevents hypertension and cardiovascular disease.
Abstract P2110: Differences by Race, but not Sex, in Metabolomic Profiles Associated with Red and Processed Meat Consumption in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Introduction: Higher red and processed meat (RPM) consumption is associated with higher cardiometabolic risk. While consumption patterns vary by sex and race in the US population, it is not known whether RPM-associated metabolic signatures differ by sex or race. Methods: We used data from 2,841 women and men of self-reported Black and White race (mean age: 45 years; 45% Black race; 57% women) at the year 20 follow-up (2005-06) of the prospective, U.S.-based CARDIA study, which boasts high-quality, interviewer-administered diet history and well-characterized lifestyle data. Using ultra-high performance liquid chromatography and mass spectrometry, we generated untargeted fasting plasma metabolomics data. We iteratively regressed each of the 7,522 metabolite peaks onto RPM consumption (servings/day, continuous variable), with race- and sex-interactions, and adjustment for multiple comparisons using false discovery rate<0.1 with three covariate-adjusted linear regression models: Minimally-adjusted=age+race+sex+center+education+metabolite batch+energy intake; Lifestyle behavior-adjusted=Minimally-adjusted+smoking status+physical activity+alcohol intake+diet quality, and Maximally-adjusted=Lifestyle behavior-adjusted+anti-hypertensive and lipid-lowering medication use+BMI. We used Mummichog software to identify enriched metabolic pathways with higher activity than expected (Fisher’s Exact Test (FET) p<0.05). We also fit orthogonal partial least squares regression (OPLS-R) models to identify metabolic signatures that distinguished participants by race and sex, with evaluation of principal components via variance explained in RPM consumption. Results: We identified metabolic pathways that were differentially enriched according to race (FET p<0.05; Figure), but not sex. Based on race- and sex-specific OPLS-R models, the full set of metabolite peaks was more strongly associated with RPM consumption among participants of White race (Q 2 :0.25) compared to participants of Black race (Q 2 :0.14). Moreover, metabolite peaks among men (Q 2 :0.098) and women (Q 2 :0.065) were similarly associated with RPM consumption. Conclusions: Metabolic pathway activity differed by race, but not sex, with slightly different strength of association between metabolite peak data and RPM consumption across groups. While we expected differences by metabolic profile reflecting biological sex-related differences, the observed race differences suggest potential environment-related metabolic activity.
Abstract P1078: Association of Poverty with Pharmacy Access in Minnesota
Background: Pharmacy access is important for medication adherence and may be a modifiable factor which could improve health equity in the management of cardiovascular disease risk factors. Methods: We geocoded all MN pharmacies in 2022 and determined the population weighted, mean drive times from each census tract to the nearest pharmacies. Census tracts were stratified by urban and rural status and divided into quartiles by poverty defined as the proportion of families living below the 75% poverty line. Poverty quartiles were characterized by demographic and income data from the 2016-2019 American Community Survey. We evaluated differences in pharmacy access by poverty quartile using one-way ANOVA. Results: In both rural and urban quartiles, the lowest poverty quartile (Q1) was majority white (96% and 83% respectively) with more college graduates (30% and 50% respectively) compared to the highest poverty quartile (Q4, 20% and 31% respectively). Q4 was more racially diverse – rural 88% white, 1% Black, 5% Hispanic; urban 61% white, 18% Black, 10% Asian, 10% Hispanic. Among urban census tracts Q1-Q3 had similar pharmacy drive times (3.3-3.5 min, Table) while Q4 (highest poverty) had a shorter mean drive time (2.8 min) and more pharmacies available within 10 and 15 min drive times compared to Q1 (Table, p<0.01 for all pharmacy access measures). Among rural census tracts, drive time to the nearest pharmacy was shortest in Q1 and Q4. Compared to Q1, rural residents in Q4 had a longer drive to the 2 nd nearest pharmacy (15.5 min vs 13.1 min) and fewer pharmacies within 15 min drive time (2.6 vs 5.9; Table, p<0.01 for all measures). Conclusion: Pharmacy access may be an important factor in low income rural communities. However, restricted pharmacy access did not correlate strongly with under-resourced neighborhoods in urban communities. Barriers to medication access are likely multifactorial and may differ between urban and rural areas
Using natural vegetation succession to evaluate how natural restoration proceeds under different climate in Yunnan, Southwest China
Currently, natural restoration has been widely proposed as the primary method of ecological restoration and has been studied for a long time. However, research on how to quantify the progress of natural restoration in different climate conditions, especially using long-term succession monitoring data combined with habitat quality data across various succession stages, has been scarce. Our study aims to address this issue in Yunnan, southwest China. To quantify the progress of natural restoration under different climates in Yunnan, we introduced an index, the Natural Succession Index. Utilizing topography and meteorological data, we divided the study area into different climate sub-areas using the Two-stage clustering algorithm. We then combined 1703 sets of 30-year succession monitoring data, each with six observations taken at five-year intervals from 1987 to 2017, with habitat quality data from different succession stages (grassland, shrub, and forest) to quantify the Natural Succession Index. Yunnan province was divided into 14 sub-areas, namely C(I to II), M(I to III), W(I to IV), and H(I to IV), each possessing a unique environment. The indices in each sub-area were calculated, with the results showing a specific order: H-I (0.7812) > H-IV (0.7739) > W-I (0.6498) > M-III (0.6356) > H-III (0.6316) > M-II (0.5735) > W-III (0.5644) > W-IV (0.5571) > C-II (0.4778) > W-II (0.3980) > M-I (0.3624) > H-II (0.3375) > C-I (0.2943). The times for natural succession to reach the forest stage vary from 5 to 19 years, which aligns with the order of indices. The stand volumes of vegetation in the forest stage range from 5 m³ to 110 m³, with a higher Natural Succession Index value corresponding to a higher stand volume of vegetation. In the future, the index could be utilized to reallocate investments in natural restoration projects for better returns. Constant vigilance is required in the first five years following the implementation of restoration actions to avoid failure due to calculation errors.
Abstract 056: Exposure to artificial light at night in relation to weight gain and cardiovascular risk among women cancer survivors
Background: Cancer survivors are at high risk for weight gain and cardiovascular disease (CVD) after treatment. Artificial light at night (ALAN) may contribute to elevate risks by disrupting circadian rhythm, affecting hormonal regulation and metabolism. This relationship has not been evaluated in women cancer survivors. Methods: After excluding women with daytime sleep schedules and those with prevalent CVD, 2,401 women (aged 35-74 years) who reported a history of cancer other than non-melanoma skin cancer when they enrolled in the Sister Study (2003-2009) were followed through September 2021 (mean follow-up: 11.8 years). Self-reported indoor ALAN exposure during sleep was categorized as: no light (reference group), small nightlight in the room, light outside the room, and television/light on in the room. Generalized Poisson regression models with a log link and robust standard errors were used to estimate multivariable relative risks (RRs) for weight gain ≥5 kg and a BMI increase ≥10% over follow-up. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD, including myocardial infarction, angina, heart failure, heart bypass surgery, angioplasty, transient ischemic attack, or stroke. Results: At cohort entry, the median time since cancer diagnosis was 9.8 years and 28.6% of participants were obese (BMI ≥30). Any ALAN was associated with weight gain (RR 1.51, 95% CI 1.12-2.03) and BMI increase (RR 1.46, 95% CI 1.02-2.09). Sleeping with a television or light on was positively associated with weight gain (RR 1.83, 95% CI 1.27-2.65, P trend =0.0002), particularly in long-term survivors (>10 years, RR 2.99, 95% CI 1.71-5.23, P trend <0.0001), and with BMI increase (RR 1.89, 95% CI 1.21-2.94, P trend =0.003) over follow-up. These associations persisted after adjusting for sleep duration and quality, dietary patterns, and physical activity. Sleeping with a television or light on was also associated with increased CVD risk (HR 1.61, 95% CI 1.05-2.46, P trend =0.03), with a stronger association among survivors with pre-existing CVD risk factors (diabetes, hypertension, or dyslipidemia) at enrollment (HR 1.90, 95% CI 1.13-3.17, P trend =0.0008). Conclusions: ALAN may contribute to weight gain, higher BMI, and elevated CVD incidence in cancer survivors who are women. ALAN may be a modifiable risk factor for obesity and CVD in this high-risk population. Future studies should include an assessment of daytime light exposure.
Abstract P2153: Correlates of Sleep Health in Women of the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Introduction: The American Heart Association recently added sleep to Life’s Essential 8 key measures for cardiovascular health. As middle age is a period when women’s risk for cardiovascular disease increases, we investigated the contributions of sociodemographic, biological, mental and lifestyle characteristics on sleep health among middle-aged women. Hypothesis: Adverse levels of these characteristics are associated with poorer sleep health and associations will vary by domain of sleep. Methods: We analyzed correlates of sleep health of 567 women using cross-sectional data from the Coronary Artery Risk Development in Young Adults sleep ancillary study at year 35, a prospective cohort study which enrolled Black and White individuals aged 18 to 30 years at baseline (1985-86). Outcomes were sleep regularity index, fragmentation, duration, and sleep percentage determined using the wrist-worn Actiwatch TM accelerometer. Values for each participant were averaged across the number of days they wore the device (min 4, max 7). The following categories of correlates were measured using questionnaires and examinations: sociodemographic (marital status, education, number of people in household, having a bed partner, retirement status); biological (BMI, waist circumference, menopausal symptoms); mental (social support, quality of life, depression, loneliness, social network); lifestyle (physical activity, alcohol use, smoking status). We used linear regression models to generate effect estimates for each of the characteristics and the 4 sleep health outcomes adjusted for age, cardiovascular disease and study center. Given known differences in sleep health by race, we chose a priori to carry out stratified analyses by race. Results: The mean age of participants was 61.3 years (SD= 3.6) and 44.8% were Black. The mean value for sleep percentage was 90.4% (SD=4.5), sleep regularity was 79.7% (SD=11.0), sleep fragmentation was 19.8% (SD =7.4), and sleep duration was 415.8 minutes (SD =59.9). Lifestyle was the only category that was associated with sleep health. Black women who were current or former smokers had less favorable sleep health (Table 1). More physical activity was associated with more favorable sleep health in White women. The characteristics we investigated were not associated with sleep duration. Conclusions: We observed a contribution of lifestyle behaviors with measures of sleep health that reflect sleep regularity and quality.
Abstract 030: The Association of Obesity Measures on the Development and Progression of Coronary Artery Calcium: Insights from the CARDIA Study
Background: Coronary artery calcium (CAC) is a well-established marker of subclinical atherosclerosis and of cardiovascular risk. Identifying modifiable risk factors early in life such as body mass index (BMI) and waist-to-hip ratio (WHR) that predict development and progression of CAC in midlife can guide early intervention to decrease cardiovascular risk. Hypothesis: We hypothesize that higher BMI and WHR in young adulthood is associated with both the presence and progression of CAC 10 years later. Methods: We analyzed participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study with BMI and WHR measured at Y5 (Ages 23 to 35), and CAC measured between Y15-25 (ages 33 to 55). We used logistic regression models to assess the association between BMI/WHR and the presence of CAC (Agatston score >0) at Y15, and a repeated-measures GEE linear model to assess the association between BMI/WHR and progression of CAC (log Agatston score) from Y15 to Y25. We conducted nested models adjusting for demographic variables (age, sex, race) and cardiovascular risk factors (diabetes, hypertension, smoking status, total cholesterol, lipid-lowering pharmacotherapy use). Results: A total of 2,838 participants had full data on obesity measures and CAC. Patients in higher quartiles of both BMI and WHR at Y5 had higher systolic blood pressures and total cholesterol. For each 5 kg/m 2 higher BMI at Y5, there was an associated increase in the prevalence of CAC>0 at Y15 (i.e., 10 years later) by 28% (OR: 1.28, 95% CI: 1.13 to 1.44, P= 0.001), adjusting for age, sex, and race; however, this association was attenuated after full adjustment (OR: 1.12, 95% CI: 0.98 to 1.29). For each 0.1 increase in WHR at Y5, there was an associated increase in the prevalence of CAC>0 at Y15 by 31% (after full adjustment (OR: 1.31, 95% Ci: 1.01, 1.69). There was an association of change in slope of yearly CAC progression between Y15-25 which increased by 18% for every 5 kg/m 2 higher BMI and by 58% for every 0.1 higher WHR assessed in young adulthood ( Figure ). Conclusion: BMI and WHR measured in young adulthood are both associated with the presence and progression of CAC 10-20 years later; however, WHR may be a stronger predictor of CAC and progression of CAC than BMI.
Perspectives of stakeholders on barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in southern Thailand: A qualitative study
Studies have been conducted on migrant health during the COVID-19 pandemic. However, in-depth information is scarce regarding the barriers to preventing COVID-19 in this vulnerable population. The objective of the study is to explore the barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in Thailand. We conducted an interview-based qualitative study among 7 migrants from Myanmar, 6 Thai employers, and 9 Thai healthcare providers in the cities of Hat Yai and Pattani in Southern Thailand. We recruited participants by purposive sampling. We conducted in-depth interviews in-person or via telephone in Thai or Burmese language, transcribed the interview, and conducted thematic analysis. Regarding adherence to COVID-19 protective behaviors, two themes emerged: lifestyle and habit-related barriers, and non-vaccine supply chain management barriers. Regarding COVID-19 vaccination, three common themes emerged: fear, barriers related to health education and health promotion, and vaccine supply chain management. Supply chain management was a common theme in both domains. However, each domain also had additional themes. Our study contributed empirical findings that could be of interest to stakeholders in migrant health. However, limitations regarding the generalizability of the findings and social desirability should be considered in the interpretation of the findings.