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Abstract TU122: Disproportionate Impact of Cardiomyopathy and Myocarditis on Youth and Males in North Africa andMiddle East: Regional Burden and Trend from 1990-2021
Background: Cardiomyopathy (CM) and myocarditis are critical contributors to non-ischemic heart failure and sudden cardiac death, particularly in young adults and children. Despite advancements in diagnostic modalities and management strategies, the epidemiological burden of these diseases in the North Africa and Middle East (NEMA) region remains poorly quantified over time. Methods: Using the Global Burden of Disease (GBD) 2021 framework, we estimated the fatal and non-fatal health outcomes of CM and myocarditis across the NEMA region from 1990 to 2021. Non-fatal outcomes were derived through systematic reviews, hospital discharge records, and survey data, modeled using Bayesian meta-regression (DisMod-MR 2.1). Mortality estimates were generated using the Cause of Death Ensemble model (CODEm). We analyzed both all-age counts and age-standardized rates per 100,000 population. Trends were assessed across sex, age group, year, and country. To quantify temporal changes, we calculated the Annualized Percentage Change (APC) in incidence, mortality, and YLDs using a log-linear regression approach. Result: From 1990 to 2021, the burden of cardiomyopathy and myocarditis in NEMA rose markedly. Prevalence increased from 122,268 (100,704–149,767) to 249,222 (200,993–303,892) (APC: 2.32%), deaths from 7,631 (5,301–10,723) to 9,973 (8,378–14,408) (APC: 0.87%), and YLDs from 10,768 (7,013–15,629) to 21,858 (13,794–31,127) (APC: 2.31%). In 2021, the highest age-standardized incidence rate (ASIR) was in Iran (12.75) and UAE (12.64) per 100,000. Prevalence rate peaked in UAE (109.8) and Bahrain (97), while mortality was highest in UAE (6.67), Oman (5.55), and Saudi Arabia (5.22). By age, in 2021, the prevalence rate per 100,000 was highest in <20 years (56.94), followed by 55+ years (45.12) and 20–54 years (25.84). Death rates were 8.02 in 55+, 0.71 in 20–54, and 0.70 in <20. YLDs rates were 5.14 in <20, 3.60 in 55+, and 2.24 in 20–54. Males showed a higher burden: incidence rose 113% vs 110%, deaths 51% vs 6%, and YLDs 121% vs 77%, compared to females. Conclusion: The burden of CM and myocarditis in the NEMA region has significantly increased over the past three decades, with a notable rise in prevalence and disability, particularly among males and younger populations. Persistently high mortality in older adults and widening sex disparities underscore the urgent need for targeted prevention, early detection, and region-specific management strategies.
Abstract TU131: Agreement Between Parent-Report and Electronic Health Record Body Mass Index Among Children in the Young Hearts Study
Background: Childhood obesity is a driver of cardiovascular disease later in life. Given the importance of childhood obesity and recent advances in electronic capture of survey data, many studies have incorporated parent-proxy reports of child weight and height into their design. Here, we aimed to assess the agreement between parent-reported and electronic health record (EHR)-based BMI within a diverse, urban cohort of children, and whether the agreement varied by child age and sex. Methods: We utilized participants aged 2-17 in the Young Hearts Study with both parent-reported and EHR-based BMI data available at baseline. Parent-reported height and weight for their child were collected through electronic surveys and were used to calculate age- and sex-specific BMI percentiles. EHR-based weights, heights, and BMI percentiles were abstracted from the encounter closest in time to the survey completion date. Overweight or obesity was defined as BMI ≥85th percentile. Agreement for BMI percentile was assessed via Pearson correlation, and for classification as overweight or obese via the Kappa statistic. Results: Data from 660 children were included in this study, of whom 319 (48.3%) were female, 166 (25.2%), 263 (39.8%), and 167 (25.3%) were non-Hispanic Black, non-Hispanic White, and Hispanic, and 184 (27.9%), 234 (35.5%), and 242 (36.7%) were aged 2-7, 8-12, and 13-17 years. Overall, the mean parent-reported BMI percentile was 64.9 (SD 32.3) in girls and 63.4 (SD 34.1) in boys; these were slightly higher than the EHR at 70.5 (SD 28.8) in girls and 66.7 (SD 32.3) in boys. Agreement of parent report of BMI percentile with EHR-based BMI percentile increased with child age. For girls, age group-specific correlations were r 2-7 = 0.40, r 8-12 =0.61, and r 13-17 =0.83, and for boys they were r 2-7 = 0.53, r 8-12 =0.69, and r 13-17 =0.75. Agreement for classification as overweight or obese also increased from poor to moderate with age; for girls, age-specific agreement was k 2-7 =0.30, k 8-12 =0.63, and k 13-17 =0.67, and for boys it was k 2-7 =0.43, k 8-12 =0.62, and k 13-17 =0.72. Discussion: Our results suggest slight under-reporting of child BMI by parents overall, with agreement between parent report and EHR BMI percentile increasing with child age. Remote collection of BMI may be a valid supplement to in-clinic assessment for use in research, particularly for teenagers, which may facilitate cheaper and more timely capture of data.
Big data approaches, overcoming critical limitations, and enhanced optical and environmental stability of Al2O3/Ti/Al2O3 colored solar-selective absorber coatings
Abstract WE559: State Support for Plant-Based Meals in U.S. School Lunch Programs: A National Policy Analysis
Background: Pediatric cardiometabolic health in the United States is declining, driven by rising rates of obesity, prediabetes, and type 2 diabetes. School lunch programs present a critical opportunity to shape children’s dietary behaviors, reaching millions of students across diverse socioeconomic backgrounds each day. Regular inclusion of plant-based or plant-forward meals in school lunches may help reduce modifiable cardiometabolic risk factors and serve as a cost-effective, population-level strategy to promote long-term cardiovascular health. Methods: We conducted a narrative policy review of school lunch programs across all 50 U.S. states and the District of Columbia. Publicly available state and district policy documents, government reports, and educational resources were systematically reviewed to identify regulations and initiatives supporting plant-based or vegetarian meals. Two primary policy outcomes were coded: (1) Level of Official Support for plant-based lunch options (“Yes/Explicit,” “Allowed/Partial,” or “Not Specified”) and (2) Frequency of Plant-Based lunch offerings in the school lunch program (Refer to Table 1 for coding labels and definitions). Results: As per our analysis, only 6 out of 51 jurisdictions had an explicit policy promoting vegetarian or plant-based meals—Alabama, California, the District of Columbia, New Hampshire, New Mexico, and New York—as part of their school lunch programs. A majority (38 jurisdictions) were classified as “Allowed/Partial,” indicating adherence to USDA guidelines that permit inclusion of plant-based foods but do not specifically promote or require them. Hawaii had a proposed policy marked as “Partial,” though implementation is pending. No state mandated the frequency of plant-based meals; however, the District of Columbia provides a suggested daily frequency. Conclusion: Enhancing state-level policies and providing standardized guidance on the frequency of plant-based meals in school lunch programs could serve as an effective, population-level approach to mitigate pediatric cardio-metabolic risk and promote long-term cardiovascular health.
Abstract TU171: Marginal food security is associated with higher waist-to-height ratio in college students: Findings from the FRESH Study
Background: Food insecurity (FI) is associated with poor cardiovascular and metabolic health (CVMH) outcomes. College students, a population of emerging adults, experience FI at a higher prevalence [SS6] than the general U.S. population. Emerging adulthood is a critical period for the development of poor CVMH. It is unknown how FI at this life stage may influence CVMH. Hypothesis: FI (low and very low food security status) is related to worse CVMH, including increased weight status, blood pressure, and blood glucose in emerging adults. Methods: The Food, Rest, Exercise, and Health (FRESH) Study is an observational[CM7] study that recruited second-year students at UC Santa Cruz. Participants were surveyed about demographic factors and food security status. Height, weight, waist circumference, blood pressure, and blood glucose (measured by HbA1c) were collected by trained research assistants. Linear regression models examined relationships between food security status (high, marginal, low and very low) and CVMH indicators: BMI, waist-to-height ratio (WHtR), systolic and diastolic blood pressure, and HbA1c. All models were adjusted for age, sex, smoking history, and race and ethnicity. Blood pressure and HbA1c were also adjusted for BMI. Results: Participants (n=350) were mainly female (69%), mean age of 19.8±1.16 years, and 20% with food insecurity. Participants had a mean BMI of 23.3±4.23 kg/m 2 and a mean WHtR of 0.46±0.06. Mean systolic blood pressure was 109.3±9.91 mmHg (systolic) and 65.2±7.85 mmHg (diastolic). Mean HbA1c was 5.0% [MS8] In fully adjusted models, we observed significantly higher WHtR in the marginal food security group compared to the high food security group (b=0.01[CM9] , p=0.03). Compared to high food security, food insecurity had a similar effect size (b=0.01, p=0.08) with WHtR, however this was not significant. Conclusion: Compared to high food security status, marginal food security was related to higher waist-to-height ratio (≤ 0.50 increased risk for obesity) in a generally healthy sample. These findings suggest that food security status plays a key role in maintaining healthy weight and promoting CVMH.
Abstract TU124: Challenges in Assessing Exercise Impairment in Adolescent Obesity: Insights From Cardiopulmonary Exercise Testing
Introduction: Adolescent obesity is linked to significantly increased risk of cardiovascular and metabolic comorbidities. Exercise outcomes are often impaired in adolescents with obesity (AO), but it remains unclear whether this reflects compromised cardiovascular reserve or non-cardiovascular factors. This study aimed to characterize mechanisms of reduced exercise performance in AO using cardiopulmonary exercise testing (CPET). The secondary aim was to assess the contribution of excess weight burden by correcting for extra fat mass in AO through estimated standard body mass (eSBM). Methods: We retrospectively analyzed CPET data from asymptomatic AO, defined as BMI ≥ 30 (n = 94), and age-matched, normal-weight controls without obesity (n = 139). In a subset of AO (n = 47), % body fat was measured by bioelectric impedance analysis, and eSBM was calculated as if they have comparable % body fat to controls using median values by sex and age in US adolescents. CPET was performed with a cycle ergometer following a ramp protocol. Results: Both male and female AO exhibited higher resting HR (p < 0.001) while peak HR remained comparable to controls. Absolute peak oxygen consumption (VO2) was higher in female AO (p < 0.001), while males showed no difference. Absolute ventilatory anaerobic threshold (VAT) was elevated in AO in both sexes (p < 0.001). When indexed by total body weight, peak VO2, peak work rate (WR), and VAT were lower in both male and female AO (p < 0.001). Peak respiratory exchange ratio (RER), peak VO2/VAT, and peak WR/peak VO2 were also significantly reduced in AO (p < 0.001). When indexed by eSBM, peak VO2 normalized only in female AO; peak WR remained lower, but VAT normalized in AO of both sexes with overcorrection in females, suggesting comparable submaximal exercise performance to controls. Conclusion: Reduced exercise performance in AO appears characterized by elevated resting HR, early exhaustion near peak exercise (lower peak RER and peak VO2/VAT), and decreased work efficiency (lower peak WR/peak VO2). Indexing CPET parameters by eSBM revealed relatively normal cardiopulmonary performance in AO during submaximal exercise, suggesting that reduced performance primarily reflects premature, fatigue-driven termination of exercise due to excess weight burden rather than true cardiopulmonary compromise. Further study is needed to clarify factors contributing to the observed sex-specific differences in AO exercise performance.
Lightweight and interpretable edge intelligence AI with intrusion detection for trustworthy cardiac arrhythmia in medical IoT
Abstract Medical Internet of Things (MIoT) systems enable continuous cardiac monitoring, but practical deployment is limited by three issues: heavy computation at the edge, limited interpretability, and vulnerability to cyber-attacks that can corrupt signals and degrade inference. We propose CLARITY-AI 2.0, a lightweight and trustworthy arrhythmia detection framework for MIoT that combines efficient ECG feature extraction, interpretable prediction, and security-aware trust assessment. The model performs arrhythmia inference using a compact feature-based learner and generates clinician-facing explanations via SHAP attributions, which are converted into structured natural-language reports using an LLM. To improve trust under hostile network conditions, an intrusion detection module outputs an attack probability and a trust score that flags unreliable inputs. On the MIT-BIH benchmark, CLARITY-AI 2.0 achieves an F1 score of 0.928 and an AUC of 0.985 for anomaly detection. It also generalizes under dataset shift with an AUC of 0.940 on PTB-XL and an AUC of 0.915 on Chapman (zero-shot evaluation). For edge feasibility, deployment on an ESP32 reduces the footprint to 350 KB, peak RAM to 120 KB, and inference latency to 8.1 ms, supporting real-time operation on resource-constrained devices. These results indicate that CLARITY-AI 2.0 is an interpretable, efficient, and security-aware approach toward scalable MIoT-based cardiac monitoring.
Abstract TH949: Sharing Health Goals Within Social Networks: Family and Friend Connections in Relation to Life’s Essential 8
Background: Extant research highlights the role of social relationships in shaping cardiovascular health, yet little is known about how social network dynamics relate to the American Heart Association’s Life’s Essential 8 (ES8) metrics among young adult Black women. Methods: We analyzed cross-sectional data from 97 young Black women in the Southeastern U.S. Participants reported health behaviors and described up to 18 members of their social network. Self-report data were available for the following five ES8 components: diet, physical activity, sleep duration, tobacco use, and body mass index. Network measures included size, relational composition, participants’ knowledge of the network members’ health history, and the proportion of network members with whom participants have discussed heart health or would share health goals. Results: The average age was 26.9 ± 6.4 years, 56.7% were college graduates, and 24.74% met four or more ES8 metrics. The average network size was 6.02 (± 2.26), and participants believed over half of their network had been diagnosed with cardiovascular disease, hypertension, or diabetes (0.55 ± 0.31). Only 23% (± 23%) of alters were described as discussion partners for heart health topics, yet most participants indicated they would share health goals with a high proportion of family (mean = 0.91 ± 0.21) and friends (0.86 ± 0.27). Although those who discussed their cardiovascular health with a higher proportion of family were more than twice as likely to meet four or more ES8 metrics (aOR = 2.18, 95% CI 0.67–7.16), confidence intervals were wide and findings were not statistically significant. Conclusions: Young adults in this sample met few ES8 goals despite active social networks. Descriptive patterns suggest that family-based goal sharing may be a promising leverage point for promoting cardiovascular health behaviors. Larger, longitudinal studies are needed to confirm these relationships and test network-informed interventions.
Abstract TU243: Type 2 Diabetes Control is Associated with Higher Social Support Among Puerto Rican Adults: A Cross-Sectional Study
Introduction: Social support has been positively related to better glycemic control in individuals with type 2 diabetes (T2D), while loneliness and social isolation are independently associated with poor health behaviors. Little is known about how individuals with controlled vs. uncontrolled T2D experience these three distinct constructs. Hypothesis: We hypothesized that adults in Puerto Rico with controlled T2D have greater social support and lower levels of loneliness and social isolation compared to those without T2D or uncontrolled T2D. Methods: We analyzed cross-sectional data from 1,517 adults aged 30-75 years participating in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). T2D status (based on laboratory, diagnosis, or medication) was categorized as no T2D, uncontrolled T2D (hemoglobin A1c ≥7%), and controlled T2D (hemoglobin A1c <7%). Primary outcomes included loneliness (3-item UCLA Loneliness Scale; range 3-9; higher = greater loneliness), social isolation (combined social network and activity metrics; range 0-29; higher = less isolation), and social support (Interpersonal Support Evaluation List-12 scale including appraisal, belonging, and tangible subscales; range 0-36; higher = greater support). Multivariable linear models estimated associations between T2D status and these scores, adjusting for sociodemographic and behavioral factors, chronic conditions, and depression. Results: In the sample, 73.4% did not have T2D, and 26.6% had T2D (14.2% controlled; 12.4% uncontrolled). Individuals with controlled T2D reported significantly higher overall social support score than those without T2D (mean difference= 1.53; 95%CI: 0.11, 2.94). Tangible support (i.e., perceived availability of material aid, such as financial assistance, goods, or services) was notably higher among those with controlled T2D vs. without T2D (mean difference= 0.58; 95%CI: 0.03, 1.13). Adjusting for loneliness and social isolation attenuated these associations to the null. No differences were observed in social support between uncontrolled T2D and other groups, nor in loneliness or social isolation across T2D categories. Conclusions: Adults living in Puerto Rico with controlled T2D perceive greater social support, particularly tangible support. Relationships between social support, loneliness, and social isolation are complex and should be further explored in the context of T2D control.
Abstract TH827: Coffee Intake, Gut Microbiome, and Blood Metabolomic Pathways in Relation to Diabetes and Cardiometabolic Health: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Background: Coffee intake has been linked to improved cardiometabolic (CM) health, yet underlying microbial and metabolic pathways remain unclear. Methods: At HCHS/SOL Visit 1 (2008-11), usual coffee intake was estimated from two 24-hour dietary recalls and food propensity questionnaires among 13634 adults. Serum metabolomics (653 metabolites) were profiled by LC-MS at Visit 1 (n=6180) and Visit 2 (2014-17; n=718). Gut microbiome was characterized by shotgun metagenomics at Visit 2 (n=2758). CM traits, including adiposity, glycemic, lipid, blood pressure, kidney, and liver markers, were measured at both visits. Among 10730 participants free of diabetes, CVD, and cancer at baseline, 2493 diabetes cases occurred during a median follow-up of 10.2 years. Results: Higher coffee intake was correlated with lower levels of waist-to-hip ratio, liver enzymes (AST, ALT, GGT), glucose/insulin indices (2-h OGTT glucose, fasting insulin, HOMA-IR, HOMA-b), TG, and blood pressure, but higher LDLC levels (all P <.05). Each additional serving/d of coffee intake was related to an HR of 0.89 (95% CI 0.80-0.98; Fig1 ) for diabetes. Coffee intake was positively related to gut microbial α-diversity and four species ( e.g., Clostridium phoceensis ), while inversely related to 27 species, including pro-inflammatory Ruminococcus gnavus , Clostridium glycyrrhizinilyticum , and Blautia hansenii , and opportunistic Klebsiella oxytoca ( q <.05), which were linked to unfavorable CM traits ( Fig2 ). We identified 165 coffee-related and 154 microbiota-related metabolites, with 55 overlapping. These 264 metabolites were clustered into 18 modules using WGCNA, one of which was mainly composed of caffeine metabolites and positively correlated with coffee intake and Clostridium phoceensis . A sphingomyelin module was positively related to coffee intake and lower diabetes risk (HR=0.88 [0.82-0.95] per SD increase in the module; Fig3 ). Modules of branched-chain amino acid (BCAA) and microbial bile acid metabolites were inversely related to coffee intake and higher diabetes risk, with HRs of 1.34 (1.24-1.45) and 1.07 (1.00-1.14), respectively. Glycerophospholipid module was positively related to Ruminococcus gnavus (inversely related to coffee intake) and an HR of 1.17 (1.09-1.26) for diabetes. Conclusions: Coffee intake was associated with gut microbial and metabolomics signatures converging on lipid, BCAA, and bile acid metabolism, and these pathways may illuminate the biological basis of coffee’s CM benefits.
Brain network functional connectivity changes induced by music-induced analgesia in fibromyalgia patients
Local Ras/actin signaling orients individual pseudopods in shallow gradients
Abstract TU151: The independent and joint effects of toxic elements on cardiovascular disease risk: A case-control study in the ELSA-Brasil cohort.
Introduction: Toxic metal exposures have been linked to cardiovascular diseases (CVD), yet most studies are cross-sectional and single-exposure focused. We investigated the independent and joint effects of arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) on incident CVD in a large prospective cohort, using advanced mixture modeling and multi-media biomarker (MMB) assessments. Methods: We conducted a nested case-control study within the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort, including 176 incident CVD cases and 7,810 controls. Baseline serum and urine samples were analyzed for toxic metals. We used conditional logistic regression to investigate associations between toxic metal levels and incident CVD risk. Mixture effects were assessed using quantile g-computation (QGC), weighted quantile sum (WQS) regression, and MMB modeling. Results: Higher urinary levels of Hg (OR: 1.82; 95% CI: 1.19-2.80) was associated with increased CVD risk. No consistent associations were found for serum metals. Urinary metal mixtures showed robust positive associations with CVD in both QGC and WQS models. MMB analyses identified urinary Hg as the strongest contributor to CVD risk across all modeling techniques. Nonlinear relationships were observed for urinary Cd and Hg. Conclusions: Urinary levels of Hg, and heavy metals as a mixture were associated with higher CVD risk. These findings support the use of advanced exposure modeling and call for greater attention to environmental metal exposures, particularly in low- and middle-income countries.
Abstract WE507: Longitudinal Changes in Diet Quality and Nutrient Intake During Pregnancy among Moms Participating in FeFiFo-MOMS: Effects of Fermented and Fiber-rich Foods on Maternal and Offspring Microbiome Study
Background: Nutrient needs increase during pregnancy, and diet quality may predict maternal and infant health outcomes. Objective: To assess diet quality and select nutrients during pregnancy among mothers who followed different diet patterns in the FeFiFo-MOMS study. Methods: Pregnant women randomized to one of four diets (high fiber, high fermented foods, both, or control) completed three 24-hour dietary recalls at baseline (12-22 weeks of gestation), mid-pregnancy (26-30 weeks), and late pregnancy (34-38 weeks) collected using Nutrition Data System for Research. Healthy Eating Index-2015 (HEI-2015) scores, macronutrient distribution, and key micronutrients of interest during pregnancy (folate, calcium, iron, zinc, DHA, choline, vitamin D) were evaluated at each timepoint. Linear mixed models compared intake levels across diet groups. Results: Of 122 participants, mean nutrient intake levels at baseline without supplementation were below recommendations for iron (15.8 mg), folate (437 mcg), DHA (0.17 g), choline (376 mg), and vitamin D (5.3 mcg). Overall, participants reported increases in calcium (+10.8%) and vitamin D (+13.7%) throughout pregnancy, both p<0.05. Comparing baseline to late pregnancy, the combined fiber and fermented foods group reported greatest increases in daily calcium (mean±SEM 997.5±59.4 --> 1199.2±71.7 mg), iron (14.6±1.1 --> 18.4±1.2 mg), folate (433.5±36.0 --> 476.5±28.8 mcg), and zinc (10.8±0.7 --> 13.0±0.7 mg), with significant detection of time x group interactions (all p<0.01). HEI-2015 scores were highest at mid-pregnancy and in the high fiber and combined groups (69.6±2.0 and 70.3±1.5 points), respectively representing +14.6% and +9.6% increases from baseline, which were greater than the control and fermented foods only groups showing minimal change (p<0.001). Only the high fiber group sustained this improvement through late pregnancy (70.1±2.0), while the fermented foods only group showed the lowest diet quality throughout (58.5±1.7 at late pregnancy). Conclusions: A combined high fiber and fermented foods diet provided greatest increases in key nutrients during pregnancy, while high fiber alone yielded most sustained diet quality improvements. Dietary fiber intake remains a key component of optimal diet quality during pregnancy.
Abstract TH857: Adaptation of digital nudges to promote healthy food choices in online food pantries using community co-design
Background: Evidence-based behavioral nudges have the potential to increase healthy food choice in charitable food settings. Food choice nudges have been used in-person in grocery stores and cafeterias, different decision environments from online food pantries. A co-design process can inform adaptation of digital nudges in online food pantries while maintaining fidelity to nudge theory. Methods: We used an iterative co-design process with adults who had ordered from (“shoppers”) or worked/volunteered (“staff”) at online food pantries. To inform prototype testing, semi-structured interviews explored the context and opinions on various nudges drawn from behavioral science literature. Next, in 3 rounds of focus groups, we shared and refined prototypes. All interviews and focus groups were transcribed, translated (for Spanish interviews), and underwent content analysis to identify strengths, concerns, and feedback to guide intervention design decisions. Results: Interviews (n=32) and focus groups (n=9) included 30 shoppers and 10 staff. In interviews, participants identified contextual factors underpinning concerns related to using nudges, especially historical lack of agency over choices and pervasive stigma in charitable settings. Interview feedback indicated that traffic light and icon labels, defaults, product organization, and filters were acceptable to prototype. Focus groups uncovered specific concerns. For traffic light labels, red labels were perceived by some participants as judgmental, reprimanding, and stigmatizing. We changed red labels to orange, leading to universal approval by participants, who perceived orange as conveying more acceptable “caution” rather than “stop” messaging. For default healthy items, some shoppers expressed a loss of agency with the automatic nature. To address this, we included “yes” and “no” response options in which those who chose “yes” or did nothing received the default, whereas those who were initially concerned about defaults felt offering both response options provided the agency they desired within the default (Figure). Conclusions: An iterative co-design process facilitated adaptation of evidence-based behavioral nudges for a charitable food setting. Incorporating the perspectives of people with lived experiences of online food pantries helped address how lack of agency and stigma influence pantry shoppers’ perceptions and interactions with nudges. Adapted digital nudges will be tested in an online food pantry.
Water treatment chemical supply chain disruption risk assessment and mitigation strategy ranking using BWM–VIKOR
Abstract TH858: NutriConnect: Enhancing Health and Food Security through Sustainable Solutions and Partnerships: Results of a Pragmatic Comparative Effectiveness Trial
Introduction: Food is Medicine, including produce prescription programs, aim to address food and nutrition insecurity while promoting health among patients with diet sensitive conditions. NutriConnect tested the effect of two produce prescription strategies, compared with usual care, on fruit and vegetable (F&V) intake and food security at 6 months among socioeconomically disadvantaged with elevated cardiovascular risk who were recently hospitalized. Hypothesis: We hypothesized that participants randomized to the NutriConnect Delivery arm would demonstrate greater increases in F&V intake at 6 months compared with those in the NutriConnect Credit arm, and that both intervention arms would demonstrate greater increase in F&V intake at 6 months compared with usual care. Methods: Eligible participants were recently hospitalized adults with food or financial insecurity and elevated cardiovascular risk. Participants were randomized (1:1:1) into three arms: Delivery (pre-selected food items), Credit (grocery coupon via email), or Usual Care (referral to community resources). The primary outcome was change in F&V intake at 6 months. Secondary outcomes included food security and self-reported health status. F&V intake was measured using 10 items from the Dietary Screener Questionnaire (DSQ). Linear mixed-effects models were used to assess changes in F&V intake over time. Household food security was analyzed using a modified Poisson model with robust standard errors. Results: NutriConnect participants (n=126) had a mean age of 55.5 years (SD=12.8) and were predominantly female (60.3%). Most had at least a secondary education (85.7%) and identified as Black (62.7%). Medicaid (34.9%) and Medicare (26.2%) were the most common insurance types. Employment status varied: 40.5% reported being disabled, while 13.5% and 7.1% reported full-time and part-time employment, respectively. The median BMI was 31 (IQR: 24.7–38.3). Nearly half (46.8%) had diabetes, 81.7% had hypertension, and 58.7% reported hypercholesterolemia. Average F&V intake was 2.3 cups/day (SD = 0.5). (Table 1) Interim 6-month retention rates were 64% in the Delivery group, 42% in the Credit group, and 51% in the Usual Care group. The trial is scheduled to conclude in Nov 2025. Conclusions: NutriConnect will generate new evidence on the comparative effects of different modes of produce prescription implementation. Future research can build on these findings to support larger-scale adaptation, implementation, and evaluation.
Abstract WE539: The Relation Between Remote Exercise and Mental Health Outcomes Among Insufficiently Active Adults with Obesity
Introduction: Physical activity (PA) has a strong positive impact on mental health outcomes, including anxiety, depression, and stress; however, there is a scarcity of studies exploring the effects of remote PA interventions for adults with obesity and the potential mechanistic role of depression, stress, anxiety, and sleep. We examined the impact of the PA for the Heart (PATH) intervention on mental health outcomes in insufficiently active adults with obesity. Hypothesis: The PATH intervention group will have significant improvement in anxiety, stress, depression, and sleep outcomes compared to the attention control (AC) group. Methods: This is a secondary analysis of a 6-month RCT including 89 adults with obesity. The PATH intervention group received an online exercise platform with biweekly coaching; controls received self-help reading materials. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), NIH Toolbox Perceived Stress Scale, PROMIS Sleep scales related to sleep disturbance (issues falling and staying asleep) and sleep impairment (effects of poor sleep on daytime function), and EuroQol 5-Dimensions quality of life questionnaire. PA was measured via Fitbit Charge 5 (active zone minutes; MVPA). Statistical analyses included t-tests for between-group comparisons, Pearson correlations, and multivariable regression models. Results: The sample (46% white, mean age 48.7±12.2 years, mean BMI 40.04±7.24 kg/m2) was 91% female. Neither depressive symptoms nor perceived stress changed significantly in either group (all p>0.05). Fitbit-measured MVPA declined in controls (-77.3±199.9 min/week) but remained stable in intervention (-5.5±161.3 min/week), though between-group difference was not significant (p=0.086). Strong correlations emerged between depression and stress (r=0.658, p<0.001), depression and sleep impairment (r=0.542, p<0.001), and depression and sleep disturbance (r=0.564, p<0.001). PA changes did not correlate with mental health changes (all p>0.05). In multivariable models, stress (β=0.535, p<0.001) and sleep impairment (β=0.293, p=0.020) were associated with depression, while PA (β=0.017, p=0.041) and depression (β=0.575, p<0.001) were associated with stress. Conclusions: Strong interconnections exist among depression, stress, and sleep in adults with obesity. PA changes did not directly impact mental health outcomes over six months, suggesting longer intervention durations or alternative mechanisms may be needed.
Abstract WE465: Pharmacologic Treatment To Lower Blood Pressure In Hypertensive Pregnant Women Living In Low- And Middle-Income Countries: Systematic Review
Background: Hypertension (HTN) is a leading cause of maternal mortality, especially in low- and middle-income countries (LMICs) where >90% of HTN-related deaths occur. HTN control during pregnancy is essential for improved maternal and neonatal outcomes. Methods: A systematic literature search was conducted to identify trials of pharmacologic blood pressure (BP) lowering in pregnant women with peripartum HTN living in LMICs. PubMed, Embase, Cochrane Library, Global Index Medicus, and the WHO International Clinical Trials Registry Platform were searched from inception to December 6, 2024. Two investigators independently screened and extracted data. Primary outcome was difference in mean arterial pressure (MAP) change between trial arms. Results: A total of 2272 unique articles were identified; 2252 were excluded during screening and 9 during full-text review. Included were 11 trials with a total of 2118 pregnant females living in Africa or Asia; sample size ranged from 70 to 894. Drugs studied included nifedipine, labetalol, hydralazine, or placebo. Nine compared either equivalent or non-equivalent dose strengths of two antihypertensive drugs; two compared drug to placebo. Difference in MAP between treatment groups was reported by or calculated for nine trials, ranging from 0.07 to 5.7 mmHg; there was no consistent pattern of greater BP reduction according to trial design (equivalent or non-equivalent dose strength or drug vs placebo; Figure). Neither was there a consistent pattern for between group systolic or diastolic BP difference. Oral nifedipine and labetalol led to fewer non-serious side effects compared with hydralazine or methyldopa. No differences were observed in serious adverse event rates. Conclusion: A systematic review found only 11 trials of pharmacologic BP lowering in pregnant women with HTN living in LMICs, highlighting need for more high-quality trials in this population. No consistent difference in BP-lowering efficacy between drugs was observed. Our results suggest tolerability, ease of administration, cost, and availability are likely more important factors to guide selection of antihypertensive drug treatment of HTN in pregnant women living in LMICs.