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Abstract MPTU01: Utilization of Long-Term Ambulatory Continuous Electrocardiographic Monitoring Has Increased between 2009 and 2022 in the United States

Introduction: Ambulatory continuous electrocardiographic (ECG) monitoring is commonly used to diagnose cardiac arrhythmias, assess arrhythmia burden, and evaluate cardiovascular therapeutic effectiveness. Novel ‘patch’ ECG monitors and mobile cardiac telemetry (MCT) facilitate long-term monitoring for 3 to 14 and 30 days respectively with greater user convenience compared to traditional lead-based Holter devices (<72 hours), although it is debated whether longer monitoring is cost-effective and improves health outcomes in different patients. We aimed to describe temporal trends and patterns of ambulatory continuous ECG monitor use in the United States. Methods: We conducted a retrospective cohort study with integrated longitudinal electronic health record data from individuals in the general population who received health care across 340 sites in the All of Us Research Program in the United States. We examined trends in the utilization of ambulatory continuous ECG monitors and characteristics of incident users by device type between 2009 and 2022. Results: Among 393,451 persons (mean age 52 years, 61% female, 53% White adults), the proportion with long-term 3-14-day monitor use following a clinical visit occurrence increased from 0 in 2009 to 6.6‰ in 2022 ( p trend <0.001), a trend that was consistent but more pronounced in those following incident arrhythmia diagnoses (up to 38‰ in 2022; n=71,703) compared to those without ( Figure 1 ). The use of 24-48-hour monitors and MCTs was relatively unchanged during this time. Comparing between 13,886, 7,568, and 386 incident users of 24-48-hour, 3-14-day, and MCT monitors, respectively, 24-48-hour and 3-14-day monitor users more frequently had preceding palpitations, while MCT users more frequently had a history of cerebrovascular accident ( Table 1 ). In subsets of patients with specific cardiovascular diseases, the increase in 3-14-day monitor use was most substantial following diagnoses of supraventricular tachyarrhythmias (up to 48‰ in 2022; Figure 2A ). The use of 24-48-hour monitors decreased but was most common following diagnoses of premature beats (66‰ in 2009 to 41‰ in 2022; Figure 2B ). Conclusions: Long-term ambulatory ECG monitor use increased substantially from 0 in 2009 to 6.6‰ in 2022 in the United States general population due to the growth of 3-14-day monitoring likely from patch ECG device use. These findings highlight the importance of studies to further optimize long-term ambulatory ECG monitor use.

Neuroimaging-driven recommendation systems for personalized sports training and injury prevention

Abstract 23: Predicting Glycemic Responses to Dietary Intake Among Non-diabetic Adults: an Evaluation of Modeling Approaches

Objective: To determine the features and models that improve the prediction of postprandial glucose response (PPGR) using continuous glucose monitoring (CGM) data. Method: We analyzed data from 860 Framingham Heart Study Third-Generation cohort participants without diabetes (with average age 60 years old, 59.8% women) who attended their fourth exam (2022-2025), wore a Dexcom G6 Pro CGM, and completed valid Automated Self-Administered 24 dietary recalls. A total of 3,402 valid meals, without eating occasions 2 hours before or after, were matched to CGM-derived PPGRs within a 2-hour postprandial window. We applied multiple predictive models, including Lasso, Linear Mixed Effect Model, Mixed Effect Random Forest (MERF), GPBoost, Generalized Additive Mixed Models (GAMM) and Supervised Autoencoder, to relate meal composition to two PPGR outcomes: incremental area under the curve (iAUC 120 , subtracting negative AUC from positive AUC) and relative glucose excursion. The baseline model included sex, age, BMI, HbA1c, and venous blood glucose, whereas fully adjusted models incorporated additional covariates including with CGM features, meal composition and context (for the specific meal and prior meals). Results: In fully adjusted models, the addition of CGM-derived variables (e.g. mean amplitude of glycemic excursions [MAGE], mean glucose over the 30 minutes prior to the meal [30mPreMeal glucose], and the change between 30mPreMeal glucose and glucose at meal time) and detailed dietary information (e.g., net carbohydrates, sugar and protein) significantly improved prediction over models using only demographic and clinical factors by at least 30% increase in R 2 . Based on the comparison of models’ results using Wilcoxon signed-rank test, we observed the highest model R 2 and strongest Pearson’s r (observed vs. predicted) with GPBoost models (iAUC 120 R 2 =57.91%, r=0.76; relative peak glucose excursion R 2 =47.57%, r=0.69). The Figure shows the top dietary predictors identified through feature importance analyses, which may inform actionable strategies to modulate glycemic response. Conclusion: Our integrative approach suggests that combining CGM-derived dynamics and dietary composition substantially enhances prediction of PPGR in real-world conditions. Optimizing such models could advance the use of CGM in the prevention and management of type 2 diabetes and related cardiometabolic disorders.

Abstract TH928: Sequence Symmetry Analysis Shows Cardiovascular Safety Signals Associated with Non-Steroidal Anti-Inflammatory Drugs

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain, inflammation, and fever; however, real-world evidence on the cardiovascular risks of individual NSAIDs remains limited. Sequence symmetry analysis (SSA) is a signal detection method for identifying adverse drug events (ADEs) in large electronic health record datasets. This study applied SSA to identify cardiovascular ADE signals associated with oral NSAIDs. Methods: This cohort study used primary care records from the UK Clinical Practice Research Datalink (CPRD GOLD). Adults ≥18 years with ≥1 year of prior observation and a new NSAID prescription between 2013-2023 were included. Incidence of seven cardiovascular events (acute myocardial infarction [MI], arrhythmia, deep vein thrombosis [DVT], heart failure, hemorrhagic stroke, ischemic stroke, pulmonary embolism [PE]) was assessed within 180 days before versus after NSAID initiation. Adjusted sequence ratios (aSR) with 95% confidence intervals were calculated for each NSAID-event pair, with aSR>1 indicating a positive ADE signal and aSR<1 indicating protective effect. Positive (NSAID-edema) and negative (NSAID-cataract) controls assessed validity. Sensitivity analyses included stratification by age and sex, alternate windows (90 and 365 days), and stratification by prior proton pump inhibitor (PPI) use. Results: 77,570 patients met inclusion criteria (median age 66 [IQR 54-76]; 53.9% male). Positive and negative controls aligned with expectations. Naproxen showed positive signals across all events, with the highest for PE (3.03 [2.63-3.51]). Ibuprofen showed six positive signals, with PE being highest (2.2 [1.88-2.59]). Diclofenac and etoricoxib each had five positive signals, with MI (3.30 [2.42-4.57]) and ischemic stroke (3.84 [2.11-7.43]) as the highest, respectively. Celecoxib and meloxicam showed four positive signals, with the highest being heart failure (2.15 [1.17-4.11]) and PE (2.66 [1.30-5.82]), respectively. MI and arrhythmia were common across all aforementioned medications. Aspirin showed negative signals across all events except PE (1.08 [0.96-1.22]). Age, sex, and window sensitivity analyses were consistent, while prior PPI stratification showed aSR attenuation in prior users. Conclusions: Individual NSAIDs exhibit varied cardiovascular ADE signals, underscoring the need for personalized risk evaluation. SSA in real-world data enhances pharmacovigilance by identifying rare ADE trends.

Abstract TU138: Cannabis Legalization and Emerging Adult Risk: A Cross-Sectional Analysis

Introduction: Cannabis use may result in adverse cardiovascular outcomes and, with growing legalization, is emerging as an important cardiovascular risk factor. More than 20% of Americans currently use cannabis, but the influence of cannabis-related policies on patterns of use remains unknown. Understanding whether cannabis policies influence relevant behaviors may be critical to addressing cardiovascular health among the public. Hypothesis: Legalization of recreational cannabis increases the prevalence and frequency of cannabis use. Methods: We conducted a cross-sectional analysis of the COVID-19 Citizen Science cohort (March 2020 to January 2024), including 89,096 adults (>18 years) residing in all 50 U.S. states and U.S. territories. The primary exposure was state cannabis policy status, with effective dates verified by legislative review through January 2024. Outcomes were any history of cannabis use, past 30-day use, and daily use. We performed bivariate comparisons using chi-square tests and estimated adjusted associations with multivariable logistic regression. Adjusted models included demographics, employment status, educational level, and tobacco use. Results: Among 89,096 participants, 56% resided in a state with recreational cannabis legalization; 67% identified as women, 84% self-identified as White, and 76% held a bachelor’s degree or higher. Participants residing in states with recreational legalization reported higher cannabis use at any time in the past (56.8% vs 44.9%, p<0.001) and in the past 30 days (11.5% vs 7.6%, p<0.001); and, among recent users, a greater proportion reported use every day (2.3% vs 1.8%, p<0.001) compared with residents of states without recreational legalization. In adjusted models, recreational legalization was associated with higher odds of lifetime cannabis use (1.53, CI 1.47-1.60, p<0.001), past 30-day use (1.38, CI 1.30-1.47, p<0.001), and daily use (1.46, CI 1.30-1.64, p<0.001). Conclusions: In this observational study including participants from all 50 states, cannabis legalization was associated with a higher prevalence and frequency of cannabis use. These data suggest that assessing the effects of cannabis-related policies on population-level cardiovascular health is worth pursuing.

Reading the climate room through unsupervised analysis of unfiltered climate perspectives

Abstract TU203: Leveraging Parks for Physical Activity Promotion and Cardiovascular Health among African American Children: Feasibility, Acceptability, and Preliminary Efficacy of the <i>NatureUplift</i> Pilot Randomized Trial

Introduction: Children remain underrepresented in cardiovascular health (CVH) research, and few studies have tested community-engaged interventions to promote CVH early in life. We conducted a park-based pilot trial and evaluated its feasibility, acceptability, and preliminary efficacy on children’s moderate- to vigorous-intensity physical activity (MVPA) (primary outcome). Methods: NatureUplift was a 12-week, two-arm pilot randomized trial conducted among African American parent-child (aged 8-12 yrs) dyads (N=13) during summer 2024, co-designed with community partners at Three Rivers Park District (Plymouth, MN) and delivered by culturally representative liaisons. The NatureUplift group (n=6) received weekly light-intensity nature-based activities (e.g., outdoor yoga, forest bathing). The NatureUplift+Active group (n=7) completed the same activities plus moderate- to vigorous-intensity hiking. Make-up sessions were offered as needed. Feasibility outcomes included recruitment, retention, and session attendance. Acceptability was assessed via Likert-scale surveys in week 12. Accelerometers measured MVPA at baseline, week 4, and week 12. Within-group changes and between-group differences were estimated using linear mixed models adjusted for child sex, with treatment-by-time interaction. Given the pilot design, interpretation focused on 95% CIs. ClinicalTrials.gov: NCT06445556. Results: Recruitment occurred April-May 2024, with 81% of eligible families enrolled. Ninety-two percent completed the 12-week intervention and follow-up assessments. Average session attendance was 74% ( NatureUplift ) and 67% ( NatureUplift+Active ). All families completed make-up sessions. In both arms, most children (83%-100%) “agreed” or “strongly agreed” that they liked participating in the study, enjoyed having a culturally representative program leader, felt the program activities were interesting, and would recommend participation. From baseline to week 12, MVPA declined in NatureUplift (-33 min/day, 95% CI -53, -13) but exhibited an attenuated decline in NatureUplift+Active (-13 min/day, 95% CI -19, 19). Wide confidence intervals indicated no precise evidence of treatment-by-time interaction. Conclusions: This pilot trial was feasible and highly acceptable, with the hiking component potentially supporting the maintenance of MVPA over time. Our community-engaged and culturally affirming approach lays the groundwork for a future full-scale efficacy trial leveraging parks to advance CVH equity.

Abstract 25: Ultra-processed Food Consumption Magnifies Genetic Risk of Obesity: A Gene-Diet Interaction Analysis in the Women's Genome Health Study

Introduction: Ultra-processed Foods (UPFs) are associated with obesity, a key modifiable factor of poor cardiovascular health. Although genetics contributes to the risk of obesity, it is unknown whether the effect of UPF consumption on body mass index (BMI) is greater among individuals with underlying genetic susceptibility. Hypothesis: We conducted gene-diet interaction analyses to assess whether the genetic risk of obesity increases the positive association between UPF consumption and BMI. Methods: We conducted a cross-sectional analysis in the Women’s Genome Health Study among women of European ancestry with complete genetic data, available FFQ data, and BMI at baseline enrollment in 1992. We derived UPF intake (as % total energy), classifying foods and beverages by NOVA based on the nature, extent, and purpose of processing. BMI-related genotypes were captured by genome-wide (gwPRS) and pathway-specific (pPRSs) polygenic risk scores from GWAS statistics. The multivariable-adjusted linear regression models with effective independent test number and Sidak-corrected thresholds multiple testing adjustment were conducted to analyze continuous PRS and UPFs exposures with BMI as the outcome. Results: Among 22,471 WGHS participants, the mean UPF intake was 29.4 (SD 10.7) % total energy and BMI was 25.9 (4.9) kg/m 2 . In main effects models, higher gwPRS and UPF intake were linearly associated with higher BMI. We observed a significant positive interaction between gwPRS and UPF intake on BMI, with each 1-SD higher UPF intake associated with 0.15 kg/m 2 higher BMI per 1-SD higher gwPRS (95% CI 0.10–0.21, p&lt;0.0001) (Table 1). Women with higher UPF intake had an incrementally higher BMI, and the magnitude of this linear association was larger among women with higher genetic risk of obesity (Figure 1). There were no significant pPRS and UPF intake interactions among individual KEGG legacy pathways. Conclusions: In this large US cohort of women, women who consumed a greater proportion of energy from UPFs or had greater genetic susceptibility to obesity had a higher BMI in midlife. A significant interaction between the overall BMI PRS and UPF intake indicated UPF intake further amplified the relationship of genetics with BMI, although insights for specific genetic pathways were limited. Next, we will test gene–diet interactions for UPF categories on weight trajectories to inform precision nutrition strategies to optimize cardiovascular health at individual and population levels.

Abstract TU231: Spousal Pregnancy Loss and Paternal Cardiovascular Disease Risk: Evidence from Chinese and U.S. Cohorts

Background: While pregnancy loss has been linked to increased long-term maternal cardiovascular risk, its implications for paternal cardiovascular health remain unclear. This study aimed to assess the association between spousal pregnancy loss and the risk of paternal cardiovascular disease (CVD), and to explore the potential modifying or mediating roles of metabolic disorders and depressive symptoms. Methods: We utilized data from two nationally representative studies: the China Health and Retirement Longitudinal Study (CHARLS) for longitudinal cohort analysis and the U.S. Health and Retirement Study (HRS) for cross-sectional validation. The primary outcomes were self-reported, physician-diagnosed CVD. Logistic regression models and Cox proportional hazards models were used to examine the cross-sectional and longitudinal associations. Results: In CHARLS (n = 3,658; mean age = 59), 896 of 3,658 men (24.5%) reported spousal pregnancy loss. Spousal pregnancy loss was associated with a 19% increased risk of CVD (HR: 1.19, 95% CI: 1.01–1.40). Risk appeared to increase with the number of losses (HR for one loss: 1.17, 95% CI: 1.00–1.39; HR for two or more: 1.37, 95% CI: 0.94–1.99; p-trend = 0.02). In HRS (n = 2,147; mean age = 67), spousal pregnancy loss was similarly associated with increased CVD risk (OR: 1.17, 95% CI: 1.07–1.38). The associations were consistent across subgroups and were not significantly modified by the presence of metabolic disorders or depressive symptoms (all p-interaction &gt; 0.1; p-mediation &gt; 0.2). Conclusions: Spousal pregnancy loss is associated with elevated CVD risk in men. These findings underscore the importance of recognizing the broader health impacts of pregnancy loss and suggest the need for supportive interventions that include paternal health. Additionally, future strategies should aim to prevent pregnancy loss as a means of facilitating early primary prevention of CVD within household settings .

Distribution and seasonality of potentially toxic elements (PTEs) in the waters of the Negro river in Manaus, Amazonas, Brazil

Abstract MPTH78: Large-Scale Proteomic Profiling of Cardiac Dysfunction in Men and Women with and without HIV: The MACS-WIHS Combined Cohort Study (MWCCS)

Background: People with HIV (PWH) exhibit a high risk of heart failure (HF). Immune dysregulation has been implicated, but the pathophysiology remains incompletely understood. Left ventricular global longitudinal strain (LVGLS) permits earlier detection of cardiac dysfunction than traditional echocardiography (Echo) measures, allowing evaluation of early mechanisms of disease. We performed proteomic profiling of PWH and sociodemographically similar people without HIV (PWOH) to identify proteins cross-sectionally associated with LVGLS. Methods: We included men from the Multicenter AIDS Cohort Study (MACS) and women from the Women’s Interagency HIV Study (WIHS) who completed Echo in 2014-2019 and had plasma for analysis using Olink Explore HT (5,416 proteins). We related individual proteins to LVGLS using multivariable linear regression adjusting for sociodemographic, behavioral and clinical factors in each cohort, and combined the results by fixed-effects meta-analysis. FDR&lt;0.05 defined significance. Results: The study included 1152 MACS (age 58, Black 28%, HIV+ 54.6%) and 1602 WIHS (age 52, Black 75%, HIV+ 70.2%) participants. There was no interaction or heterogeneity by cohort. Meta-analysis identified 6 proteins associated with LVGLS, including two (UMOD, SHBG) with better, and four (MZB1, PRAP1, CES1, PXDNL) with worse, LVGLS (Figure). Both UMOD and SHBG have known inverse associations with CVD events, while PXDNL is upregulated in end-stage HF. The other proteins have not been previously linked to clinical HF. In mice, MZB1 modulates cardiac mitochondrial function and suppresses inflammation in heart and gut; PRAP1 facilitates gut apoB assembly and protects gut epithelium from apoptosis; and CES1, involved in lipid metabolism and drug detoxification, has been linked to atherosclerosis. There was no interaction by race/ethnicity or HIV in either cohort, except for COL3A1, which was associated with worse LVGLS only in women with HIV (WWH). Conclusions: We identified three novel plasma proteins associated with LV dysfunction in PWH and PWOH, extending three other proteins to the HIV setting. The new proteins have roles in cardiac mitochondrial homeostasis, intestinal epithelial function and lipid metabolism, dysregulation of which is prevalent in HIV. A signal for collagen type 3 in WWH suggests a more prominent role for cardiac fibrosis in this population. Additional work is needed to replicate these associations and evaluate their causal nature.

Abstract MPWE39: Pilot Randomized Clinical Trial of Produce Prescription with Dietitian Coaching to Improve DASH Diet Adherence and Diet Quality: THRIVE Food is Medicine Trial

Background: Despite the efficacy of the Dietary Approaches to Stop Hypertension (DASH) diet, adherence remains low due to barriers, including food access, affordability, lack of tailored support. We hypothesized that a Food is Medicine intervention combining produce prescriptions with personalized dietitian coaching would improve dietary quality in high-risk populations. Methods: THRIVE was a 24-week, 2-arm randomized pilot feasibility trial conducted among Black and Hispanic adults with hypertension living in Healthy Food Priority Areas in Maryland (NCT06257550). Participants were randomized 1:1 to: (1) THRIVE intervention: $30/week produce prescription via “FARMacy” market + individualized DASH-aligned dietitian coaching + adaptive bi-directional text messaging + social resource navigation, or (2) Enhanced usual care (EUC): produce bags without coaching + social resource navigation. Outcome was a change in DASH adherence score (0-9 scale) via interviewer-administered 24-hour dietary recalls . Secondary outcomes included Healthy Eating Index (HEI 2015) total score, total fruit and vegetable intake assessed at 12 and 24 weeks. Intention-to-treat analyses were conducted using paired t-tests for within-group changes and difference-in-differences (DiD) for between-group tests. Results: Among 80 randomized participants (40 per group): mean age 54.5±11.4 years, 57% female, 62% Black, 34% Hispanic. At 12 weeks, both groups had improvements in DASH adherence scores (THRIVE: +0.33, 95% CI: -0.77, 1.43; EUC: +0.68, 95% CI: 0.06, 1.30, p=0.033, Table 1 ). By 24 weeks, improvements persisted in both groups (THRIVE: +0.78; Control: +0.25), DiD of +0.53 (95% CI: -0.88 to 1.94, p=0.452). There were clinically meaningful gains in total HEI scores in the THRIVE group at 12 weeks (+10.63, 95% CI: 2.85 to 18.40, p=0.010, Table 2 ) compared with EUC (+3.61, 95% CI: -1.83 to 9.06, p=0.186). At 24 weeks, HEI improvements were sustained in THRIVE (+6.44) vs. minimal change in EUC (+0.11), with a DiD of +6.32 (95% CI: -3.73 to 16.37, p=0.212). Vegetable intake increased at 12 weeks in the EUC group (+0.63 cups, 95% CI: 0.15 to 1.11, p=0.012) Conclusion: This pilot trial demonstrates the feasibility and promise of a multi-component Food is Medicine intervention to improve DASH diet adherence and overall diet quality among Black and Hispanic adults with hypertension. Preliminary results support the potential value of combining produce prescriptions with personalized nutrition support

Abstract 26: Reproductive Milestones and Cardiovascular Disease Risk Among Postmenopausal Women by Obesity Status in the Women’s Health Initiative (WHI)

Introduction: Early menarche (&lt;12 years), menopause (&lt;40 years), and a short reproductive lifespan (&lt;35 years), have been associated with increased CVD risk. It is unclear whether these reproductive factors are independently associated with CVD risk or if associations are modified by adiposity. Purpose: Examine whether early menarche, menopause, and a short reproductive lifespan are independently associated with incident CVD and examine heterogeneity by obesity status. Methods: Postmenopausal women enrolled into the WHI observational study or trials with ages at menarche and menopause recalled at baseline were included. Reproductive lifespan was defined as the difference between age at menopause and menarche. Obesity was defined as either a waist circumference (WC) of ≥88 cm or a body mass index (BMI) of ≥30 kg/m 2 at enrollment. Incident CVD was a composite outcome including incidence of coronary artery disease, heart failure, peripheral artery disease, and stroke. Multivariable cox regression models assessed associations of reproductive characteristics and incident CVD, adjusting for lifestyle, demographic, and clinical factors. Interactions of reproductive factors, WC, and BMI were also examined. Results: At enrollment, participants (N=119182) were on average 68.2±7.1 years with a WC of 85.9±13.6 cm and BMI of 27.7±5.8 kg/m 2 . Over a median follow-up of 12.6 years, there were 12,731 (10.7%) incident CVD cases. Mean ages at menarche and menopause were 12.6±1.5 and 48.2±6.3 years, yielding an average reproductive lifespan of 35.6±6.4 years. Early menarche (HR: 1.15, 95% CI: 1.07-1.23), menopause (HR: 1.24, 95% CI: 1.12-1.38), and a short reproductive lifespan (HR: 1.15, 95% CI: 1.08-1.23) were significantly associated with increased risk of incident CVD. Excess menopausal adiposity significantly modified association of early menarche and CVD only ( Table ). Conclusions: Among postmenopausal women, age at reproductive transitions and duration of reproductive lifespan were independently associated with incident CVD. Future research should examine whether prioritizing weight management earlier in the life course, especially among those with menarche before age 12, impacts CVD risk and can inform public health strategies.

Real-time underwater object detection via frequency-domain dynamics and spatially enhanced feature modulation

The private solution trap in collective action problems across 34 nations

Collective action problems emerge when individual incentives and group interests are misaligned, as in the case of climate change. Individuals involved in these problems are generally considered to have two options: contribute toward public solutions such as global warming mitigation or free ride. However, many collective action problems today involve a third option of investing in a “private solution” such as local adaptation. The availability of this third option can lead to a private solution trap whereby private solutions are adopted, collectively optimal public solutions are not provided, and existing inequalities are exacerbated. We investigated the private solution trap with a collective action game featuring private and public solutions, wealth inequality determined by luck or merit, and participants from 34 countries. We found that the joint existence of private solutions and wealth inequality had a consistent effect across countries: Participants given a higher endowment adopted private solutions almost twice as often as those given a lower endowment, regardless of whether it was determined by luck or merit, and contributed proportionally less toward public solutions. Wealth inequality increased in every country and those given lower endowments were often left unprotected as public solutions were not provided. Across countries, cultural values of hierarchy and harmony were associated with preferences for private and public solutions, respectively. We also identified two universal pathways toward public solution provision: early contributions and conditional cooperation. Our findings highlight the ubiquity of the private solution trap, its cultural underpinnings, and its potential consequences for global collective action problems.

Abstract WE521: Clinical Obesity: Prevalence, Cardiometabolic Risk, and Response to Lifestyle Intervention

An expert commission proposed novel diagnostic criteria distinguishing between preclinical and clinical obesity, recommending treatment indications for the latter. However, their relative proportions in adults with obesity and associated disease risks are unknown. We aimed to quantify the prevalence of preclinical and clinical obesity, investigate their associations with incident cardiovascular diseases (CVD) and type 2 diabetes (T2D), and assess remission from clinical obesity after lifestyle intervention. We used the nationally representative NHANES 2017-2018 survey cycle (n=5,265) and a random subcohort of the population-based EPIC-Potsdam study (n=2,500) to estimate prevalence of preclinical and clinical obesity. We assessed risk of CVD and T2D across the defined obesity groups in established CVD and T2D case-cohorts (including 403 CVD and 778 T2D cases) in EPIC-Potsdam using weighted Cox proportional hazard regression. Remission from clinical obesity was investigated in the Tuebingen Lifestyle Intervention Program study (n=150) after a 9-months lifestyle intervention focused on weight loss. In NHANES 2017-2018 and EPIC-Potsdam, among those with BMI-defined obesity (≥30kg/m 2 ), 100% were confirmed to have obesity by at least one other anthropometric measure (waist circumference, waist-to-height, waist-to-hip ratio, or DXA-measured body fat). More than 80% of adults with confirmed obesity met the proposed diagnostic criteria for clinical obesity, depending on age, BMI and metabolic criteria used. Compared to adults without obesity and not fulfilling proposed diagnostic criteria, adults with clinical obesity had increased risk of CVD (HR: 2.78, 95%CI: 1.78-4.34) and T2D (7.88, 5.56-11.2). Adults with preclinical obesity had no elevated risk of CVD, but T2D risk was markedly increased (4.32, 1.77-10.5). In adults with a weight loss &gt;3% (median 7.4%) by the lifestyle intervention, prevalence of clinical obesity decreased from 71% to 57%, and that of prediabetes (as component of the metabolism criterion) from 52% to 29%. Age and liver fat content, but not BMI or visceral fat mass, independently predicted remission of clinical obesity. In conclusion, our findings indicate that a very large proportion of adults with BMI-based obesity had clinical obesity. This proportion varied depending on BMI and criteria used. Weight loss moderately decreased prevalence of clinical obesity, but improved metabolic health in many who may not be classified to clinical obesity.

Abstract 71: Replacing Sedentary Time by Moderate-to-Vigorous Physical Activity or Sleep on a 24h Period in Early Adolescence Is Associated with Lower Insulin Resistance Five Years Later: Prospective Analysis Within the Project Viva Cohort

Introduction: Physical activity, sedentary time and sleep are determinants of adolescent cardiometabolic health. However, few studies have examined the interrelatedness of these behaviors in a 24h period, which is more applicable to the real world and could better inform public health policies. Hypothesis: Reallocation of time from sedentary behaviors to physical activity over 24h in early adolescence is associated with the most cardiometabolic health benefits in late adolescence. Methods: We used data from the ongoing Project Viva prebirth cohort (Eastern Massachusetts, USA, births 1999-2002). In early adolescence (median age 12.9 years), participants wore a wrist accelerometer for 7-10 consecutive days and completed sleep logs. We determined the average minutes spent in sleep, sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) using validated cut points. In late adolescence (median age 17.5 years), we collected fasting blood for adiponectin, glucose, and insulin and calculated HOMA-IR. We analyzed how proportion of time spent in each of the four activity categories in early adolescence was associated with glucose, insulin, and adiponectin in late adolescence using compositional data analysis, adjusting for participants’ age, sex, and season of actigraphy in early adolescence and maternal education and household income at enrollment. Results: A total of 802 adolescents (n=394 with outcome data) had valid accelerometer data, with 51.9% female and 63.7% non-Hispanic white (Table). The sample average 24h time composition was 33% for sleep, 48% for sedentary activities, 17% for LPA and 2% for MVPA. Allocating time towards sleep or MVPA at the expense of sedentary time in early adolescence was associated with lower HOMA-IR in late adolescence (Figure). More specifically, reallocating 30 minutes of sedentary time to MVPA or to sleep was associated with a 14.8% (95%CI: -23.3; -5.1) and 4.7% (95%CI: -7.8; -0.6) reduction in HOMA-IR, respectively, while reallocating to LPA would yield no significant change in HOMA-IR (2.9%, 95%CI: -0.9; 7.4). Our results did not support associations of activity 24h composition with adiponectin or fasting glucose. Conclusions: Allocating more time in MVPA and sleep on a 24h period in early adolescence is associated with lower insulin resistance in late adolescence. Public health strategies should focus on promoting MVPA and sleep to preserve optimal cardiometabolic health in adolescents.

Abstract TU222: Lactation and Maternal Serum Metabolomic Profiles in Relation to Cardiometabolic Disease: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: Lactation has been associated with improved long-term cardiometabolic health in women, but the underlying mechanisms remain unclear. Methods: We studied 194 parous women (mean age: 32.8 years) from the HCHS/SOL with singleton births and self-reported lactation information. A total of 694 serum metabolites were profiled a median of 3 years (IQR: 1-4) after delivery. Lactation duration was categorized as &lt;6 months or ≥6 months. Lactation-related metabolites were identified by metabolome-wide association analyses with an Empirical Bayes method and adjusting for sociodemographic and reproductive factors (|fold change|&gt;1.2 and FDR-adjusted p&lt;0.05). We examined the correlations between selected metabolites and cardiometabolic traits. We further examined the prospective associations of selected metabolites with incident diabetes (without baseline diabetes, n=2,341) and CVD (without baseline CVD, n=2,968) over 12 years of follow-up among parous women in the HCHS/SOL. Results: In this study, 26 (13.4%) women reported no lactation for this birth, 100 (51.5%) lactated &lt;6 months, and 68 (35.1%) lactated ≥6 months. Compared with &lt;6 months (n=126), lactation for ≥6 months (n=68) was associated with 46 metabolites, including lower levels of 37 metabolites (e.g., amino acid derivatives [involved in energy balance and methylation process] and glycerophospholipids [key membrane and lipoprotein components linked to dyslipidemia]), and higher levels of 9 metabolites (e.g. certain plasmalogens [antioxidant phospholipids] and sulfated steroids [involved in hormonal and metabolic regulation]). Most lactation-increased metabolites were positively correlated with triglycerides and LDL cholesterol, while many lactation-decreased metabolites were positively correlated with HDL cholesterol. Furthermore, 17 metabolites (e.g., N-acetylvaline and 3,4-dihydroxybutyrate) that were higher in women with &lt;6 months lactation, were associated with increased risk of incident diabetes or CVD (HRs per SD range:1.12-1.64, p&lt;0.05); while 2 metabolites (pregnenolone sulfate and a plasmalogen), higher in women with ≥6 months lactation, were inversely associated with incident diabetes (HRs per SD: 0.88 and 0.90, p&lt;0.05) ( Figure 1 ). Conclusion: Longer lactation duration was associated with a favorable maternal serum metabolomic profile 1-4 years after delivery, which may partly explain the protective effects of sustained lactation on diabetes and CVD risk among Hispanic/Latino women.

Deep learning–based quantitative CT assessment of interstitial lung abnormalities: prognostic risk thresholds in a health screening population

Correction for Fernández et al., Transcranial magnetic stimulation to frontal but not occipital cortex disrupts endogenous attention