bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P145: Circulating and Dietary Trans-Fatty Acids and Incident Type-2 Diabetes Mellitus in Older Adults: The Cardiovascular Health Study
Authors: Wang Qianyi , Imamura Fumiaki , Ma Wenjie , Lemaitre Rozenn N , King Irena B , Song Xiaoling , Biggs Mary L , Delaney Joseph A , Mukamal Kenneth J , Djousse Luc , Siscovick David , Mozaffarian Dariush
Published: July 2021

Background:
While trans-fatty acids (TFA) influence CHD, their effects on type 2 diabetes mellitus (DM) are not established, with mixed findings of experimental, short-term intervention, and observational studies. Effects may vary depending on specific TFA subtype or method of assessment (circulating biomarkers vs. diet).

Objectives:
To examine prospective associations of circulating and estimated dietary TFA with risk of incident DM in older adults.

Methods:
Plasma phospholipid trans-(t-)16:1n9, total t-18:1, and cis/trans-(c/t-), t/c- and t/t-18:2(n6,9) were measured in blood stored among 3,076 adults in the Cardiovascular Health Study (CHS), aged 74±5y and free of prevalent DM in 1992. Dietary TFA was estimated among 4,246 adults free of prevalent DM when dietary questionnaires were initially administered in 1989 (n=3,917) or in 1996 (n=329). Incident DM up to 2009 was defined as new use of insulin or hypoglycemic drugs, fasting glucose≥126 mg/dL, nonfasting glucose≥200 mg/dL, or 2-hour post-challenge glucose≥200 mg/dL. The relative risk of incident DM associated with each TFA subtype was assessed using multivariate Cox proportional hazards regression.

Results:
Levels of each circulating TFA subtype varied from 2.00±0.73 (% of fatty acids) for t-18:1 to 0.05±0.02 for t/t-18:2. TFA subtypes were moderately to highly intercorrelated (r=0.4 to 0.8), except for t/t-18:2 which weakly correlated with all other TFAs (r<0.1). During 30,927 person-years, 364 DM cases occurred among participants with plasma phospholipid TFA measures. Adjusting for demographics, lifestyle factors, and medical history, lower DM risk was associated with higher levels of t-16:1n9 (Quartile 4 vs. Quartile 1 HR=0.76, p trend=0.03), total t-18:1 (HR=0.71, p trend=0.02) and t/t-18:2 (HR=0.73, p trend=0.04). However, further mutual adjustment for the different TFA subtypes attenuated these inverse associations, and none of the 5 circulating TFA biomarkers were independently related to incident DM (p trend≥0.14 for all). During 50,508 person-years in the dietary analyses, 453 DM cases occurred. Adjusting for demographics, lifestyle, medical history, and other dietary habits, increased DM risk was observed among participants with higher consumption of total TFA (Quartile 4 vs. Quartile 1 HR=1.40, p trend=0.04) and t-18:2 (HR=1.49, p trend=0.006), and t-18:1 consumption (HR=1.32, p trend=0.08), although the latter was not statistically significant.

Conclusions:
Plasma phospholipid TFA subtypes were not associated, whereas dietary total TFA and t-18:2 were positively associated, with incident DM among older adults. These findings highlight the need to understand how dietary TFA may influence DM and why associations may differ for circulating versus dietary TFAs.
Abstract P158: Relationship Between Wealth Factors and Health Status Among Hispanic/Latinos: Preliminary Findings from the HCHS/SOL Sociocultural Ancillary Study
Authors: Lopez-Cevallos Daniel F , Gonzalez Patricia , Bethel Jeff W , Castañeda Sheila , Isasi Carmen R , Penedo Frank J , Ojeda Lizette , Davis Sonia M , Chirinos Diana A , Molina Kristine M , Teng Yanping , Gallo Linda C
Published: July 2021

Background:
Studies show that wealth factors are associated with health status. Limited research has examined this association among Hispanic/Latinos of diverse backgrounds. The purpose of this study was to examine the associations between wealth factors, and subjective and objective health status.

Methods:
This cross-sectional study used data from 4,716 Hispanic/Latinos, 18 to 74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (SCAS). Participants provided information on wealth and “traditional” socioeconomic measures (i.e., education, occupation, income), and subjective health status (i.e., mental health [MCS] and physical health [PCS] scores of the SF-12®). Blood pressure, cholesterol, and weight and height were assessed and all medications were reviewed. Objective health status measures included: hypertension (blood pressure ≥140/90 or on antihypertensive medications); hypercholesterolemia (total cholesterol ≥240, HDL cholesterol < 40, LDL cholesterol ≥ 160, or receiving cholesterol-lowering medication); and obesity (Body Mass Index ≥30). Wealth was measured using a Home Affluence Scale (HASC: range 0 - 6); ability to maintain a standard of living greater than or equal to 6 months; and having accrued savings greater than or equal to $5,000. Other factors included sociodemographic (age, sex, marital status, family size, years in the US, Short Acculturation Scale for Hispanics score), health-related (physical activity, diet) and healthcare access variables (health insurance coverage). Data analyses consisted of weighted summary statistics and multivariable linear and logistic regression models using the svy commands in Stata IC 12.1.

Results:
The mean HASC score was 2.9 (95%CI: 2.8-3.0). Approximately 25% (95% CI: 23-27%) of participants reported they would be able to maintain their standard of living for 6 months or more. Almost a third (29%, 95%CI: 27- 32%) had $5,000 or more in savings. Multivariable analyses showed that wealth, as measured by HASC, was positively associated with PCS score (β= 0.54, SE= 0.13, p< 0.01), even after adjusting for “traditional” SES and other sociodemographic factors. In turn, wealth was not associated with MCS score or objective health status.

Discussion:
Results demonstrate that among Hispanic/Latinos of diverse backgrounds, a measure of wealth (HASC score) was associated with perceived physical health status (PCS score) but not other subjective (mental health status [MCS score]) or objective health status measures (i.e., hypertension, hypercholesterolemia, obesity). Future studies should address mechanisms via which wealth factors may impact health status in longitudinal designs.
Abstract P165: Trends in Diabetes by Socioeconomic Status between 1999-2010: National Health and Nutrition Examination Surveys
Authors: Carnethon Mercedes R , De Chavez Peter John D , Rasmussen-Torvik Laura J , Womack Veronica , Kershaw Kiarri
Published: July 2021

Background:
Diabetes (DM) is more common among adults with lower socioeconomic status (SES). However, it is not known whether the socioeconomic disparities in DM are obscured by the overall rising prevalence of DM. Our objective was to test whether disparities in diabetes by SES have changed between 1999 and 2010.

Methods:
Participants from National Health and Nutrition Examination Surveys aged > 20 years with data available to determine DM at each examination were included (n= 11,952). DM was determined as fasting glucose ≥126 mg/dL or self-report of DM medication use. Educational attainment was used to represent SES and categorized into 4 groups. Predictive marginal probabilities from logistic regression models were used to calculate the age-standardized prevalence of DM by educational category across 3 survey periods (1999-2002, 2003-2006, 2007-2010). We tested whether the relationship of SES with DM changed over time using interaction terms between education and survey period.

Results:
The age-standardized prevalence of diabetes was 8.5% (95% CI: 7.3-9.7) in 1999-2002, 9.6% (95% CI: 8.4-10.7) in 2003-2006 and 11.3% (95% CI: 10.0-12.5) in 2007-2010. In each survey period, DM prevalence was highest among adults with the least education (p<0.01) and that relationship did not change over time (p=0.50 for education*year). When we stratified by race/ethnicity, non-Hispanic whites and blacks had the same socioeconomic patterning over time as the total population (Figure). However, education was not associated with DM in Mexican Americans, and this did not change over time.

Conclusion:
Socioeconomic disparities in DM persist over time; however, the inverse gradient in DM prevalence is not present in Mexican Americans.
Abstract P169: Ethnic Disparities In Short- And Long-term Prognosis After A First Cardiovascular Hospitalization
Authors: Van Oeffelen Louise , Agyemang Charles , Koopman Carla , Stronks Karien , Bots Michiel , Vaartjes Ilonca
Published: July 2021

Introduction:
Ethnic disparities in prognosis after a cardiovascular event have been reported. We investigated differences in mortality and readmission after a first hospital admission for total cardiovascular disease (CVD), AMI, CVA, peripheral arterial disease (PAD), and congestive heart failure (CHF) between several ethnic minority groups and the Dutch majority population.

Methods:
A nationwide prospective cohort of CVD patients hospitalized between 1998 and 2010 was constructed (N=776,574). Differences in short- and long-term mortality and readmission (0-28 days after admission and 28 days-5 years after admission respectively) between first generation ethnic minority groups (henceforth: migrants) and the Dutch majority population were calculated using multivariable Cox proportional hazard models .

Results:
In particular mortality after AMI and CVA was higher in migrants compared to the Dutch majority population, except for Moroccans. Short- (HR 1.36; 1.07-1.74) and long-term ( HR 1.45; 1.20-1.75) mortality after CVD was the highest in Chinese migrants. Short-term readmission rates were similar between migrants and the Dutch majority population, except after AMI where mainly lower rates were found (HR:0.37-1.26). Long-term readmission rates were also similar to the Dutch majority population, except after CHF where readmission rates were lower (HR varies between 0.67-0.95), and after AMI where readmission rates for AMI were higher (HR varies between 1.24-1.83).

Conclusion:
Short- and long-term mortality after CVD is higher in migrant groups than in the Dutch majority population, except after CHF. Differences in readmission rates were more similar to the Dutch majority population, with some fluctuations between sub diseases and migrant groups.
Abstract P170: Ideal Levels of Cardiovascular Health Metrics across Racial and Ethnic Groups in California
Authors: Waris Mohammed Umer A , Wong Nathan D
Published: July 2021

Introduction:
The American Heart Association (AHA) set a goal to improve the cardiovascular health of the nation by 20% by 2020 and identified cardiovascular disease (CVD) health metrics. We estimated the prevalence of adults at ideal levels for six key CVD health metrics among the racial and ethnic groups in California.

Methods:
Using data from the California Health Interview Survey (CHIS) 2009 study of adults aged 18 and over, and closely following AHA definitions, we identified prevalence of “poor”, “intermediate”, and “ideal” levels of 6 key CVD health metrics: 1) smoking status, 2) physical activity, 3) BMI, 4) diet score, 5) fasting plasma glucose, and 6) blood pressure among Chinese, Filipino, South Asians, Japanese, Koreans, Vietnamese, Caucasians, Mexican Americans, Other Hispanics, African Americans, and Native Americans/ Alaskan Natives living in California (n=46,693, projected = 26.6 mil). The seventh key AHA metric, cholesterol, was not available in our sample.

Results:
Among all racial/ ethnic groups, physical activity, BMI, and diet score were the metrics at poorest levels. Wide variability in ideal levels for the six key CVD health metrics is seen across all racial/ ethnic groups (table). The CVD health metrics were most consistently poor among American Indians/ Alaskan Natives but were also at low levels for specific Asian, Hispanic, and African American groups. Less than 1% of all California adults had ideal measures for all six CVD Health metrics.

Conclusions:
Our study shows wide variability between Asian and other racial/ ethnic groups in key CVD health metrics in California. Larger scale national surveys representing all key US racial and ethnic groups are needed to validate these findings and to document the gaps needed to be addressed for improving CVD health. These findings provide opportunities for targeted health outreach to those racial/ ethnic groups most at risk and addressing metrics at poorest attainment.

Table. Proportion (%) at Ideal Levels of CVD Health Metrics, by Race and Ethnicity
Abstract P171: Ethnic Inequalities In Cardiac Revascularization After Acute Coronary Syndrome
Authors: Van Oeffelen Louise , Vaartjes Ilonca , Stronks Kariien , Bots Michiel , Agyemang Charles
Published: July 2021

Background:
Extensive literature in the USA reports lower revascularization rates after coronary heart disease among African Americans than among White Americans. Ethnic differences in revascularization procedures in European countries with an egalitarian health care system are rarely studied. We investigated disparities in revascularization procedures after an acute coronary syndrome (ACS) between ethnic minority groups and the Dutch majority population.

Methods:
All ACS events between 2006 and 2011 were identified in the Agis insurance Health Database using Diagnosis Treatment Combinations. Multivariable logistic regression analyses (adjusted for age, sex, ACS type, degree of urbanisation, socioeconomic status and comorbidity) were used to identify ethnic differences in revascularization procedures (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)) within 30 days after the ACS event.

Results:
On average, after 41.3% of all ACS events a revascularization procedure was performed. In the fully adjusted model, no difference in revascularization rate between the Dutch majority population and the ethnic minority groups under study were found (Moroccan (1.05; 0.77-1.43), Turkish (0.94; 0.75-1.18), Hindustani Surinamese (0.92; 0.70-1.21), and non-Hindustani Surinamese (1.15; 0.61-2.17)). Also age-stratified results did not show significant differences.

Conclusion:
In the Netherlands, a country with an egalitarian health care system, no ethnic inequalities in revascularization rate within 30 days after an acute coronary syndrome were observed. ACS type, degree of urbanisation, SES, and comorbidity did not influence the findings. Future research should elucidate whether disease severity may have obscured results.
Abstract P172: Attributable risks of hypertension and diabetes for stroke, myocardial infarction and vascular death in the Northern Manhattan Study
Authors: Willey Joshua , Khan Emily , Cespedes Sandino , Moon Yeseon P , Rundek Tatjana , Cheung Ken , Sacco Ralph L , Elkind Mitchell S
Published: July 2021

Objective:
To determine the attributable risks (AR) for vascular events (VE: stroke, myocardial infarction, and vascular death) due to hypertension and diabetes by race/ethnicity, sex and age.

Background:
Understanding the distribution of risk factors and their contribution to disease incidence is critical for effective allocation of resources for disease prevention. There is little data on the relative contribution of vascular risk factors among multiethnic elderly populations.

Methods:
The Northern Manhattan Study is a population-based prospective cohort study of incidence, risk factors, and outcomes in a multiethnic urban population. Multi-variable Cox models adjusted for socio-demographic and vascular risk factors were used to calculate hazard ratios, AR and 95% confidence intervals (95%CI) for (1) all stroke and (2) VE.

Results:
The cohort (n=3,298) had mean age 69.2+/-10 years with 63% women, 52% Hispanic, 73% hypertensive and 21% diabetics. There were 347 strokes and 835 VE during a median follow-up of 12 years. The AR due to hypertension was 30% (95%CI 13-48%) for stroke and 24% (95%CI 13-35%) for VE; AR due to diabetes was 19% (95%CI 12-27%) for stroke and 13% (95%CI 8-17%) for VE.The AR for stroke from hypertension differed by age and race-ethnicity (table), while for diabetes it only differed by age. For VE, the AR of hypertension and diabetes did not differ by age, sex, or race-ethnicity.

Conclusions:
On a population level diabetes and hypertension have important effects on the risk of VE across all socio-demographic groups. For stroke, these effects are more notable at age< 80. Our results may in part be driven by competing risks for other VE outcomes with stroke, or a differential impact of risk factors on stroke in younger individuals.
Abstract P182: Glycaemic Index and Glycaemic Load of East Asian foods: The INTERMAP Study
Authors: Yan Li , Chan Queenie , Aljuraiban Ghadeer , Oude Griep Linda M , Tzoulaki Ioanna , Stamler Jeremiah , Van Horn Linda , Daviglus Martha L , Daviglus Martha L , Miura Katsuyuki , Ueshima Hirotsugu , Zhao Liancheng , Frost Gary , Elliott Paul ,   the INTERMAP Rsch Group
Published: July 2021

Background:
According to recent national health surveys (2010-2013), diabetes mellitus (DM) is more prevalent in East Asian populations (11.6% in China, 11.3% in Japan) compared with Western populations (4.5% in UK and 8.3% in US), even though body weight and body mass index (BMI) are much lower in East Asian populations (mean ≈ 22-23 kg/m2 in China/Japan vs. ≈ 27-28 kg/m2 in UK/US, WHO 2008 report). Consumption of total available carbohydrate (CHO) (%kcal) in Eastern countries is higher than in Western countries. The patterns of CHO intake, dietary glycaemic Index (GI)/glycaemic Load (GL), may be important in accounting for these differences and their metabolic effects. Data on GI/GL of Asian foods are, however, limited.

Objectives:
To develop systematic methodology for assigning GI values to East Asian foods, and to identify East Asian foods contributing most to total GL, using data from the International Collaborative Study on Macro-/Micronutrients and Blood Pressure (INTERMAP).

Methods:
The INTERMAP Study is a cross-sectional epidemiologic investigation with standardized quality-controlled methods; it accrued four in-depth 24-hour dietary recalls, 2 timed 24-hour urine collections, 8 BP measurements and questionnaire data. National and International GI databases were used to develop a standardized algorithm for assigning GI values to the INTERMAP data on East Asian foods. “GL contribution of a food”, defined as the GI value of this food multiplied by total amount of available CHO contained in this food as consumed on average by all participants, was used to estimate total influence of each food on blood glucose, including absolute levels and relative percentages.

Results:
GI values of total of 2,928 East Asian individual food codes (2,030 Japanese food codes and 898 Chinese food codes) were assigned using this newly developed algorithm. Foods assigned with GI>0 using this algorithm contributed 92% (Japan) and 98% (China) of total CHO intake per day. Among Japanese foods, high GI foods were sweet red bean paste (Monaka, GI=91), rice cookie (GI=91), and rice cracker (GI=91). Among Chinese foods, high GI foods were flour and flour products (e.g., Mantou, steamed bread, fried dough sticks, and noodles, GI=88) and glutinous rice (GI=87). Foods contributing most to GL in Japan were white rice (54%), white bread (5%), sugar, syrup and preserves (3%); for Chinese foods: flour and flour products (25%), white rice (21%), and baked products (10%).

Conclusion:
With the algorithm we developed, it was feasible to assign GI values to East Asian foods. The composition of top GL contributors is different between China and Japan.
Abstract P189: Acculturation Status is Associated with Selected Plasma Nutrient Biomarkers of Dietary Intake and CVD Risk in Adult Chinese Americans
Authors: Matthan Nirupa R , Yeum Kyung-Jin , Booth Sarah L , Suchday Sonia , Wylie-Rosett Judith , Lichtenstein Alice H
Published: July 2021

The demographic changes anticipated in the U.S. over the next decade magnify the importance of addressing health disparities among minority populations. Chinese Americans are a fast growing minority subgroup, yet there is limited and inconsistent data on the impact of dietary acculturation and subsequent cardiovascular disease (CVD) risk in this population. This discrepancy could be related to the subjective nature of the assessment tools used to collect dietary data along with cultural/linguistic barriers to the implementation of these methods. We hypothesized that higher acculturation status will be associated with dietary patterns that more closely resemble the typical U.S. diet and subsequently with a higher risk of CVD in Chinese Americans (N=225). Dietary intake was evaluated using plasma concentrations of validated objective plasma nutrient biomarkers: phylloquinone for green leafy vegetables/vegetable oils and partially-hydrogenated fat; phospholipid concentrations of 15:0 and 20:4n-6 for dairy and meat, omega 3 for fish,
trans
(18:1n-9T, 18:1n-7T) for partially-hydrogenated fat; carotenoids for fruit and vegetables (F&V) including carotene (green/yellow/orange F&V), cryptoxanthin (orange/red F&V), lutein/zeaxanthin (green leafy vegetables), lycopene (tomatoes, mainly from pizza and pasta sauce); and isoflavones (genistein, diadzein) for soy containing foods. The biomarker data was then correlated with acculturation status (assessed using the Stephenson Multigroup Acculturation scale) as well as the CVD risk factor data. Results (for all r values, p<0.05) indicate that higher dominant culture identification was associated with higher 15:0, 18:1n-7T and lycopene intakes (r=0.11, r=0.14 and r=0.15, respectively), while higher ethnic culture identification was associated with higher plasma phylloquinone (r=0.12) and isoflavone (r=0.34) concentrations. With regard to CVD risk factors, plasma LDL-cholesterol was positively associated with 20:4n-6 (r=0.13) and inversely associated with lutein (r=-0.13) and zeaxanthin (r=-0.12) concentrations. Plasma triglyceride was positively associated with carotene (r=0.14); plasma insulin was also positively associated with carotene (r=0.15), lycopene (r=0.120 and 15:0 (r=0.11); while plasma glucose was positively associated with 18:1n-9T (r=0.16), 18:1n-7T (r=0.12) and zeaxanthin (r=0.20) concentrations. These results indicate that higher acculturation status is associated with dietary patterns that more closely resemble the typical U.S. diet, as reflected by higher concentrations of dietary biomarkers for meat, dairy and tomato based products and partially-hydrogenated fat intake; and lower fruit, vegetable and soy intake and subsequently an unfavorable CVD risk profile.
Abstract P194: Fruit and Vegetable Slows Subclinical Atherosclerosis in Chinese Women
Authors: Ho Suzanne S
Published: July 2021

Objectives:
This study aimed to investigate lifestyle factors, particularly fruit and vegetable intake in the protection against the progression of SA in early postmenopausal Chinese women.

Methods:
This is a community-based 5-year followup study on a cohort of 518 women recruited through random telephone dialing. All were aged 50-64y and within 10 years menopause. Lifestyle and dietary variables based on validated and structured questionnaires, clinical assessments and fasting blood samples were obtained at baseline (T
1
) and 5-year followup (T
2
). A 12.5-MHz linear probe of the HDI 5000 ultrasound scanner was used for measuring intima-media thickness (IMT) at the near and far walls of three 10-mm segments: distal common carotid, bifurcation, proximal internal carotid of both the left and right carotid arteries. The final IMT was the averages of maximum IMT free of atherosclerotic plaques measured at each of the 12 segments. Atherosclerotic plaques defined as a focal wall thickening of at least 1.5mm were also identified along the defined segments. Plaque was graded as: grade 0, no observable plaque; 1, one small plaque <30% of vessel diameter; 2, one medium plaque between 30-50% of vessel diameter or multiple small plaques; 3, one large plaque >50% vessel diameter or multiple plaques with at least one medium plaque. Repeated measurements of IMT and plaque were also obtained at T
2
. Plaque progression was computed by subtracting the plaque index at T
1

from the plaque index at T
2
. The within-sonographer intraclass correlations were 0.83-0.88 for IMT and 0.99 for plaque index, and between sonographer correlations were 0.81-0.88 for IMT, and 0.88- 0.99 for plaque index.

Results:
The five-year followup study of asymptomatic Chinese early postmenopausal women (mean age 61.5 years at T
2
) has revealed a progression of IMT of 2.1 % (standard deviation =1.7) or a progression rate of 0.015 mm/year (standard deviation = 0.013). 25 % were found to have plaque progression (change of plaque index score of ≧1). Besides the traditional CVD risk factors (age, higher values of total cholesterol, systolic and diastolic blood pressure, LDL-cholesterol and triglyceride), multiple regression analysis showed that higher fruit and vegetable intake was a significant (p=0.001) and independent predictor of lower IMT at T
2
. Analysis of the followup data showed that maintenance of high intake of fruit and vegetable (>median) at both T
1
and T
2

was associated with lower IMT at T
2
, even adjusted for the other significant predictors. Similar relationship with plaque progression was also observed.

Conclusion:
This population-based cohort study of Chinese asymptomatic midlife women has identified maintenance of high fruit and vegetable intake tended to reduce the risk of SA.
Abstract P195: Dietary Diversity and Quality, Change in Waist Circumference and Risk of Diabetes in the Multi-Ethnic Study of Atherosclerosis
Authors: de Oliveira Otto Marcia C , Padhye Nikhil S , Bertoni Alain , Jacobs David R , Mozaffarian Dariush
Published: July 2021

Background:
Diet guidelines recommend dietary diversity, but metrics for dietary diversity have not been well defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown.

Aims:
To characterize metrics of dietary diversity and prospectively assess change in waist circumference (WC) and incident diabetes (DM) in a multi-ethnic population; and whether associations were independent of diet quality.

Methods:
Among 5,215 Whites, Hispanic, Blacks, and Chinese age 45-84 y and free of DM at baseline (2000-02), diet was assessed using a validated questionnaire, WC was directly measured, and incident DM defined from fasting glucose and medications. Three separate aspects of diet diversity were characterized: count (different food items eaten >once/week), evenness (Berry index) and dissimilarity (Jaccard distance). Diet quality was characterized using DASH, AHEI, and a priori patterns. Diversity metrics were also separately defined based only on generally healthier or less healthy foods. We evaluated associations with 5 y change in WC using linear regression; and incident DM using Cox models.

Results:
After multivariable adjustment, neither count nor evenness was associated with WC or DM (Table). Higher dissimilarity was associated with gain in WC in Hispanic, Blacks and Chinese, but not Whites; and higher risk of DM in Chinese and Blacks. Most associations were independent of diet quality. No associations were found for diversity metrics defined on strata of only healthier or less healthy foods. Higher diet quality was associated with less WC gain in Hispanics only, and lower risk of DM in Whites and Chinese only.

Conclusion:
Our findings provide little evidence for benefits of dietary diversity for either WC or DM. Greater dissimilarity was actually positively associated with change in WC in most ethnicities. These results support need for greater investigation of role and relevance of diet diversity for metabolic health in diverse populations.
Abstract P196: Unhealthful Dietary Intake Pattern Identified by Reduced Rank Regression is Associated with Increased Arterial Stiffness among Youth with Type 1 Diabetes
Authors: Lamichhane Archana P , Liese Angela D , Urbina Elaine M , Crandell Jamie L , Jaacks Lindsay M , Dabelea Dana , Black Mary Helen , Merchant Anwar T , Mayer-Davis Elizabeth J
Published: July 2021

Introduction:
Youth with type 1 diabetes (T1DM) are at substantially increased risk for adverse vascular outcomes, but little is known about the influence of dietary behavior on cardiovascular disease (CVD) risk profile and outcomes.

Objective:
We applied reduced rank regression (RRR) to identify a specific dietary pattern that explained the maximum amount of variation in CVD risk factors, and was strongly associated with markers of arterial stiffness (AS) in a cohort of youth with T1DM.

Methods:
Baseline diet data from a food frequency questionnaire and CVD risk factors (triglycerides, LDL-cholesterol, systolic blood pressure, hemoglobin A1c, C-reactive protein and waist circumference) were available for 1,153 youth aged ≥10 years with T1DM from the SEARCH for Diabetes in Youth Study. Dietary intake patterns were identified using 33 food-groups as predictors and six CVD risk factors as responses in an RRR analysis. AS outcomes were measured on average 18.9±7.1 months after the baseline diet assessment and were available only in a subset of participants from the SEARCH CVD pilot study. Associations between the RRR-derived dietary pattern explaining the maximum variation in CVD risk factors and AS measures [augmentation index(AIx75),n=229; pulse wave velocity(PWV),n=237; and brachial distensibility(BrachD),n=228] were then assessed using linear regression.

Results:
The RRR-derived pattern of interest was characterized by high intakes of sugar-sweetened beverages (SSB) and diet soda, eggs, potatoes and high-fat meats, and low intakes of sweets/desserts and low-fat dairy; major contributors were SSB and diet soda. This pattern captured the largest variability in the adverse CVD risk profile and was subsequently positively associated with AIx75 in the final model (β=0.47; p<0.01). The mean difference in AIx75 concentration between the highest and the lowest dietary pattern quartiles was 4.3% in fully adjusted model. Associations of the dietary pattern with the other measures of AS, PWV and BrachD, were attenuated and became non-significant after adjustment for potential confounders.

Conclusions:
Intervention strategies to reduce consumption of unhealthful foods and beverages among youth with T1DM may significantly improve CVD risk profile and ultimately reduce the risk for AS. Future studies with larger samples are needed to explore the associations between the derived dietary pattern and other measures of AS (PWV and BrachD), which can provide further insights into possible pathways linking diet to AS in this high risk population.
Abstract P198: Cumulative Abdominal Obese-Years and Arterial Stiffness in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Palta Priya , Snyder Michelle , Tanaka Hirofumi , Aguilar David , Agarwal Sunil K , Heiss Gerardo
Published: July 2021

Introduction:
Arterial stiffness quantifies subclinical cardiovascular disease (CVD) and is predictive of athero-thrombotic events and mortality. Time-cumulative measures of obesity may more accurately estimate the lifetime burden of CVD due to obesity by accounting for both duration and intensity. Compared to generalized obesity, abdominal obesity is more consistently associated with vascular outcomes and, specifically, arterial stiffness. We examined whether 20-year cumulative abdominal obese-years is associated with greater arterial stiffness in older adults.

Methods:
We analyzed 5,177 participants from the ARIC cohort. Cumulative abdominal obesity was defined as the product of waist circumference units above the conventional cutpoints for obesity, 88 cm for women and 102 cm for men, and the years of exposure to that waist circumference. This accounts for obesity exposure over 20 years from the five ARIC visits. Arterial stiffness was measured by pulse wave velocity (PWV) at the fifth ARIC visit. Measures of PWV obtained include: carotid-femoral PWV (cfPWV), brachial-ankle PWV (baPWV), and segment-specific measures [heart-femoral (hfPWV) and femoral-ankle (faPWV)]. Multivariable linear regression, adjusted for age, sex, race, systolic blood pressure and smoking, was used to quantify the change in PWV (cm/s) per unit increase in cumulative abdominal obese-years. Subsidiary analyses examined visit five waist circumference. Hypertension and diabetes were explored as effect modifiers.

Results:
Among the 5,177 participants (mean age: 75, 43% male, 21% African-American), 66% had cumulative abdominal obese-years greater than zero (range: 1-1595), while 34% were not abdominally obese across any ARIC visit and thus had zero cumulative abdominal obese-years. Participants with higher cumulative abdominal obese-years were more often male, African-American and had a history of diabetes and hypertension. Cumulative abdominal obese-years were associated with lower baPWV (beta=-0.19, 95% CI: -0.23, -0.14), lower faPWV (beta=-0.12, 95% CI: -0.15, -0.09) and lower hfPWV (beta=-0.06, 95% CI: -0.10, -0.03). There was no significant association with cfPWV (beta=-0.03, 95% CI: -0.08, 0.01). The cross-sectional association between visit five abdominal circumference and PWV were similar in magnitude to cumulative abdominal obese-years. Hypertension and diabetes did not modify these associations.

Conclusions:
We observed an inverse association between cumulative exposure to abdominal fat and arterial stiffness in older adults. Survivor bias or the role of sarcopenia may explain these findings.The association of fat deposits with subclinical vascular disease in older adults deserves careful evaluation. Estimation of long-term exposure to abdominal obesity did not reveal associations with arterial stiffness beyond a cross-sectional assessment of abdominal obesity.
Abstract P201: Cardiovascular Risk Factor Patterns And Their Associations With Total And Abdominal Obesity In Children Referred To A Cardiology Clinic
Authors: de Koning Lawrence , Denhoff Erica , Kellogg Mark D , de Ferranti Sarah D
Published: July 2021

Background:
Excess adipose tissue is associated with abnormal lipids, glucose, blood pressure, and inflammatory factors. In children, body mass index percentiles (BMI%) are commonly used to define adiposity. Although waist circumference percentiles (WC%) have not been universally accepted, they may better reflect visceral fat. The objective of this study was to determine the relationship between BMI% and WC% in identifying risk factor patterns in children at risk for developing cardiovascular disease.

Methods:
Children (8-19y free of major disorders and medications) with obesity, hypertension, lipid disorders, and/or a family history of premature cardiovascular disease (< 55 years in male and <65 years in female first-degree relatives) were recruited from the Preventive Cardiology clinic at Boston Children’s Hospital (n=150). Lifestyle (physical activity, screen time, tobacco exposure), anthropomorphic (height, weight, WC) and blood pressure (SBP, DBP) measures were made, as well as fasting lipids (total cholesterol, HDL, triglycerides (TG), LDL, VLDL) and inflammatory markers (hs-CRP, ICAM-1, P-selectin, and TNFαR2) from a serum sample. Principal component analysis (PCA) with varimax rotation was used to identify independent patterns explaining risk factor variance. Quintiles of pattern scores were associated with BMI% and WC% using multiple linear regression.

Results:
PCA identified 4 patterns: lipid (low HDL, high TG and LDL), inflammatory (high ICAM and TNFαR2), blood pressure (high SBP and DBP) and Lp(a) [high Lp(a)]. BMI% was significantly associated with higher levels of the lipid and blood pressure patterns (p<0.03), explaining 15.8% and 4.7% of variance (partial r2) respectively. A higher WC% was associated with significantly higher levels of the lipid pattern (p<0.001), explaining 16.2% of variance. When both BMI% and WC% were used together, neither BMI% nor WC% remained associated with the lipid pattern;, however, BMI% was inversely associated (p=0.02) and WC% positively associated (p=0.01) with the inflammatory pattern. The combined use of BMI and WC explained 12.2% of variance in the inflammatory pattern.

Conclusion:
In a sample of high-risk children, BMI% or WC% explained similar variance in lipid levels; however, the combined use of BMI% (representing lean body mass) and WC% (representing abdominal fat) together explained greater variance in elevated inflammatory factors than either alone. This suggests that using WC% along with BMI% may contribute to cardiovascular risk assessments of high-risk children.
Abstract P203: Demographic Predictors of Long-term Weight Loss Beginning One-Year After Bariatric Surgery at Two Medical Centers
Authors: Rasmussen-Torvik Laura , Baldridge Abigail , Pacheco Jennifer , Aufox Sharon , Kim Kwang-Young , Silverstein Jonathan , Denham Erwin , Hungness Eric , Smith Maureen , Greenland Philip
Published: July 2021

Objective:
Existing studies of predictors of weight loss after bariatric surgery suffer from simplistic statistical methods and relatively short follow-up. We sought to determine predictors of long-term weight loss up to 9.6 years after bariatric surgery using data extracted from two electronic health records (EHR) systems and linear mixed effects models.

Methods:
Participants were selected from patients enrolled in the NUgene biorepository at either Northwestern Memorial HealthCare or NorthShore University HealthSystem. Individuals who had undergone Roux-en-Y gastric bypass (RNY) were identified through billing or surgical history procedure codes in the electronic health records (EHRs). All available weight measurements and dates were extracted from the EHR as well as surgery date. Sex, race/ethnicity, education, marital status, and height were taken from the NUgene intake questionnaire. SAS PROC MIXED was used to create linear mixed effects models to examine weight loss from 1- 9.6 years post-surgery. To examine overall weight loss and slope of weight regain, covariates and covariate interactions with time post-surgery were included in the mixed effects models.

Results:
119 individuals from Northwestern and 43 individuals from NorthShore had undergone gastric bypass and had at least 1 weight measurement 1 year post-surgery. There were 3071 weight measurements which occurred at least 1 year post-surgery in the dataset; the median number of observations per person was 10 and the median weight loss represented by these measurements was 32.7% from pre-surgical weight. The regression model indicated that, on average, individuals experienced slight weight regain of about 0.8% of pre-surgical weight per year after their first year post-surgery. Over the 1- 10 years of follow up African Americans lost nearly 5 percentage points less weight than whites ( p =.0025) . People who were older and taller also experienced less percentage weight loss, and people with higher initial weights experienced a higher percentage weight loss (all p <.05), Older age was associated with significantly (p<0.05) slower weight regain after 1 year post-surgery.

Discussion:
EHR records from multiple institutions can be integrated to study outcomes after bariatric surgery. Demographic factors predict overall weight loss and a rate of weight regain after 1 year post RNY surgery. This information may be useful for both surgeons and prospective patients.
Abstract P207: Sociodemographic Predictors of Overweight or Obese Incidence Among Normal Weight 18-Year Olds
Authors: Young Deborah R , Koebnick Corinna , Hsu Jin-Win
Published: July 2021

The transition from adolescence to adulthood is associated with increased risk for excess weight gain. Transitioning adults are relatively difficult to study, however, because unless they matriculate to secondary education there are few opportunities to track them. Thus, demographic and socioeconomic factors associated with overweight obesity are not well-documented, much less so among adolescents who have maintained normal weight throughout adolescence. We examined the incidence of overweight and obesity among 10,723 healthy, normal weight (body mass index [BMI] < 25 kg/m
2
)18-year olds in 2008 who remained members of Kaiser Permanente Southern California through 2012. Sex, race/ethnicity, height, and weight were recorded in electronic medical records; BMI was calculated. Neighborhood education was determined from US 2000 Census block group data, and quartiles defined by the proportion of adults with an education below high school. We followed 3,677 men (BMI: 21.5±1.96) and 7,046 women (BMI: 21.2±2.0). Relative risks (RR) and 95% confidence intervals (CI) were determined controlling for sex, race/ethnicity, neighborhood education, and smoking history. During 34,660 person-years of follow-up (mean 3.23±1.34 years), we documented 2,672 incident cases of overweight (24.9%) and 237 of obesity (2.2%). The RR of overweight was 1.25 (95% CI: 1.13, 1.38) in the lowest quartile of neighborhood education compared with the highest quartile (test for trend p=0.001). The RR for obesity was 1.50 (95% CI: 1.00, 2.25; test for trend p=0.025). While women were less likely to become overweight than men (RR 0.88, 95% CI: 0.82, 0.94), they were twice as likely to become obese (RR: 1.99, 95% CI: 1.45, 2.72). Hispanics had greater risk of overweight (RR: 1.09, 95% CI: 1.00, 1.18) and Blacks had greater risk of obesity (RR: 1.46, 95% CI: 1.00, 2.15) than non-Hispanic whites. Compared with their non-Hispanic white peers, Asians had lower risk of overweight and obesity (RR: 0.79, 95% CI: 0.67, 0.93 and RR: 0.46, 95% CI: 0.21, 0.99, respectively). In conclusion, normal weight adolescents are at risk for becoming overweight as they transition to adulthood. Sociodemographic factors predict incidence of overweight and obesity. Women and Blacks are at particular risk for excessive weight gain trajectories.
Abstract P208: Changes in metabolic profiles among evacuees after the Great East Japan Earthquake: the Fukushima Health Management Survey
Authors: Ohira Tetsuya , Hosoya Mitsuaki , Yasumura Seiji , Sato Hiroaki , Suzuki Hitoshi , Sakai Akira , Ohtsuru Akira , Kobashi Gen , Ozasa Kotaro , Kamiya Kenji , Yamashita Shunichi , Abe Masafumi ,   The Fukushima Health Management Survey Group
Published: July 2021

Background:
The Great East Japan Earthquake occurred on 11 March 2011 in Japan. To this day, over 140,000 people have been forced to evacuate their homes due to a nuclear accident, which occurred at the Fukushima Daiichi Nuclear Power Plant.

Hypothesis:
We assessed the hypothesis that prevalence of obesity, hypertension, dyslipidemia, and diabetes mellitus was increased among evacuees after the disaster, compared with that before the disaster.

Methods:
A prospective study of Japanese subjects aged 40-90 years was undertaken using data collected from 32,949 participants (14,963 men and 17,986 women) in general health checkups conducted in 12 communities, including the evacuation zone specified by the government, between 2008 and 2010. Height, body weight, blood pressure, and blood test such as glucose, hemoglobin A1c (HbA1c), and lipid panel were examined. Follow-up examination was conducted between 2011 and 2012 (at least of 6-month after the disaster). The participants were divided into two groups: evacuees and non-evacuees. Changes in metabolic profiles among the evacuees and non-evacuees were compared between before and after the disaster.

Results:
22,117 participants (10,170 men and 11,947 women, follow-up rate: 67%) received follow-up examination after the disaster, and an average follow up was 1.5-years. Mean levels of body weight were significantly increased in the both evacuee and non-evacuee groups after the disaster, and changes in body weight and body mass index were greater in the evacuee group than those in the non-evacuee group; +1.3kg versus +0.3kg, p<0.001, and +0.60kg/m
2
versus +0.13kg/m
2
, p<0.001. In the evacuee group, prevalence of obesity, hypertension, dyslipidemia, and diabetes mellitus was increased after the disaster. Respective prevalence before and after the disaster were 31.8% and 39.4% for obesity (body mass index>=25.0kg/m
2
), 54.2% and 60.2% for hypertension, 41.2% and 53.9% for dyslipidemia, and 10.2% and 11.9% for diabetes mellitus, while, in the non-evacuee group, those were 28.3% and 30.3%, 54.7% and 60.0%, 42.6% and 49.4%, and 8.5% and 9.9%.

Conclusions:
Prevalence of obesity, hypertension, dyslipidemia, and diabetes mellitus may be increased among residents, especially evacuees, in the evacuation zone of Fukushima prefecture after the Great East Japan Earthquake.
Abstract P209: Which Comes First, Type 2 Diabetes (T2DM) or Hypertension?
Authors: Masuo Kazuko , Lambert Gavin W
Published: July 2021

Objectives:
It is well demonstrated that there is a higher prevalence of hypertension (HT) in patients with type 2 diabetes (T2DM) than non-DM individuals as well as higher prevalence of DM in HT than normotensives (NT). However, it has not been clarified which of DM or HT leads to other, and what mechanisms may play a major role.

Methods:
In the present study, we compared neurohormonal parameters in the following 4 groups in weight loss (WL) program with a mild calorie restriction and exercise over 12 weeks; 53 obese NT without DM, 44 NT with T2DM, 68 HT without DM, and 43 HT with T2DM. HT and T2DM were all diagnosed in the last 3 months and none had medications. At entry period, the 4 groups were strictly matched in BMI and in BP. They were measured BMI, total body fat-mass, waist/hip ratio (W/H), BP, PR, HbA
1c
, fasting glucose, insulin (HOMA-IR), norepinephrine (NE) and leptin (LEP) at entry, 4 and 12 weeks.

Results:
At entry, fat-mass was greater in subjects with T2DM than non-DM in both NT and HT and HT had slightly greater fat-mass than NT, although BMI were strictly matched in the 4 study groups. HbA
1c
in T2DM was greater than non-DM, and slightly greater in HT than NT. Fasting insulin was greater in HT and T2DM than NT or non-DM, and HOMA-IR was slightly greater in HT than NT and significantly greater in T2DM than non-DM. LEP was similar between NT and HT, but it was greater in T2DM than non-DM. (HbA
1c
, HT with T2DM>NT with T2DM>>HT without DM>NT without DM; Insulin, HT with T2DM>NT with T2DM>>HT without DM>NT without DM; NE, HT with T2DM>>HT without DM≥NT with T2DM>>NT without DM; LEP, HT with T2DM≈NT with T2DM>>HT without DM>NT without DM). WL over 12 wks in HT and T2DM were smaller than those in NT or non-DM. At 12 weeks, in HT groups regardless of T2DM, percent (%) decreases in plasma NE and BP, and reductions in HbA
1c
were smaller than those in NT groups, although reductions in fat-mass and leptin were similar. In T2DM groups regardless of BP levels at entry, reductions in BMI, BP, HbA
1c
, HOMA-IR and NE were smaller than those in non-DM group. In the 4 groups, reductions in plasma NE was observed at first followed by reductions in HOMA-IR, HbA
1c,
BMI and BP over 12 weeks.

Conclusions:
These findings demonstrate that insulin resistance (IR) may play an important role on the onset of T2DM and high plasma NE appears to cause HT. HT had resistance to normalized high plasma NE and %reductions in NE, and T2DM had resistance to normalize IR and sympathetic overactivity. We previously reported that high plasma NE could predict future weight gain and BP elevation, and high NE preceded IR in non-obese subjects. Taken together, sympathetic overactivity observed in high NE may cause obesity and HT, and then IR seems to start with weight gain leading T2DM, suggesting that HT may lead to T2DM with this mechanisms.