bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P066: Consumption of a Greater Variety of Healthful Foods is Associated with Metabolic Syndrome and its Components in U.S. Adults
Authors: Vadiveloo Maya , Parekh Niyati , Mattei Josiemer
Published: July 2021

Introduction:
Consuming a wider variety of nutrient-dense foods may promote adherence to more healthful dietary patterns and enhance metabolic health by improving dietary quality. To examine these associations, we developed the U.S. Healthy Food Diversity (HFD) index to measure dietary variety alongside dietary quality and proportionality.

Hypothesis:
We assessed the hypothesis that greater diversity within healthful foods would be protective against metabolic syndrome and its components.

Methods:
A representative sample of non-pregnant, non-lactating adults ages 20+y with two 24-hour recalls and complete fasting biochemical data from the cross-sectional National Health and Nutrition Examination Survey 2003-2006 were selected (n=3,089). Associations between the U.S. HFD, metabolic syndrome, and its components were assessed across U.S. HFD tertiles. The U.S. HFD was generated from dietary recall data and the MyPyramid Equivalent database using a previously validated equation. The index ranges from 0 to nearly 1, with higher scores indicative of more varied diets with a higher proportion healthful food groups. Metabolic syndrome was defined using both the International Diabetes Federation (IDF) and the Adult Treatment Panel (ATP) III criteria based on biochemical parameters, anthropometrics, and self-reported medication. Fasting weights were used to analyze biochemical data and 2-day dietary weights were used in the remaining analyses. Survey-weighted multivariable linear and logistic regression adjusted for demographic factors, smoking, energy, screen time, and leisure activity were used to compute beta coefficients, odds ratios(OR) and 95% confidence intervals(CI).

Results:
The odds of metabolic syndrome were lowered by nearly 40% in men and women using both the IDF (OR:0.65; 95%CI:0.51-0.83) and ATP III criteria (OR:0.63; 95%CI:0.49-0.80) after multivariable adjustment. Compared to the first tertile, adults in tertile 3 had a lower age- and sex-adjusted odds of impaired fasting glucose (OR:0.79; 95%CI:0.65-0.95) and hypertension (OR:0.81; 95%CI:0.68-0.96). In all models, the odds of reduced HDL and abdominal obesity were 22-33% lower in the highest vs. lowest tertile (p-trend<0.05). Fasting glucose (age- and sex-adjusted), blood pressure, and waist circumference were also lowered across U.S. HFD tertiles following multivariable adjustment in continuous linear regression models.

Conclusion:
In conclusion, the odds of metabolic syndrome defined using IDF and ATP III criteria were lower across U.S. HFD tertiles and some metabolic parameters improved with greater consumption of a variety of healthful foods. This study provides preliminary evidence that diversity within healthful foods may be protective against metabolic syndrome and highlights the need for future research using longitudinal and experimental study designs.
Abstract P068: Soda Consumption and Biomarkers of Cardiovascular Risk in Mexican Women
Authors: Tamez Martha , López-Ridaura Ruy , Monge Adriana , Romieu Isabelle , Rinaldi Sabina , Yunes Elsa , Blanco Margarita , Lajous Martin
Published: July 2021

Background:
Soda consumption is associated with type 2 diabetes and cardiovascular disease. Few studies have investigated the relation between sugar-sweetened and artificially sweetened soda consumption and cardiovascular risk biomarkers.

Methods:
We evaluated the cross-sectional association between sugar-sweetened and artificially sweetened soda consumption and biomarkers of cardiovascular risk in 874 Mexican women from the Mexican Teachers’ Cohort study. We collected information on habitual consumption (never to ≥6 times per day) of a standard 12 oz serving (1 glass, can, or bottle) of sugar-sweetened and artificially sweetened sodas through a food frequency questionnaire. Plasma concentrations of biomarkers were measured by standard methods. Geometric means were calculated where appropriate.

We used multivariable linear regression models to assess the associations of sugar-sweetened and artificially sweetened soda consumption with CRP, C-peptide, leptin, adiponectin, glucose, HDL-c, LDL-c, total cholesterol and triglycerides. Models were adjusted for age, BMI, physical activity, smoking, menopause, alcohol, family history of coronary heart disease and batches.

Results:
Per 12 oz serving/d of sugar-sweetened soda consumption, CRP was 1.07 mg/dL higher (95% CI 1.03 to 1.17), triglycerides were 10.3 mg/dL higher (95% CI 2.2 to 20.4), and adiponectin was 115 ng/mL lower (95% CI -122 to -107). Per 12 oz serving/d of artificially sweetened soda consumption, C-peptide was 0.18 ng/mL lower (95% CI -0.32 to -0.02) (Table 1).

Conclusions:
Intake of sugar-sweetened but not artificially sweetened sodas was significantly associated with increased plasma CRP and triglycerides, and decreased adiponectin. Artificially sweetened soda consumption was significantly associated with lower C-peptide.
Abstract P069: Quantifying the UK Benefits of reducing dietary trans fats: Modelling study
Authors: Pearson-Stuttard Jonathan , Critchley Julia , Capewell Simon , O'Flaherty Martin
Published: July 2021

Introduction:
Coronary Heart Disease (CHD) disease remains a leading cause of UK mortality, generating a large and unequal burden of disease. Dietary trans-fats represent a powerful CHD risk factor. However, UK efforts to reduce the dietary intake of trans-fats (currently 1% of daily energy) have been limited in comparison with some other nations. Furthermore, quantifying the potential outcomes of such measures, and the effects on health inequalities has rarely been researched. We therefore modelled the effect of specific reductions in trans fatty acid (TFA) intake on CHD mortality, CHD related admissions and its effect on socioeconomic inequalities up to 2030.

Methods:
We extended the previously validated IMPACT model, to estimate the potential effects of reductions in TFA intake by 1% and 0.5% of daily energy upon the England and Wales population aged 25 years and above. We stratified these estimates by age, sex and Socioeconomic circumstances(SEC). We estimated a reduction in expected CHD deaths in 2030 attributable to a modest reduction in TF intake (-0.5% energy) and a complete ban (-1% energy). Main output measures were deaths prevented or postponed (DPP), life years gained (LYGs) and hospital admissions.

Results:
Reducing trans-fat consumption in the English and Welsh population by 1% of daily energy intake would result in approximately 3,900 fewer deaths per year; 10,000 fewer hospital admissions; and 37,000 additional life years. Smaller TFA reductions of 0.5% would yield approximately 1,900 fewer deaths, 5,000 fewer hospital admissions, and gain approximately 18,000 life years.

Further, reducing trans-fats consumption to 0.5% across all SECs would reduce health inequalities. Three times as many DPPs and LYGs would be observed in the most deprived compared with the most affluent groups.

Conclusions:
Reducing dietary trans-fat intakes could substantially decrease CHD mortality and hospital admissions, gaining thousands of life years. Crucially, this policy could also reduce health inequalities. Strategies should therefore aim to achieve the lowest possible trans-fats intakes, as successfully achieved in many other European countries. However, such policies currently remain underused in the UK, generating an avoidable and unequal burden on the health services and on society.
Abstract P078: Effects Of Individual Dietary Factors On Metabolic Risks Within The Context Of Overall Dietary Patterns: A Systematic Review And Meta-analysis
Authors: Singh Gitanjali M , de Oliveira Otto Marcia C , Mozaffarian Dariush
Published: July 2021

Background:
Effects of dietary factors on cardiometabolic risk are often studied in isolation. Yet, multiple dietary components are often consumed together, which may alter effects of individual dietary factors.

Objective:
To quantify effects of 7 diet components (fruits, vegetables, nuts/seeds, whole grains, fish, dietary fiber) when consumed within the context of overall dietary patterns on major metabolic risks.

Methods:
Using MOOSE and PRISMA guidelines, we systematically searched multiple databases to identify randomized controlled feeding studies evaluating effects of diet patterns on cardiometabolic risk factors. We focused on trials evaluating major diet patterns that included fruits, vegetables, nuts/seeds, whole grains, fish, and dietary fiber as major components and tested effects on BP, lipids, BMI or waist circumference, or glucose-insulin homeostasis (fasting glucose, HbA1c, oral glucose tolerance test, postprandial glucose, fasting insulin). Studies were excluded if <4 weeks, utilized diet advice rather than feeding, involved other major interventions, relied on self-reported outcomes, or included only patients with cachectic or end-stage disease. Multivariate inverse-variance weighted meta-regression estimated the pooled effects of individual diet components, when consumed together, on cardiometabolic risks.

Results:
Meta-regression analyses of 6 intervention arms in 3 large dietary pattern trials demonstrated significant effects of several individual components (Table) Pooled results including additional dietary pattern trials and results for adiposity and glucose/insulin homeostasis are to be shown.

Conclusions:
This systematic assessment quantifies the impact of individual dietary factors on cardiometabolic risks within the context of overall diet patterns, more accurately reflecting complementary effects of multiple components and informing magnitudes of benefits for preventive policies and interventions.
Abstract P082: Estimating Equation for Computed Tomography Derived Visceral Fat: The Multi-Ethnic Study of Atherosclerosis
Authors: Mongraw-Chaffin Morgana L , Woodward Mark , Allison Matthew A , Golden Sherita H , Kronmal Richard , Ouyang Pamela , Szklo Moyses , Anderson Cheryl A
Published: July 2021

Background:
The only way to determine visceral fat separately from subcutaneous fat is through magnetic resonance imaging (MRI) or computed tomography (CT) scans. The use of MRI or CT scans is unacceptable for screening in the general population. Given this, estimating equations for visceral fat that use commonly collected clinical variables have potential utility.

Methods:
Data are from 1842 participants, aged 45 to 84, from the Multi-Ethnic Study of Atherosclerosis with visceral fat assessed by CT scan at study visit 2 or 3, and anthropometry measured at matched visits. We excluded 19 participants with reported thiazolidinedione use, 11 with waist circumference greater than 140cm, and 5 with BMI greater than 45kg/m
2
. Visceral fat area, measured in cm
2
, was calculated as the average area from two CT scan slices at the L4/L5 vertebrae. Visceral fat was naturally log transformed to account for non-normality. Anthropometric indices included: height(cm), weight(kg), BMI(kg/m
2
), waist circumference(cm), hip circumference(cm), waist to hip ratio, and waist to height ratio. Other variables included sex, Black, Asian, and Hispanic race/ethnicities, and age. Data were separated into training and testing datasets containing 2/3 and 1/3 of the data, respectively. Multivariable linear models were used to generate coefficients for the estimating equations and included non-linear and interaction terms. The PRESS statistic, R
2
, and RMSE were used to determine goodness of fit and likelihood ratio tests were used for variable and model selection.

Results:
Models including multiple measures of anthropometry performed better than models including only waist circumference or BMI. Models including non-linear terms for anthropometry and interaction by sex and race performed better than simple linear models. After analysis, the final estimating equation was: Ln Visceral Fat = -8.64 + 0.006*age - 8.42*sex - 8.53*black - 0.099*weight + 0.41*bmi + 0.022*waist + 0.029*hip + 8.58*waist/hip - 0.00396*bmi
2
+0.00015*waist
2
- 0.0003*hip
2
- 4.89*(waist/hip)
2
- 0.014*weight*sex - 0.066*waist*sex + 0.076*hip*sex + 8.57*(waist/hip)*sex - 0.097*waist*black + 0.088*hip*black + 10.31*(waist/hip)*black. The R
2
in the testing dataset for this model was 0.62. The estimates of visceral fat from the final equation provided estimates within 10% of measured values for nearly 90% of the observations.

Conclusion:
Our final model, that predicts visceral fat from CT scans, is highly parsimonious involving only seven variables that can be easily collected in the clinical setting. This practical equation might help improve the estimation of visceral fat in order to determine who is at greatest risk for CVD and who might benefit most from weight loss interventions.
Abstract P084: Influence Of Amount And Rapidity Of Weight Loss On The Risk Of Subsequently Regaining Weight And Drop-out From Treatment Among Patients With Severe Obesity Dieting In Hospital Without Bariatric Surgery
Authors: Yamada Tomohide , Hara Kazuo , Kadowaki Takashi
Published: July 2021

Although many obese patients with type 2 diabetes lose weight by dieting, most subsequently regain it. We performed a retrospective cohort analysis to assess the influence of the amount and rapidity of weight loss during hospitalization on the risk of subsequently regaining weight and stopping treatment in patients with severe obesity who dieted without bariatric surgery.

A total of 131 severely obese patients (48±14 years old; BMI: 41.7±8.8; 75% with diabetes) received inpatient treatment that included diet, exercise, behavioral modification (charting weight four times daily), and educational seminars, and were followed after discharge. Regaining weight and drop-out were defined as returning to baseline body weight and failing to keep outpatient appointments, respectively.

Patients lost an average of 5.3±3.0kg (4.9±2.4%) in hospital (mean: 19 days). Over the median 2-year follow-up period, unadjusted analysis showed that patients with >3% weight loss in hospital had significantly less risk of regaining weight than patients losing≤3%. The risk decreased further with greater weight loss (>7% loss; hazard ratio (HR):0.06; 95% confidence interval:0.007-0.47).

Adjusted analysis revealed that >5% weight loss was associated with significantly less risk of regaining weight after adjustment for age, sex, BMI, smoke, diabetes, insulin, sulfonylurea, antidepressant medication, and duration of hospitalization (>7% loss; HR 0.04(0.004-0.36, p=0.004), 7%≥loss>5%; HR 0.3(0.11-0.85, p=0.02)).

No significant relation was observed between weight loss and drop-out. Among patients with >3% weight loss during hospitalization, rapid weight loss (>3% within 7 days) did not increase the risk of subsequently regaining weight compared with patients showing slower weight loss.

In conclusion, achieving >5% weight loss during comparatively brief hospitalization predicts subsequent maintenance of lower weight. Experiencing success in hospital might increase the motivation of obese patients.
Abstract P086: Urbanization and Geographic Variation of Overweight/Obesity in India: the 2005-06 India Demographic Health Survey
Authors: Siddiqui Saad T , Kandala Ngianga-Bakwin , Stranges Saverio
Published: July 2021

Background:
Obesity and overweight are considered to be the fifth leading risk factor for deaths worldwide. In India, the prevalence of overweight and obesity is growing, along with an ongoing nutritional transition as more people adopt urban lifestyles or migrate to urban areas for economic opportunities.

Objective:
This study examined the geographic variation of overweight/obesity in India, as well as a wide range of potential risk factors and correlates of overweight-obesity, including socio-demographics and level of urbanization.

Methods:
We conducted cross-sectional analyses of the 2005-06 India Demographic Health Survey (DHS), using anthropometric data from 161,050 individuals to determine prevalence of obesity and overweight, and demographics with regards to urban or rural settings. We then used a multivariate logistic regression model to determine the odds of combined overweight and obesity in urban settings as adjusted for age, sex, education level, standard of living, religion and zone for 111,730 individuals (after excluding underweight subjects [BMI < 18.5] and missing cases) for India overall, and then for each zone separately.

Results:
The overall prevalence of combined overweight/obesity (BMI ≥ 25) was 15.5%. The odds of overweight/obesity in urban settings after adjusting for confounders as age, sex, education level, standard of living, religion and zone were nearly twice that of rural settings (OR 1.95, 95% CI: 1.88-2.02). We also found significant associations between overweight/obesity and higher education (OR 2.11 95% CI: 2.62-2.87), and higher standard of living (OR 6.71 95% CI: 6.25-7.21). Individuals from the southern zone were most likely to be overweight/obese when compared to the northern zone in multivariate analyses (OR 1.44, 95% CI: 1.36-1.52). While urban settings were consistently and significantly associated with higher risks of overweight/obesity across all zones, the risk was highest for individuals from the eastern zone (OR 2.57, 95% CI: 2.30-2.87).

Conclusions:
The results demonstrate significant associations between overweight/obesity and urbanization in India, with high risk estimates for overweight/obesity in urban settings even for the least urban zones. Socioeconomic prowess and the resulting nutritional transition in India make a compelling case for administrative policy on nutrition and healthy lifestyles to avert future burden of non-communicable diseases associated with overweight/obesity.
Abstract P095: Preterm Delivery and Incident Metabolic Syndrome: A 25-year Prospective Study of CARDIA Women
Authors: Catov Janet M , Althouse Andrew , Lewis Cora , Goswami Upasna , Harville Emily , Gunderson Erica
Published: July 2021

Introduction:
Women who deliver preterm births have excess risk for cardiovascular disease and diabetes later in life, perhaps related to metabolic dysregulation. Previous studies, however, have not evaluated how the pre-pregnancy metabolic status, other pregnancy characteristics and post pregnancy weight gain may be involved.

Hypothesis:
We hypothesized that women who delivered preterm births would have excess risk of incident metabolic syndrome (MetS) compared to women with term births independent of their pre-pregnancy metabolic profile, parity and other risk factors.

Methods:
We studied 1,246 women (50% Black; 624 of 1,246) in the Coronary Artery Risk Development in Young Adults (CARDIA study) who had at least one singleton birth between baseline (1985-1986) and year 25, and no MetS before pregnancy. Blood pressure, lipids, and anthropometrics were measured at baseline and at up to 7 subsequent exams. We ascertained incident MetS cases using the National Cholesterol Education Program Adult Treatment Panel III criteria and estimated the relative hazards (RH) of MetS in women with 1 or more preterm births (<37 weeks, n=306) versus 1 (n=558) and 2 or more (n=382) term births (≥37 weeks) using complementary log-log models adjusted for race, age, education, smoking, time-varying parity and pre-pregnancy metabolic syndrome components. Gestational diabetes mellitus (GDM), self-reported hypertension during pregnancy, and time dependent weight gain were considered as potential mediators.

Results:
Of 338 incident MetS cases in 17,212 person years, the crude incidence rate among women with preterm birth was higher than among those with 1, but not 2 or more term births (24.2, 14.4, and 32.2, respectively). After adjustment for covariates, however, including time-varying parity, the adjusted RH (95%CI) for incident MetS was 1.89 (1.24, 2.89) for women with preterm vs. term births. Additional adjustment for GDM or hypertension during pregnancy only modestly affected this estimate, but accounting for time-varying weight gain attenuated it to be non-significant (adj HR 1.42 (0.92, 2.21). Increased waist circumference (18.1 ± 12.3 vs. 15.9 ± 11.9 cm, p<0.01) and increased systolic blood pressure (13.6 ± 18.3 vs. 6.6 ± 12.5 mmHg, p<0.01) were the MetS components that changed the most from baseline to year 25 among women with preterm vs. term births.

Conclusions:
In conclusion, women with a history of preterm birth have an almost two-fold increased risk of incident MetS compared to those with term births after 25 years of follow up. This was independent of the pre-pregnancy metabolic status, other complications and time dependent parity. It was explained, in part, by post pregnancy weight gain.
Abstract P109: The Cross-sectional and Longitudinal Association of Dispositional Optimism with Sleep Duration and Quality: Findings form the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Hernandez Rosalba , Vu Thanh-Huyen T , Kershaw Kiarri N , Carnethon Mercedes , Knutson Kristen L , Colangelo Laura , Liu Kiang
Published: July 2021

Background:
Sleep disturbance is associated with multiple adverse cardiovascular-related health outcomes. Little is known about the relationship between psychological well-being, an independent modifiable risk factor for cardiovascular disease, and sleep disruptions. This study examines cross-sectional and longitudinal associations of optimism with sleep duration and quality.

Methods:
Data were collected from 3,549 Black and White adults aged 33-45 years who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study during follow-up years 15 (2000-2001) and 20 (2005-2006). Optimism was assessed in 2000-2001 using the Life-Orientation Test—Revised, with possible scores ranging from 6 (least optimistic) to 30 (most optimistic). Single-item questions on sleep quality and duration in the past month were assessed during 2000-2001 and 2005-2006. Cross-sectional analyses considered optimism and sleep measures at follow-up year 15. Longitudinal analyses considered 5-year incidence of poor sleep quality (fairly/very bad) and duration (short/long sleep) in 2005-2006 by optimism in 2000-2001 (participants with poor sleep quality and duration in 2000-2001 were excluded).

Results:
Among 3,549 participants (56% female, 46% Black) with complete data on optimism in 2000-2001, 15.9% reported fairly/very bad sleep quality. Sleep duration was distributed as follows: short-sleep (47.9%), sufficient sleep (31.6%), and long-sleep (20.5%). In unadjusted and fully adjusted models, a 1-unit higher optimism score was cross-sectionally associated with 11% lower odds of having fairly/very bad sleep quality and 3-5% lower odds of having short-sleep duration (Table 1). Cross-sectional associations were attenuated after adjustment for depressive symptoms (not shown). Incidence of poor sleep quality in 2005-2006 was 7% lower with each unit higher optimism score, after full adjustment.

Conclusion:
Optimism is associated with lower incidence of poor self-reported sleep quality over a 5-year period.
Abstract P112: Association between sleep duration and serum lipid levels in an elderly Korean population: The Korean Urban and Rural Elderly (KURE) Study
Authors: Choi Hansol , Lee Ju-Mi , Youm YooSik , Rhee Yumie , Kim Chang Oh , Kim Hyeon Chang
Published: July 2021

Importance:
Sleep duration has been considered as a risk factor for cardiometabolic disease and mortality. Several studies suggest that sleep duration can influence the serum lipid levels, but the association remains unclear.

Objective:
The aim of present study is to assess the association of sleep duration with serum lipid levels in an elderly Korean population.

Methods:
The KURE study is a cohort study to investigate risk factors for major disorders of the elderly. This cross-sectional analysis was conducted among 926 participants (302 men and 624 women aged 64-87 years) who completed baseline health examination in 2012. Sleep duration was measured by the interviewer-assisted questionnaire. Habitual sleep time was calculated based on the response to the questions about hour of bedtime, hour of rising, and hours of nap during the passing year. Total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol concentrations in serum were measured from overnight fasting blood samples. Low density lipoprotein (LDL) cholesterol was calculated from total cholesterol, HDL cholesterol and triglyceride levels using Friedewald’s formula. Multiple linear regression models were conducted to examine whether sleep duration was associated with serum lipid levels.

Results:
Sleep duration was not significantly associated with total cholesterol (β=-0.154mg/dL per sleep hour,
p
=0.843), triglyceride (β=-1.000,
p
=0.506) and LDL cholesterol (β=0.678,
p
=0.339) after adjusting for age, sex, body mass index, systolic blood pressure, tobacco smoking, alcohol intake, physical activity, diabetes mellitus, myocardial infarction and stroke. However sleep duration was inversely associated with HDL cholesterol (β=-0.644,
p
=0.015) in fully adjusted model. In the sex-specific analysis, sleep duration was marginally associated with HDL cholesterol in men (β=-0.770,
p
=0.078) and significantly associated with HDL cholesterol in women (β=-0.685,
p
=0.037) after fully adjustment.

Conclusions:
Our findings suggest that longer sleep duration was associated with lower serum HDL cholesterol level in an elderly Korean population.

Keywords:
Sleep duration, lipids, HDL cholesterol, elderly
Abstract P124: My Unlimited Potential: Achieving Weight, Fitness And Cardio-metabolic Health Objectives Using A 12-week, Multicomponent, Behavioral Intervention
Authors: Rouseff Maribeth , Tran Thinh H , Nasir Khurram , Bou-Khalil Josette , Mora Joseph J , Guzman Henry , Das Sankalp , Brown Doris , Santiago-Charles Joann , Ochoa Teresa C , Gilliam Cynthia , Lehn Virginia , Aneni Ehimen , Oni Ebenezer , Roberson Lara , Veledar Emir , Post Janisse , Castillo Beatriz
Published: July 2021

Background:
With about 59% of the entire US population currently in the work force, American Heart Association has emphasized worksite-based interventions to improve cardiovascular health among the working population. The primary aim of this study was to assess the short-term (12 weeks) efficacy of an ongoing multi-component, behavioral intervention improvement program (My Unlimited Potential (myUP), among employees of Baptist Health South Florida (BHSF), a large not-for-profit health care system.

Methods:
BHSF employees with two or more Cardio-metabolic risk factors, such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were considered for the study. Behavioral interventions were focused on diet and physical activity modifications.

Results:
Overall 202 (48±10 years, 78% females) employees enrolled in myUP wellness program. The retention of subjects was high with 89% (n=181) of subjects following up at 12 weeks. The figure below demonstrates the baseline, follow-up and estimated mean change in anthropometric, exercise capacity on treadmill test and CM participants. BMI reduction >5% was noted in 38% of the participants. Significantly higher, clinically meaningful, endpoints, especially in attaining blood pressure goals and exercise capacity (>10 METS), during the short-term follow-up in this behavioral intervention program (figure), were achieved.

Conclusion:
These findings suggest that an intensive behavioral modification intervention program, delivered to employees in a health care setting, results in significant short term benefit in weight reduction, increase fitness level and concomitantly improve cardio-metabolic risk profile. Further follow-up is in progress to ascertain whether these benefits are sustainable over a longer duration.
Abstract P128: A New Device for Objective Measurement of Sedentary Behavior
Authors: Rosenberger Mary , Haskell William , Buman Matthew , LaStofka Brent , Carstensen Laura
Published: July 2021

Objective measurement of sedentary behavior with accelerometers is an important part of epidemiological research. Unfortunately, the definition of sedentary behavior includes both “sitting and low levels of energy expenditure”, which are not usually measured by popular activity monitors. Currently, there is only one research device (ActivPAL) that can objectively measure both body posture and activity for sedentary behavior classification. The purpose of this study was to compare the Lumoback device, a commercial accelerometer-based posture monitor, for sedentary measurement during daily activities to the ActivPAL. The Lumoback also has real-time feedback delivered to the user through their mobile device, which may prove to be instrumental in sedentary intervention research. Subjects (N=33) wore the Lumoback and ActivPAL devices simultaneously during waking hours while continuing with their normal activity patterns. Linear regression showed good correlation between sitting minutes (R2=0.89, p < 0.001) and standing minutes (R2=0.86, p < 0.001) from the devices. There was no significant difference (p > 0.05) between the seconds of sedentary behavior measured with the lumoback and seconds sitting/lying measured with the ActivPAL. The lumoback posture monitor was similar to the ActivPAL for measurement of sedentary behavior, and could be used to measure sedentary behavior over the course of a waking day.
Abstract P130: Association between Weight Loss Program Attendance and Weight Loss among Adults with Serious Mental Illness
Authors: Jerome Gerald J , Young Deborah R , Dalcin Arlene T , Gennusa Joseph V , Oefinger Meghan , Yu Airong , Wang Nae-Yuh , Appel Lawrence J , Daumit Gail L
Published: July 2021

Introduction:
Obesity is epidemic among adults with serious mental illness (SMI) (e.g., schizophrenia, bipolar disorder) and evidenced-based weight loss programs are needed for this group. We examined the association between attendance to program sessions and weight change among adults with SMI who were enrolled in a lifestyle-based weight loss trial.

Methods:
Overweight and obese adults with SMI were randomized to either a control group (n=147) or an active intervention group (n=144) that received weight loss classes (3/month), individual weight management sessions (monthly), and group exercise classes (3/week) during the first 6 months. These classes tapered off during months 7-18. Study staff maintained attendance records. Standardized weight was assessed at baseline, 6 and 18 months. Regression analyses included weight change as the dependent variable and controlled for sex, age, and site.

Results:
The active intervention group was 51% female with an average age of 47 years. Main results have reported significant weight loss at 6 (M=-1.7kg, SD=4.6) and 18 months (M=-3.4kg, SD=7.4). Attendance at 6 and 18 months are reported in the figure below. Attendance was not associated with weight change at 6 months. Overall percent attendance was not associated with 18 month weight change (B=-0.02, p=-.59). A second regression model included percent attendance individually for each of type of session and group weight loss attendance (B=-0.10, p=.04) was associated with weight loss; however, individual weight loss sessions (B=0.002, p=.95), and group exercise (B=0.08, p=.08) were not associated with weight loss.

Conclusion:
Although overall attendance was not associated with weight loss, attendance to the group weight loss session was associated with weight loss at 18 months. It is not clear if the content of the weight loss groups was particularly effective or if adherence to these sessions was the strongest indicator of adherence to the behavioral recommendations.
Abstract P135: Varenicline and the Risk of Adverse Cardiovascular Events: A Population-Based Cohort Study
Authors: Filion Kristian B , Dell'Aniello Sophie , Eberg Maria , Renoux Christel , Daskalopoulou Stella S , Suissa Samy
Published: July 2021

Background:
Clinical trial results suggest that varenicline is the most efficacious smoking cessation therapy. However, its cardiovascular safety is controversial, with recent meta-analyses providing conflicting results. Our objective was to compare the effect of varenicline to that of bupropion on the risk of cardiovascular events.

Methods:
We conducted a population-based cohort study of new users of varenicline or bupropion using data extracted from the UK’s Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics. Our primary endpoint was a composite of myocardial infarction, coronary revascularization, stroke, and all-cause mortality. An ‘as-treated’ analysis with a Cox proportional hazards model was used, with patients censored 7 days after the end of their last prescription or upon switching smoking cessation drugs. In secondary analyses, we compared varenicline and bupropion to nicotine replacement therapy (NRT) in pairwise comparisons. All analyses used high-dimensional propensity scores to adjust for potential confounding.

Results:
Our primary cohort included 90,522 varenicline users and 12,640 bupropion users. The mean age was 44 years, and 48% were men. The mean treatment duration was 45 days. A total of 128 events occurred among varenicline users, and 15 occurred among bupropion users. Although estimates suggest that varenicline may modestly increase the risk of cardiovascular events compared to bupropion, they were accompanied by wide 95% CIs (Table). Both varenicline and bupropion users had significantly lower risks of cardiovascular events than NRT users (Table).

Conclusions:
While we cannot exclude a modestly increased risk of cardiovascular events with varenicline relative to bupropion, such events remain rare, and both varenicline and bupropion are associated with a decreased risk of cardiovascular events compared with NRT. The long-term benefits obtained due to the increased smoking abstinence with varenicline likely outweigh any increased cardiovascular risk.
Abstract P137: Smoking Susceptibility and its Predictors among Nepalese Adolescents: Evidence from the Jhaukhel- Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal
Authors: Aryal Umesh R , Petzold Max , Bondjers Göran , Krettek Alexandra
Published: July 2021

Introduction:
Cognitive susceptibility to smoking is defined as absence of firm commitment not to smoke in the future or if offered a cigarette by best friends. It begins in adolescence and is the first step in the transition to current smoking. Psychosocial risk factors play a crucial role to discourage susceptible adolescents from becoming established smokers. Most studies were conducted in the USA and evidence from low-income countries is limited. Despite the established Tobacco Product Control and Regulatory Bill 2011S in Nepal, cigarette smoking is widely prevalent among adolescents and the absolute number of smokers continues to rise.

Hypothesis:
We tested the hypothesis that socio-demographic and environmental risk factors associated with susceptibility to smoking among adolescents living in a peri-urban area of Nepal.

Methods:
We conducted a community cross-sectional study during October-November 2011 in the Jhaukhel - Duwakot Health Demographic Surveillance Site, a peri-urban area in Bhakapur district, 13 km east of the capital Kathmandu in Nepal, where tobacco products are easily available to adolescents. Trained local enumerators conducted face-to-face interviews with 352 randomly selected 14-16 year old non-smoking adolescents. The Nepal Health Research Council and Ethical Committee of Kathmandu Medical College approved this study.

Results:
The percentage of smoking susceptibility was 49.70% (95% CI: 44.49%-54.93%). In univariate analysis, sex, family members/relatives smoke, teacher smokes, friend smokes, exposure to secondhand smoke, participation in picnic/concerts, exposure to tobacco advertisements, and having seen actors smoke were associated with susceptibility to smoking. While in multiple regression analysis, smoking behavior of family members/relatives, teacher smoking, exposure to pro-tobacco advertisements and involvement in picnic/concerts were associated with susceptibility to smoking.

Conclusion:
Our results reveal that non-smoking adolescents, depending on their socio-demographic and environmental backgrounds, consider smoking initiation risk factors differently. We therefore suggest that future smoking intervention programs should also take socio-environmental influences into account for efficiently preventing non-smoking adolescents becoming susceptible to smoking.
Abstract P149: The Effect of Alcohol Consumption on Insulin Sensitivity and Glycemic Status: A Systematic Review and Meta-analysis of Intervention Studies
Authors: Schrieks Ilse C , Heil Annelijn L , Hendriks Henk F , Mukamal Kenneth J , Beulens Joline W
Published: July 2021

Introduction:
Moderate alcohol consumption is associated with a reduced risk of type 2 diabetes, but this relation appears stronger for women than men. The reduced risk of diabetes could be explained by improved insulin sensitivity or glycemic status, but results of intervention studies on this relation are inconsistent. Our aim was to conduct a systematic review and meta-analysis of intervention studies investigating the effect of alcohol consumption on insulin sensitivity and glycemic status.

Design:
Systematic review and meta-analysis of intervention studies.

Data sources:
PubMed and Embase were searched until May 2013 using a pre-specified search string.

Methods:
Intervention studies on the effect of more than 2 weeks alcohol consumption on biological markers of insulin sensitivity or glycemic status were identified and assessed on their quality. Pooled standardized mean differences (SMD) were calculated using either fixed or random effects models. Gender-stratified analyses and sensitivity analyses excluding studies with high doses of alcohol (> 40 g/day). In a meta-regression the influence of dosage and duration of intervention was tested.

Results:
We included 14 intervention studies in a meta-analysis on 6 glycemic endpoints. Alcohol consumption did not influence insulin sensitivity (SMD=0.06 [-0.13 to 0.26]) or fasting glucose (SMD=0.09 [-0.09 to 0.27]). Alcohol consumption reduced HbA1c (SMD=-0.62 [-1.01 to -0.23], P=0.002) and insulin concentrations (SMD=-0.17 [-0.34 to 0.00] P=0.049) compared with the control group. In women, alcohol consumption reduced fasting insulin (SMD=-0.23 [-0.41 to -0.04], P=0.019) and improved insulin sensitivity (SMD=0.19 [-0.03 to 0.41], P=0.087), but no significant differences were observed among men. Results were similar when only studies with moderate alcohol dosages were analysed and were not influenced by dosage and duration of the intervention.

Conclusions:
This study showed that moderate alcohol consumption may reduce fasting insulin and improve insulin sensitivity among women, but not among men. These effects may provide an explanation for the relation between alcohol consumption and type 2 diabetes. Furthermore, moderate alcohol consumption may reduce HbA1c levels among both men and women.
Abstract P193: Relation to Blood Pressure of Total and Individual Components of Dietary Fiber and Sugar: The Intermap Study
Authors: Aljuraiban Ghadeer S , Oude Griep Linda M , Chan Queenie , Daviglus Martha L , Stamler Jeremiah , Van Horn Linda , Elliott Paul , Frost Gary
Published: July 2021

Background:
Epidemiological evidence is limited and inconclusive on the separate contributions of soluble, insoluble fiber and dietary sugars to blood pressure (BP). This population based study examines relations to systolic and diastolic BP (SBP/DBP) of total dietary fiber and sugar and their individual components.

Methods:
Cross-sectional data were analysed from the population-based INTERMAP study, including 2,195 participants ages 40 to 59 from the United States. During 4 visits, eight BP readings were recorded and dietary intake was assessed by four in-depth 24-hour dietary recalls. Intakes of fiber and sugars (g/1000 kcal) were averaged over 4 days. In successive models, BP regression coefficients per 2 SD higher intake were estimated using isocaloric, multivariable linear regression with adjustment for multiple possible confounders (non-dietary and dietary), including each of the other individual dietary fiber or sugars.

Results:
Average intake (SD; g/1000 kcal) of total fiber was 8.8(3.3); soluble fiber 2.8(1.0); insoluble fiber 5.3(2.2). Average intake (SD; %kcal) of total sugar was 26.7(7.9) and of sucrose, the largest component, 10.8 (5.1). Partial Pearson correlation coefficients were low between total fiber and total sugar (
r
=0.02), and high between soluble and insoluble fiber (
r
=0.80). Correlations between fructose and other individual sugars were high only for glucose (
r
=0.93), low (
r
<0.15) for other sugars.Total dietary fiber intake higher by 7 g/1000 kcal was associated with SBP lower by 1.7 mm Hg (P=0.01) in an isocaloric model adjusted for lifestyle factors in addition to total sugar (%); this was attenuated with further adjustment for urinary potassium excretion. This association was accounted for by the observed inverse association of insoluble fiber with SBP (-2.0 mm Hg, P=0.04), additionally adjusted for soluble fiber. Inverse associations with SBP were found for dietary galactose (-1.5 mm Hg; P=0.04) and lactose (-2.1 mm Hg;P=0.0006). Intakes of total sugar, fructose, glucose, maltose, and sucrose were not associated with BP in isocaloric models adjusted for lifestyle factors and each of the other individual dietary sugars.

Conclusions:
Higher intakes of dietary fiber, especially insoluble fiber, may contribute to lower BP, possibly driven by potassium present in high fiber foods. Total sugar intake was not associated with blood pressure; however, intakes of galactose and lactose may favorably influence blood pressure.
Abstract P202: Is There a Relationship Between the Psychological Influence of the Highly Palatable Food Environment and Weight Loss Attempts?
Authors: Matthews-Ewald Molly , Brantley Phillip J , Harris Melissa N , Myers Valerie , Newton Robert , Champagne Catherine
Published: July 2021

Background:
Research suggests that the degree of food desirability may have an impact on successful weight loss. Defined as susceptibility to eating when presented with environmental stimuli, hedonic hunger is related to increased food consumption. Individuals with higher hedonic hunger may be less able to successfully maintain weight loss and, therefore, may have more weight loss attempts (WLA). The purpose was to examine associations between the number of WLA and the PFS total scale and subscale scores, controlling for race, sex, BMI, and age.

Methods:
Participants were obese adults enrolled in Heads Up, an insurance-sponsored observational study examining surgical and non-surgical weight loss techniques. Individuals completed the Power of Food Scale (PFS) and demographic information, including the number of WLA. The PFS was developed to assess hedonic hunger when food is: 1) available, 2) present, and 3) tasted.

Results:
Of the 705 participants, 409 (57.8%) were Caucasian, 597 (84.3%) were female, and had attempted to lose weight 9.13 (SD=9.8) times. The number of WLA significantly predicted PFS total scores and subscale scores except for the “Food Tasted” subscale. The full linear regression models accounted for 4.7%, 4.1%, and 6.2% of the variance in the total PFS, Food Available subscale, and Food Present subscale scores, respectively.

Conclusions:
Results demonstrate that hedonic hunger may be a factor in repeated WLA. Future research should examine the temporal sequence to fully explain this relationship to provide additional tailoring of behavioral weight loss interventions to address hedonic hunger as a hindrance to successful weight maintenance.
Abstract P214: Twenty-five Years Trends in Stroke Incidence in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Koton Silvia , Schneider Andrea L , Rosamond Wayne D , Gottesman Rebecca F , Coresh Josef
Published: July 2021

Introduction:
Prior studies have shown a decrease in stroke mortality rates, but data on validated stroke incidence and trends by race are more limited. We aimed to study trends in stroke incidence by age and race in the Atherosclerosis Risk in Communities (ARIC) population from 1987 to 2010.

Hypothesis:
We assessed the hypothesis that total stroke incidence rates are decreasing over calendar time in all age groups, and in whites and African-Americans.

Methods:
ARIC participants were recruited in 1987-1989 and followed until 2010. A computer algorithm and physician reviewers identified and adjudicated definite and probable stroke as ischemic, intracerebral hemorrhage and subarachnoid hemorrhage (total stroke). A person-years (PY) approach using 5-year periods for age and calendar time was used for studying rates of total stroke incidence and trends. Poisson regression modeled calendar time in 5-year periods and linearly per decade, adjusted for 5-year age group.

Results:
From 1987 to 2010, 994 strokes occurred over 274,837 PY in 14,145 participants free of stroke at baseline. Total stroke incidence rates by age and calendar time increased with age and generally decreased with time (
Table
). Poisson regression adjusted for age group showed incidence rate ratios of 2.28 (95% CI 2.01-2.59) for African-Americans, compared to whites. Using the 1992-1996 as reference period, incidence rate ratios were 0.90 (0.70-1.16) for 1987-1991, 0.84 (0.69-1.02) for 1997-2001, 0.69 (0.56-0.85) for 2002-2006, and 0.59 (0.46-0.75) for 2007-2010. Analysis stratified by race shows an incidence rate ratio decrease per decade of -27% (-13% to - 39%) in whites and -22% (-5% to -34%) in African-Americans.

Conclusions:
Validated total stroke incidence rates decreased over calendar time from 1992 to 2010 in the ARIC cohort in both whites and African-Americans, after taking the aging of the cohort into account. Cohorts like ARIC only represent a limited age range but provide an ability to use validated events in updating stroke incidence trends.
Abstract P218: Long-term Risk Of Recurrent Stroke After Ischemic Stroke Among Younger Adults Under 55 Years Of Age, Sweden
Authors: Giang Kok Wai , Björck Lena , Zverkova Sandström Tatiana , Ståhl Christina-Heden , Torén Kjell , Rosengren Annika
Published: July 2021

Purpose:
The purpose of the present study was to investigate the 4-year risk of recurrent stroke among patients below 55 years with a first ischemic stroke (IS), 1987-2006.

Methods:
All men and women (17,149 cases) aged 18-54 years who survived at least 28 days after a first IS were identified in the Swedish Inpatient register (IPR) from 1987 until 2006. All patients were followed-up at 1 year, 2 years, 3 years and 4 years for a first recurrent stroke after index event.

Results:
From 1987 to 2006 a total of 1808 first recurrent stroke were identified. Long-term risk of a first recurrent stroke declined over time in both men and women. Among men, the absolute 4-year cumulative risk of a recurrent stroke decreased from 17.5% (95% CI 15.7%-19.4%) to 8.8% (95% CI, 7.7%-10.0%) from the first to the last 5-year period. Corresponding result for women was 15.6% (95% CI, 13.3%-18.2%) and 6.0% (95% CI, 4.9%-7.3%). Despite an overall decrease, the risk of a recurrent stroke was highest during the first year after index stroke (men=3.9%, 95% CI, 3.3%-4.8%, women=2.9%, 95% CI, 2.2%-3.8%).

Conclusions:
Over the 20-year period, the 4-year cumulative risk of a first recurrent stroke decreased over time. For both men and women the risk was greatest during the first year, emphasizing the importance of early secondary prevention in young stroke victims.