bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P092: Debunking the Myth of the “Jolly Fat and Fit”: A Longitudinal Cohort Analysis
Authors: Vaidya Dhananjay , Yanek Lisa R , Moy Taryn F , Kral Brian G , Becker Diane M
Published: July 2021

Background:
Positive emotional health has been shown to be protective against coronary artery disease, putatively through pro-health behaviors including exercise and fitness. It has been suggested that this positive emotion trait is prevalent among obese persons (“jolly fat” hypothesis) implying that it may lead to fitness even with higher BMI. We thus examined the longitudinal associations among fatness, fitness and positive emotion using structural equation modeling (SEM).

Methods:
We examined GeneSTAR (Genetic Study of Atherosclerosis Risk) cohort data (N = 947, 57% women, 50% African American, baseline age 47 ± 7 years, follow-up measures 7 ± 2 years). We fit SEMs to determine the temporal associations between fatness (BMI), fitness (METs achieved on a treadmill test) and positive emotion (General Well Being Schedule, GWBS) adjusting for age, sex, race and follow-up time.

Results:
The cross-sectional correlations were significant in SEM (BMI-METs -0.42, GWBS-MET -0.14, BMI-GWBS -0.15; all p<0.001). Significant or suggestive temporal paths (standardized r) are shown in the figure. All within-variable correlations were strong (p < 0.001). Baseline BMI was negatively correlated with GWB scores at follow-up but baseline GWBS was not associated with BMI at follow-up (difference between paths, p = 0.007). Thus, adjusting for cross-sectional correlations, lower BMI occurs temporally prior to measures of a greater level of positive emotion. Although the temporal paths between baseline BMI and followup MET and vice versa were jointly significant (p = 0.004), neither was significantly stronger (p = 0.25), suggesting temporal bidirectionality. There was no significant temporal relationship between GWBS and MET.

Conclusion:
Both cross sectional and longitudinal relationships are contrary to the “jolly fat” hypothesis. Greater BMI is temporally and cross-sectionally associated with worse measures of the positive emotion trait and fitness.
Abstract P093: Psychological Stress is Associated with Increases in Weight and Waist Circumference over Time: Longitudinal Data from the Dallas Heart Study
Authors: Cooper-McCann Rebecca , Ayers Colby , Albert Michelle , de Lemos James , Neeland Ian , McClurkin Michael , Shropshire Eric , Powell-Wiley Tiffany M
Published: July 2021

Background:
Psychological stress (stress) is associated with cardiovascular events, but the impact of stress on changes in adiposity as a measure of cardio-metabolic risk is unknown.

Methods and Results:
We examined the relationship between self-reported psychological stress level at baseline and change in weight and waist circumference (WC) over a median 7-year interval in the Dallas Heart Study, a multiethnic, population-based sample of Dallas County residents aged 18-65 (N = 1603; whites = 615; blacks = 754; Hispanics = 234). Participants answered a questionnaire and underwent measurement of weight, height and WC at baseline and follow-up visits between 2000 and 2009. Stress levels were determined by self-report using a five-point scale, with responses categorized as low (1-2), moderate (3) and high (4-5) stress levels. Linear regression modeling was used to determine the association between baseline stress category and weight/WC change over time. At baseline, 24% of participants reported low stress, 49% moderate, and 27% high stress. No significant differences were observed in weight, BMI or WC at baseline between stress groups. Compared to participants reporting high stress, those with low stress were older (45 vs. 43 yrs), more likely to be male (54% vs. 37%) and be of black race (55% vs. 34%) [p<0.01 for all]. In unadjusted modeling, those in the high stress group gained more weight and had greater WC increase compared to the low stress group (Table). After adjusting for age, sex, baseline adiposity, race, education and income, the high stress group still had greater weight gain compared to the low stress group.

Conclusions:
Higher levels of self-reported stress are associated with adverse changes in adiposity among DHS participants. These results suggest that interventions targeting psychological stress may lessen the impact of obesity on subsequent cardio-metabolic risk.
Abstract P096: Maternal Serum C-Reactive Protein Levels During Pregnancy and Risk for High C-Reactive Protein 7-13 Years Later
Authors: Rockette-Wagner Bonny , Holzman Claudia , Bullen Bertha L , Althouse Andrew D , Catov Janet M
Published: July 2021

Introduction:
Elevated serum C-reactive protein (CRP) can be a marker of disease activity involving inflammation, such as pregnancy complications and cardiovascular disease (CVD). Systemically high levels of CRP in women, including during pregnancy, may indicate higher risk for CVD. It is unknown if CRP measured during the pro-inflammatory state of pregnancy correlates with concentrations assessed 7-13 years after delivery.

Hypothesis:
Concentrations of CRP assessed during pregnancy will be related to CRP measured several years after pregnancy, independent of weight gain.

Methods:
We studied the first 252 women enrolled in the follow-up of the Pregnancy Outcomes and Community Health Study (POUCHmoms 2011-2013) with complete CRP data for the pregnancy (mean gestational age: 22.36 [2.22] weeks) and POUCHmoms visits (mean follow-up: 10.76 [1.38] years). The relative risk for high hsCRP (≥ 3.39 μg/ml) at the follow-up visit, related to quartiles of CRP during pregnancy, was examined using stepwise regression models.

Results:
Median (IQR) levels of pregnancy CRP and hsCRP at the follow-up visit were 5.68 [3.08, 9.76] and 3.39 [0.69, 9.73] μg/ml, respectively. Although absolute values of hsCRP at follow-up were generally lower than pregnancy CRP, 56% of women in the top and bottom quartiles of pregnancy CRP (71 of 126) were in the same quartile for hsCRP at follow-up (figure). The relative risk of having high hsCRP (≥ 3.39 μg/ml) at follow-up ranged from 2.7-5.2 for the 2
nd
- 4
th
quartiles of pregnancy CRP (vs. the 1st quartile). Controlling for pre-pregnancy BMI and follow-up weight change, the relative risk of having high hsCRP at follow-up was significantly higher for the 2
nd
(1.15 [1.02-1.30]),3
rd
(1.19 [1.05-1.35), and 4
th
(1.22 [1.05-1.41]) quartiles of pregnancy CRP.

Conclusions:
Pregnancy CRP levels are related to hsCRP levels several years later in this cohort of women, even after adjusting for pre-pregnancy BMI and follow-up weight change. CRP assessed in pregnancy may reflect inflammatory status later in life.
Abstract P100: Trends in gestational weight gain: Results from the Pregnancy Risk Assessment Monitoring System, 2000-2009
Authors: Johnson Jonetta L , Farr Sherry L , Dietz Patricia M , Sharma Andrea J , Barfield Wanda D , Robbins Cheryl L
Published: July 2021

Introduction:
Excessive gestational weight gain (GWG) is associated with adverse outcomes for women and infants (gestational hypertension, cesarean delivery, postpartum weight retention and large for gestational-age infants). Current population-based trends in GWG are unknown. This study estimates current trends in mean GWG and trends in gaining below, within, and above the 1990 IOM recommendations among women who delivered live births in multiple states from 2000-2009.

Methods:
We included Pregnancy Risk Assessment Monitoring System (PRAMS) data from 95,025 women ≥18 years of age, who delivered a singleton infant between 39-40 weeks gestational age in one of 14 states during 2000 through 2009. We defined self-reported GWG in pounds as a continuous variable and as a three-level categorical variable according to 1990 IOM recommendations (below, within and above recommendations). Self-reported pre-pregnancy weight and height from PRAMS were used to calculate pre-pregnancy body mass index and gestational weight gain was extracted from the birth certificate. We grouped live births into 5 biennial intervals and estimated percentage point changes in prevalence using the beta coefficient of the biennial intervals. Adjusted trends in gaining below or above (compared to within) IOM recommendations for GWG from 2000-2001 to 2008-2009 were assessed using multivariable multinomial linear regression. We examined the trend in mean GWG from 2000-2001 to 2008-2009 using multivariable linear regression adjusted for maternal and pregnancy characteristics. SUDAAN was used to account for the complex sampling design and weights were used to provide population-based estimates.

Results:
There was a 0.9 biennial percentage point increase in the percent of women gaining above IOM recommendations, from 43% in 2000-2001 to 46% in 2008-2009 (p- trend < 0.01). Women gaining within IOM recommendations decreased at a rate of 1.1 percentage points biennially, from 38% in 2000-2001 to 34% in 2008-2009 (p-trend <0.01). There was a statistically significant increase in the adjusted odds of gaining above (odds ratio (OR) = 1.2, 95% confidence interval (CI: 1.1-1.2) and below (OR= 1.2, 95% CI: 1.1-1.3) IOM recommendations over time. From 2000-2009, there was no change in mean GWG.

Conclusion:
From 2000-2009, there was a modest increase in the percent of women gaining above IOM recommendations while mean GWG remained constant. These seemingly contradictory findings may be due to a larger percentage of women entering pregnancy overweight and obese and gaining above recommended limits. Results from this analysis highlight the need for continued clinical and public health efforts to develop and implement effective strategies to ensure women enter pregnancy at a healthy weight and achieve recommended GWG.
Abstract P101: Hypertension in Pregnancy and Risk of Hypertension in Later Life: The Bogalusa Heart Study
Authors: Li Shengxu , Xiong Xu , Fernandez Camilo , Chen Wei , Srinivasan Sathanur R , Berenson Gerald S
Published: July 2021

Background:
Few studies have examined whether hypertension in pregnancy imposes long-term cardiovascular risk compared to a normal pregnancy. The objective of this study was to examine if previous history of hypertension in pregnancy is a risk for hypertension after pregnancy.

Methods:
A case-control analysis was performed using the Bogalusa Heart Study database. Cases were defined as women whose systolic blood pressure ≥140 mmHg or diastolic ≥ 90 mmHg, or having hypertension treatment. Controls were defined as women with normal blood pressure. After exclusions, 604 women (67% white and 33% black, aged 32-44 years) were included for analysis. Univariable and multivariable logistic regression were used to estimate the odds ratio (OR) and 95% confidence interval (CI).

Results:
The prevalence of hypertension in women was 12.1% (73/604). Hypertensive women had higher proportion of previous history of hypertension in pregnancy (25/73, 34%) than normotensive controls (83/531, 13.7%), with an OR of 2.81 (95% CI: 1.64-4.81). After adjustment for age, race, body mass index and smoking, adjusted OR (aOR) of having previous history of hypertension in pregnancy for developing hypertension later was 1.36 (1.00-3.75). In addition, age, black ethnicity and body mass index were associated with hypertension, with aORs of 1.16 (1.09-1.25), 3.73 (2.13-6.52), and 1.09 (1.05-1.13), respectively.

Conclusions:
Hypertension in pregnancy may be associated with an increased risk of hypertension in later life. Further studies are needed to separate the effect of pregnancy-induced hypertension and pre-exiting chronic hypertension on the subsequent risk of hypertension later in life.
Abstract P102: Risk of Incident Hypertension and Diabetes Mellitus in Habitual Snorers and Sleep Apneic Individuals; The Multiethnic Study of Atherosclerosis
Authors: Qureshi Waqas , Yeboah Joseph , Bertoni Alain , Burke Gregory , Herrington David , Foy Capri , Redline Susan
Published: July 2021

Background:
Data regarding temporal association of sleep apnea and snoring with incident hypertension (HTN) and diabetes mellitus(DM) are limited.

Hypothesis:
We hypothesized that sleep apnea and snoring are associated with incident HTN and DM.

Methods:
Participants of age 45 - 65 years from 4 ethnicities (Asian, Hispanic, African American and Caucasian) without known cardiovascular disease from Multi Ethnic Study of Atherosclerosis (MESA) were administered a sleep questionnaire. HTN was defined as being on antihypertensive medication or blood pressure ≥140/90 mmHg. DM was defined as fasting blood glucose ≥126 mg/dL or use of antidiabetic medications. Participants with baseline HTN and DM were excluded. Cox proportional hazard models were constructed to evaluate the association of habitual snoring (defined as snoring on ≥3 days of week) and sleep apnea (self-report of diagnosis by doctor) with hypertension or diabetes. The analysis was adjusted for age, gender, race, body mass index (BMI), exercise, education. Two separate analyses were performed after excluding hypertensives and diabetics at baseline.

Results:
Out of 6618 participants, 6206 responded to the sleep questionnaire. There were 213 (3.4%) participants with sleep apnea and 1481 (23.8%) were categorized as habitual snorers. 98% of participants reporting sleep apnea also reported snoring. There were 1364 (38.7%) cases of incident hypertension and 619 (11.3%) incident DM over a period of 10 years. Habitual snoring and sleep apnea both were not associated with incident HTN. Habitual snoring was also not associated with incident DM. Sleep apnea was independently associated with incident DM (see table).

Conclusion:
Despite potential misclassification of sleep apnea due to self -report, our study shows a strong association between sleep apnea and incident DM but not with incident hypertension. The findings support future research addressing role of sleep apnea in development of DM.
Abstract P106: Infant Sleep Problems Increase the Odds of Childhood Overweight at Grade 6: Differential Effects of Commonly Used Definitions of Sleep Problems
Authors: Alamian Arsham , Wang Liang , Pitts Melanie , Ikekwere Joseph , Hall Amber M
Published: July 2021

Introduction:
Infant sleep problems have been defined using a variety of definitions. No study has assessed the association between infant sleep problems and childhood overweight or obesity using different definitions of sleep problems.

Hypothesis:
We assessed the hypothesis that the effect of infant sleep problems on childhood overweight or obesity would differ based on the definition of sleep problems used.

Methods:
In the multi-site study of Early Child Care and Youth Development of the National Institute of Child Health and Human Development, sleep problems were assessed using Lozoff and colleagues (night waking occurring more than 3 times per week accompanied by parental report of disturbance), Richman and colleagues (waking 5 or more nights per week for the past 3 months in addition to one of the following: co-sleeping with parents, waking 3 or more times per night, or waking event lasting at least 20 minutes), and Zuckerman and colleagues (waking 3 or more times per night, waking event lasting at least 1 hour, or parental report of severe disturbance) definitions. Infants (<24 months of age) with sleep problems (ever versus never) were included in this analysis. Childhood weight status (normal: BMI 5th-< 85th percentile; being overweight: BMI 85th-<95th percentile; or being obese: BMI ≥95th percentile) was defined according to 2000 Centers for Disease Control and Prevention cut-offs (N=895). Multinomial logistic regression was used to examine the association between sleep problems during infancy and the odds of childhood overweight or obesity at grade 6 after adjusting for birth weight, race, sex, breastfeeding, maternal poverty, family structure, and maternal education.

Results:
The prevalence of childhood overweight and obesity at grade 6 was 15.6% and 19.0%, respectively. The prevalence of having sleep problems during infancy was 24.9% (Zuckerman definition), 12.6% (Richman definition), and 20.6% (Lozoff definition), per different definitions used. Infants with history of having sleep problems were found more likely to be overweight at grade 6 using either Zukerman’s (Odds ratio (OR) = 1.68; 95% Confidence interval (CI) = 1.11-2.55) or Richman’s definition (OR = 1.76; 95% CI = 1.05-2.97), but not using Lozoff’s definition of sleep problems.

Conclusion:
Infant sleep problems increased the odds of childhood overweight (but not obesity) at grade 6. However, the observed associations varied according to the definition of sleep problems used. More research is needed to construct a single definition of infant sleep problems in order to more accurately predict overweight or obesity later in life.
Abstract P111: Sleep duration is associated with serum osteocalcin level in an elderly Korean population: the Korean Urban and Rural Elderly (KURE) study
Authors: Lee Ju-Mi , Choi Hansol , Kim Kyung Min , Youm YooSik , Rhee Yumie , Kim Chang Oh , Kim Hyeon Chang
Published: July 2021

Importance:
Association between sleep duration and health related outcome studies have been published consistently. However there have been few studies of the association between sleep duration and bone formation in elderly.

Objective:
The aim of this study is to examine association between sleep duration and serum osteocalcin level in an elderly Korean population.

Design:
Cross sectional analysis using baseline cohort data.

Setting:
Community based setting

Participants:
Among the total of 927 participants, we excluded 1 participant because of the absence on sleep duration answer. A final total of 926 participants (624 women and 302 men aged 64-87 years) who completed baseline health examination in 2012 were enrolled in this study.

Measurement:
Sleep duration was measured by interviewer-assisted questionnaire. Participants answered their regular time of going to bed, time of opening eyes in the morning, and time of regular nap using open questions during the passing year. Serum osteocalcin level, a known biomarker of osteogenesis, was measured by electrochemiluminescence immunoassay method in the central research laboratory. The association between sleep duration (minutes/day) and serum osteoclacin level (ng/ml) was assessed by multiple linear regression analysis.

Results:
In the total population, sleep duration had significant association with serum osteocalcin level (ß=-0.008, p=0.013). One hour increase in sleep duration was associated with 0.48 ng/ml increase in serum osteocalcin level. This association remained after controlling for age, sex, body mass index, cigarette smoking, alcohol drinking, physical activity, and serum 25(OH) vitamin D (ß=0.012, p<0.001). This association was consistent before and after adjusting confounders in women (ß=-0.010, p=0.019, ß=-0.011, p=0.009, respectively) and men (ß=-0.013, p=0.012, ß=-0.013, p=0.011, respectively).

Conclusions:
Our findings suggest that longer sleep duration is associated with higher bone formation process in an elderly of Korean.
Abstract P118: County-Level Disparities in the Availability of Farmers Markets in the United States: An Ecological Study
Authors: Singleton Chelsea , Affuso Olivia , Sen Bisakha
Published: July 2021

Introduction:
Farmers markets (FM) have been hypothesized to be a potential community-level obesity prevention strategy for populations at risk for chronic diseases because they provide a mechanism for communities to purchase healthy locally grown produce. This study aimed to identify county-level factors associated with FM availability in an effort to determine if disparities in availability exist in the US.

Hypothesis:
Increased FM availability will be associated with higher median household income, lower % minority residents, lower % obese residents and a higher number of grocery stores and recreation centers per 100,000 residents.

Methods:
An ecological study was conducted using 2009 data from the USDA Food Environment Atlas on 3,135 US counties. Crude and multivariable adjusted logistic regression models where used to determine associations between having at least one FM available and county-level variables such as % African American (AA) residents, % Hispanic residents, median household income, % WIC participants, % adults obese, % adults with diabetes, per capita grocery stores, per capita supercenters and per capita recreation centers. All analyses were stratified by metro county status and adjusted to address data clustering at the state-level.

Results:
There were 1,088 and 2,047 counties labeled metro and non-metro respectively.
Metro Results
: Median household income (p = 0.002) and per capita recreation centers (p < 0.0001) were positively associated with FM availability while % WIC residents (p = 0.008), per capita grocery stores (p = 0.02) and % adults with diabetes (p < 0.0001) showed a negative association.
Non-Metro Results:
Median household income (p < 0.0001), per capita recreation centers (p < 0.0001) and per capita supercenters (p < 0.0001) were positively associated with FM availability while % WIC residents (p = 0.02), per capita grocery stores (p < 0.0001) and % adults with diabetes (p < 0.03) showed a negative association. The % AA residents appeared to be negatively associated with FM availability but did not achieve statistical significance. County obesity prevalence was not associated with FM availability in both metro and non-metro counties.

Conclusion:
Results showed that counties with more recreation centers and a higher median household income have increased FM availability while counties with more WIC participants and residents with diabetes have less availability. More information on the association between FM access, diet and obesity in at risk populations should be collected at the individual level.
Abstract P119: Assessment of Cardiovascular Health among Older Women in Primary Care
Authors: Foraker Randi E , Shoben Abigail B , Lopetegui Marcelo A , Lai Albert M , Payne Philip R , Kelley Marjorie , Roth Caryn , Tindle Hilary , Schreiner Andrew , Jackson Rebecca D
Published: July 2021

In 2010, the American Heart Association (AHA) launched the groundbreaking
Life’s Simple 7™
campaign to improve the cardiovascular health (CVH) of Americans. Five of the 7 [smoking, body mass index (BMI), blood pressure, cholesterol, and glucose] are commonly recorded in electronic medical records (EMRs). Although CVH components are often included in patient-provider discussions, to date there has been no formal attempt to characterize CVH from EMR data. We characterized the CVH of 160 female patients ages 65 and older seen in an Ohio State University primary care clinic from May 1 through July 31, 2013. We defined CVH according to AHA criteria, and assigned each behavior and factor to either an “ideal”, “intermediate”, or “poor” category. We calculated an overall CVH score ranging from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. We calculated means and standard deviations (sd) of continuous variables and report frequencies within CVH categories. Patients were an average of 74.2 (sd=6.7) years old, and 35% were black. Among the 126 (79%) women who had data available on all 5 factors, mean CVH score was 6.0 (sd=1.3). Among all women, the mean fractional score (actual score/maximum possible) was 0.63 (sd=0.14), and it did not differ significantly by race. Greater than 10% of data were missing for BMI (13%) and cholesterol (11%).
Figure 1
shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor. We have demonstrated that a majority of
Life’s Simple 7™
components are easily queried from EMRs. These data indicate that older female patients seen in the primary care setting have less-than-ideal CVH. There exists great potential to leverage the EMR for patient-provider communication and engagement around CVH. As such, we are implementing an automated assessment of CVH targeted to primary care providers and their older female patients. Following the intervention, CVH values will be compared to these baseline data.

Figure 1. Percent of older female patients (n=160) who were seen in a primary care clinic by category of CVH: behaviors and factors*.

*Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal), since over 90% of data were missing for fasting glucose or hemoglobin A1c.
Abstract P139: Insulin Resistance in Premenopausal Women with Type 1 Diabetes is Explained by Abdominal Obesity, Physical Inactivity and Altered Sex Hormones
Authors: Duca Lindsey M , Sippl Rachel M , Snell-Bergeon Janet K
Published: July 2021

Women with type 1 diabetes (T1D) lose the premenopausal protection from cardiovascular disease (CVD) that non-diabetic (non-DM) women have compared to men, and are also more insulin resistant than non-DM women. Standard CVD risk factors have not been found to adequately predict CVD in the T1D population, but insulin resistance is emerging as a potentially important risk factor. The aim of this study was to determine whether sex hormone levels such as estradiol (E2), total testosterone (TT), and sex-hormone binding globulin (SHBG) explained any of the decreased insulin sensitivity in women with T1D, which could be important in CVD prevention.

This study included 25 premenopausal women 18-45 years of age with a mean ± SD age of 33 ± 8 years who completed a three stage (4, 8 and 40 mU/m2/min) hyperinsulinemic-euglycemic clamp during the luteal phase of the menstrual cycle (T1D n=12 and non-DM n=13). A steady state was achieved during the last 30 minutes of the high insulin infusion stage and mean glucose infusion rate (GIR [mg/kg/FFM/min]) during this time was used as an estimate of the skeletal muscle glucose disposal rate. Sex hormones were compared using unpaired Student t tests between T1D and non-DM participants during each phase of the menstrual cycle and during the morning of the clamp.. Significant differences were explored in multivariable linear regression in which stepwise model selection was used to determine the final model adjusting for age and diabetes status.

In age-adjusted analysis, women with T1D were less than half as insulin sensitive as non-DM women (least squares mean ± SE: 7.5±2.2 vs. 19.0±2.1, respectively, p=0.0014). SHBG was significantly higher in the T1D than the non-DM subjects the morning of the clamp (p<0.0001) and during each phase of the menstrual cycle (p = 0.01). TT was significantly higher in T1D women during the early follicular phase of the menstrual cycle (p=0.02) and was negatively correlated with GIR (r = -0.54, p = 0.04). E2 during the early follicular phase was positively correlated with GIR (r = 0.83, p = 0.01). In multivariable analysis, the difference in the GIR was attenuated by 58%(1-(5.1/12.14)) (least squares mean ± SE: 10.9 ± 1.7 in T1D vs. 16.0 ± 1.5 in non-DM, p = 0.07) after adjusting for age, diabetes status, minutes of vigorous activity, average waist circumference, free estradiol index and testosterone during the early follicular phase of the menstrual cycle In conclusion, the decreased insulin sensitivity observed in premenopausal T1D women with regular menstrual cycles can be mostly explained by lower levels of physical activity, greater central adiposity and differences in sex hormone levels. Most of these factors are modifiable, and so could be important targets in the reduction of CVD.
Abstract P143: Hemoglobin A1C Screening in 31546 Adolescent Blood Donors
Authors: Gore Maria Odette , Eason Stephen J , Ayers Colby R , Turer Aslan , Khera Amit , de Lemos James A , McGuire Darren K , Sayers Merlyn
Published: July 2021

Objective:
While the global epidemic of diabetes mellitus in adults is well documented, there are few reliable estimates of the prevalence of diabetes and prediabetes in adolescents in the United States. We conducted systematic hemoglobin A1C (HbA1C) screening in a very large adolescent blood donor population.

Methods:
A screening program was implemented in which HbA1C was measured at the time of blood donation among 31,546 volunteer high-school blood donors, 16-19 years of age, who participated in school blood drives conducted by Carter BloodCare, the largest independent blood program in Texas, between 2011 and 2013. The main study measures were the prevalence of HbA1C in the prediabetes range, 5.7-6.4% (39-46 mmol/mol) and in the diabetes range, ≥ 6.5% (≥ 48 mmol/mol), in the overall cohort as well as stratified by sex, race/ethnicity, and sociodemographic characteristics.

Results:
In the overall cohort, the prevalence of HbA1C in the prediabetes range was 11.0% (95% CI 10.7, 11.4), and the prevalence of HbA1C in the diabetes range was 0.53% (95% CI, 0.46, 0.62). The prevalence of HbA1C ≥ 5.7% (including prediabetes and diabetes) was higher in boys compared with girls (15.7% vs.7.9%, P<0.001), and was especially high in race/ethnic minorities (32.7%, 19.7%, 13.1%, respectively in Blacks, Asians, Hispanics) compared with 8.0% in Whites (p<0.001 for each vs. Whites). In analyses of cardiovascular risk factors stratified by HbA1C categories, higher total cholesterol and systolic and diastolic blood pressure were observed in donors with HbA1C in the prediabetes and diabetes range (P trend < 0.001 for all,
Table
).

Conclusions:
HbA1C values in the prediabetes or diabetes range are common among adolescent blood donors, particularly among boys and ethnic minorities. Blood donation programs can be used as a valuable portal for public health screening, and may provide the opportunity for targeted public health interventions, triaging of donors to medical care, and research programs for community-based participatory interventions.
Abstract P150: Association of Non-Framingham Stroke Risk Factors With Incident Stroke Among Individuals With and Without Diabetes
Authors: Booth John N , Bromfield Samantha , Carson April P , Judd Suzanne E , Howard George , Kissela Brett M , Safford Monika M , Muntner Paul
Published: July 2021

Diabetes is a pro-inflammatory state characterized by a high burden of non-traditional risk factors not included in the Framingham stroke risk equation. We assessed the association between factors absent from the Framingham stroke risk equation with incident stroke among individuals with and without diabetes, separately, using the US population-based REasons for Geographic and Racial Differences in Stroke study. Diabetes was defined by self-report with concurrent insulin or oral hypoglycemic medication use, fasting serum glucose ≥126 mg/dL or non-fasting serum glucose ≥200 mg/dL. Non-Framingham risk factors included high sensitivity c-reactive protein >3.0 mg/dL, low high-density-lipoprotein (HDL-C; men: <40 mg/dL, women: <50 mg/dL), triglycerides >150 mg/dL, abdominal obesity (waist circumference: men >102 cm, women >88 cm), urinary albumin-to-creatinine-ratio (ACR) >30 mg/dL, and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m
2
. Bi-annual telephone contacts were used to identify incident stroke events that were subsequently adjudicated. During a median follow-up of 5.9 years, there were 329 and 697 incident strokes among individuals with (n = 6,258) and without (n = 22,226) diabetes, respectively. For individuals with and without diabetes, the prevalence of ≥3 non-Framingham risk factors was 50.4% and 23.9%, respectively. C-reactive protein >3.0 mg/dL and eGFR <60 ml/min/1.73 m
2
were associated with stroke among individuals with but not those without diabetes (Figure 1). In addition, ACR >30 mg/dL had a stronger association with stroke among individuals with versus without diabetes [HR (95% CI), 2.08 (1.65[[Unable to Display Character: –]]2.63) versus 1.36 (1.12[[Unable to Display Character: –]]1.66), respectively; p-interaction=0.04]. Low HDL-C, triglycerides >150 mg/dL and abdominal obesity were not associated with stroke among individuals with or without diabetes. In conclusion, non-Framingham stroke risk factors are common and associated with increased stroke risk among individuals with diabetes.
Abstract P151: Neighborhood-Level Socioeconomic Deprivation Is Associated with Diabetes Mellitus in a Multi-Ethnic Population: The Dallas Heart Study
Authors: McClurkin Michael , Ayers Colby , Leonard Tammy , Cooper-McCann Rebecca , Hoehner Christine , Powell-Wiley Tiffany M
Published: July 2021

Background:
Although neighborhood-level socioeconomic deprivation has been associated with obesity, its relationship with diabetes, a cardio-metabolic risk factor and determinant of cardiovascular health, is poorly understood.

Methods and Results:
We examined the relationship between neighborhood-level socioeconomic deprivation and prevalent diabetes in the Dallas Heart Study (DHS), a multi-ethnic, population-based sample of Dallas County residents aged 18-65 (N=1621). Participants underwent detailed examination between 2000-2002. Geo-coded home addresses defined neighborhood block groups; a neighborhood-level deprivation index (NDI) for Dallas County was created using factor analysis based on 21 Census block-group characteristics (higher scores=greater neighborhood-level deprivation). Diabetes was defined by self-report, use of anti-hyperglycemic medication, or fasting glucose≥126 mg/dl. Logistic regression modeling was used to determine odds of prevalent diabetes for those in highest vs. lowest NDI tertile.

In DHS, diabetes prevalence was 5%, 13%, and 16% across NDI tertiles (p<0.001). In modeling diabetes, we found a significant interaction between race and NDI (p=0.03); therefore, models were race-stratified. White, Hispanic, and black DHS participants in neighborhoods in the highest NDI tertile were up to seven times more likely to have diabetes than those living in the lowest tertile (Table). In whites and Hispanics, higher deprivation remained associated with a greater likelihood of diabetes after adjustment for age, sex, smoking, and education and was only attenuated after adjusting for income. In contrast, adjustment for confounders attenuated the relationship between NDI and diabetes among blacks.

Conclusions:
Residing in socioeconomically deprived neighborhoods is associated with prevalent diabetes among whites and Hispanics in DHS. These data suggest racial/ethnic disparities in cardio-metabolic risk within areas of higher socioeconomic deprivation in Dallas County.
Abstract P160: Conflicting Associations of Acculturation and Cardiovascular Risk in Hispanics in the National Health and Nutrition Examination Survey 1999-2010: What Are We Measuring?
Authors: Lopez Lenny , Rodriguez Fatima , Meigs James B , Ashburner Jeffrey M
Published: July 2021

Background:
Acculturation is the process by which immigrant groups adopt the cultural practices and values of the host country. Research has produced conflicting results in the association between acculturation and cardiovascular disease (CVD) risk among Hispanics. The National Health and Nutrition Examination Survey (NHANES) has collected multiple acculturation measures. We evaluated the hypothesis that the acculturation measure utilized impacts the association with CVD risk.

Methods:
The following measures of acculturation were available: Nativity, Language spoken at home (‘mostly English,’ ‘Equal English/Spanish,’ ‘Mostly Spanish’), Years in the US (0-5, 6-10, 11-15, 16-20, >20), and US citizenship. The validated Short Acculturation Scale (SAS) was only used between 1999 and 2004. Chi-squared analyses and logistic regression models were used to examine the independent association of acculturation with CVD risk factors: hypertension, BMI, diabetes (HgbA1c ≥6.5), total cholesterol ≥ 240 mg/dl, HDL (male: <40 mg/dl, female <50 mg/dl). Models were adjusted for age, gender, insurance, education, income, having a usual place of care, and appropriate sampling weights. Nominal association between acculturation variables was assessed with the uncertainty coefficient (UC) (Range: -1 [100% negative association] to 1 [100% positive association]).

Results:
Of 8707 Hispanics, less acculturated adults, as measured through language, were slightly older (mean age 41 vs. 39), were more likely to have less than a high school education (66 vs. 25%), less likely to have a usual source of care (61 vs.79%), and more likely to be uninsured (57 vs. 27%). Only 8% were born in the US, 31% were US citizens, and 58% reported 15 yrs or less in the US. In fully adjusted models, the SAS and other language based acculturation measures showed null association with CVD risk while increasing years in the US was consistently associated with increasing risk over time of hypertension (ORs range: 1.1-2.3), obesity (ORs range: 1.2-2.4) and diabetes (ORs range: 1.0-2.6). Only obesity had similar point estimates and confidence intervals across acculturation measures (ORs range: 1.0 - 2.4). Moderate positive correlation was highest between language usually spoken at home and country of birth (UC=0.4) followed by US citizenship (UC=0.3).

Conclusions:
NHANES is widely used in the study of Hispanic health. Different acculturation measures demonstrate differing associations with CVD risk factors. In contrast to language-based measures, only length of residence in the US showed consist associations across CVD risk factors. Future research is needed to further characterize acculturation metrics among heterogeneous Hispanic populations.
Abstract P163: Racial Disparities In Coronary Heart Disease Risk Among United States Adults
Authors: Lu Yuan , Hajifathalian Kaveh , Ezzati Majid , Rimm Eric , Danaei Goodarz
Published: July 2021

Introduction:
Health disparities remain pervasive in US and eliminating such disparities is one of the overarching goals of the Healthy People 2020 agenda. Previous studies have assessed the disparities in risk of coronary heart disease (CHD) mortality by race/ethnicity, but most of them only focused on the average CHD risk without taking into account the full risk distribution which would enable analysis of specific high-risk sub-groups. In this study, we estimated the 10-year risk distribution of CHD mortality based on 5 leading modifiable risk factors in US (i.e. smoking, adiposity, high blood pressure, serum cholesterol and blood glucose). We quantified the racial disparities in absolute CHD risk while accounting for full risk distribution.

Methods:
We included 3866 individuals aged 45 to 74 years, who were black or white, non-pregnant, free of CHD and had measurements of all 5 risk factors from 6 consecutive 2-year cycles of the National Health and Nutrition Examination Survey 1999-2010. We used mortality data from National Center for Health Statistics to estimate the cause-age-sex-race specific mortality in 2010. We also obtained hazard ratios of the selected 5 risk factors on CHD mortality from large meta-analyses of epidemiological studies. We predicted the 10-year risk of CHD death for each individual by simulating their survival process from 2010 to 2020 incorporating competing risks by death from other correlated causes. To assess health disparities, we compared the 5
th
, 25
th
, 50
th
, 75
th
and 95
th
percentile of the predicted risks between black and white by age and sex.

Results:
More than half of the black and white population aged 45 to 74 years had a low 10-year risk of CHD death (< 2%). The age-sex-race specific distributions of 10-year CHD risk were right-skewed with a large proportion of population on the low risk tail. Comparing to white, black had similar shape of CHD risk distributions, but higher risk levels at all percentiles across age and sex groups. In 55-64 ages where CHD was the major cause of death, the median of CHD risk for black males was 2.9% (interquartile range (IQR) 1.7% - 4.4%), which was 0.7% larger than that for white males (2.2%, IQR 1.4% - 3.3%). This risk difference was similar in females: the median CHD risk for black females was 1.6% (IQR 0.9% - 2.4%) and 0.9% for white females (IQR 0.5% - 1.5%). The disparities became larger on the high risk tail (95
th
percentile of predicted risk), where black had 2.7% higher risk for male and 2.3% for female in 55-64 ages. In older age groups (65-74 ages), such difference increased to 3.5% for both male and female.

Conclusions:
This analysis showed a skewed 10-year CHD risk distribution in US. The racial disparities are larger in the high risk sub-groups compared to those in the center of the risk distribution, indicating that the high risk subgroups should be the target population of intervention that aims to reduce health disparities in US.
Abstract P167: The Body Adiposity Index in Africans is a more Practical Measure of Percent Fat than Bioelectric Impedance
Authors: Courville Amber B , Bello Dilatat , Thoreson Caroline K , O'Connor Michelle Y , Chung Stephanie T , Ricks Madia , Sumner Anne E
Published: July 2021

As the obesity epidemic overtakes Africa, practical methods to measure percent body fat need identification. Possibilities which have not been validated in Africans are the Body Adiposity Index (BAI), which uses hip circumference and height and the same formula for men and women, and bioelectric impedance (BIA) derived from NHANES III data and uses different equations for men and women. Using dual-energy X-ray absorptiometry (DXA) scans as the reference method, 107 Africans (71% male; age 39.5∓10.3 y, range 22 to 64 y; BMI 27.9∓4.5 kg/m
2
, range 19.7 to 41.2 kg/m
2
) had percent body fat assessed in two ways. Method 1 was: BAI (Hip circumference/Height
1.5
)-18). Method 2 was: BIA (Men: weight - (-10.678 + 0.262*weight + 0.652*height
2
/resistance + 0.015*resistance))/weight*100; Women: (weight - (-9.529 + 0.168*weight + 0.696*height
2
/resistance + 0.016*resistance))/weight*100)). Percent body fat by DXA, BAI and BIA are shown in the Figure. Concordance was between 0.5 and 0.6 with
P
<0.001 for DXA and BAI as well as between DXA and BIA. Bland-Altman analyses revealed the BAI estimated percent body fat with a mean difference of 1.1% and limits of agreement of -9.7 and 11.9. With BIA the mean difference was 6.0% and the limits of agreement were -2.3 and 14.4.The BAI and BIA are similar in accuracy, but BAI is easier to apply as it requires only hip circumference and height measurements and uses the same equation for men and women. Therefore, BAI is a superior measure of body fat for both clinical and epidemiological studies in Africans.
Abstract P176: Cardiovascular Disease Risk among West African Immigrants in the US: the AFRO-CardiAC study
Authors: Commodore-Mensah Yvonne Y , Agyemang Charles O , Aboagye Jonathan K , Abu-Bonsrah Nancy , Himmelfarb Cheryl R
Published: July 2021

Introduction:
There are research gaps on cardiovascular disease (CVD) risk of the burgeoning West-African immigrants (WAI) in the United States (US) because they are lumped into the racial category of “Black/African-American”. The epidemiological transition in Africa suggests that WAI may be at high risk for CVD prior to migration, which may worsen with increased years of US residence. We sought to examine the global CVD risk using the 10-year Framingham CVD score (FRS10), CVD risk factors and identify independent predictors of increased CVD risk, among WAI.

Methods:
The “AFRO-CardiAC” study is a community-based cross-sectional study among first generation WAI aged 35-74 years, born in Ghana/Nigeria and residing in the Washington, D.C metropolis. Cardiovascular disease risk factors (total cholesterol, HDL cholesterol, hypertension (HTN), diabetes, smoking and body mass index) and health behaviors were determined according to AHA guidelines. Descriptive statistics were performed on participant’s FRS10 and CVD risk factors with comparison by sex. Participants with FRS10 below 10% were deemed low risk and those at ≥ 10% were classified as high risk. A multivariate logistic regression was fitted to identify independent risk factors associated with high CVD risk.

Results:
A total of 145 participants have been recruited to date; aged 50±8.5years and 61% female. The majority (72%; 104/145) have resided in the US for more than 10 years. The overall prevalence of HTN was 53% with no significant difference between males (46%) and females (57%)[p=0.201]. The prevalence of overweight/obesity was 94% in females and 82% in males (p<0.0001). Only one participant reported smoking and 15% were diabetic, with no sex differences (males 20 % and females 12 %). Males had a significantly higher mean FRS10 (11.10±8.85) than females (6.66±6.48) [p=0.0016]. Also, 13%, 23%, 64% (n=56) of males were classified as having high, intermediate and low risk of CVD compared to 3%, 20%, and 77% of females (n=87)[p=0.082]. The predictors of high CVD risk using dichotomized FRS10 categories (<10% vs. ≥10%) as the outcome included increasing length of stay in the US, [Odds Ratio (OR):1.12, 95%CI: 1.04-1.20,p= 0.001], unemployment[OR:7.0, 95% CI: 1.69-29.79, p=0.008] and household income less than $25,000 (OR: 4.17, 95%CI:1.33-13.08,p=0.014)

Conclusion:
In conclusion, this preliminary analysis of an ongoing study shows a high prevalence of major CVD risk factors in relatively young WAI. Males had a significantly higher global CVD risk although females had a striking prevalence of overweight/obesity. Employment was protective against high CVD risk while lower income and longer stay in the US were associated with higher CVD risk. These data suggest a need for CVD prevention strategies that are tailored to the needs of the WAI with consideration of socioeconomic status and gender.
Abstract P178: Dairy Consumption and Risk of Becoming Overweight or Obese in Middle-Aged and Older Women.
Authors: Rautiainen Susanne , Wang Lu , Lee I-Min , Manson JoAnn E , Buring Julie E , Sesso Howard D
Published: July 2021

Background:
Dairy products have been positively associated with weight loss and inversely associated with weight gain. However, limited number of studies has investigated the role of dairy consumption in the prevention of becoming overweight or obese. The aim of this study was to prospectively investigate how consumption of dairy products was associated with the risk of becoming overweight or obese among initially normal-weight women.

Methods:
We studied 19,180 women aged ≥45y from the Women’s Health Study free of cardiovascular disease (CVD), cancer, and diabetes with an initial body mass index (BMI) of 18.5-<25 kg/m
2
. Dairy intake was assessed through a 131-item food-frequency questionnaire. Total dairy intake was defined as the sum of servings per day of low-fat dairy products (skim/low-fat milk, sherbet, yogurt, and cottage/ricotta cheese) and high-fat dairy products (whole milk, cream, sour cream, ice cream, cream cheese, other cheese, and butter). Women self-reported body weight along with obesity-related risk factors on baseline and annual follow-up questionnaires. In multivariable-adjusted analyses, we included the following covariates: baseline age, randomization treatment, BMI, smoking status, vigorous exercise, postmenopausal status, postmenopausal hormone use, history of hypercholesterolemia, history of hypertension, multivitamin use, alcohol intake, total energy intake, and fruit and vegetable intake.

Results:
During a mean follow-up of 11.2y (216,979 person-years), 8,582 women became overweight or obese (BMI ≥25 kg/m
2
). The multivariable-adjusted mean changes in body weight (95% confidence interval (CI)) during the follow-up were 3.9 (3.5-4.3), 3.9 (3.5-4.2), 3.8 (3.5-4.2), 3.7 (3.4-4.1), and 3.4 (3.0-3.7) lbs in quintiles 1-5 of total dairy consumption (P-trend: 0.01), respectively. In multivariable-adjusted analyses
(Table 1)
, women in the highest versus lowest quintile of had a rate ratio (RR) of 0.91 (0.84-0.98, P-trend: 0.16) of becoming overweight or obese. No associations were observed in highest quintiles of low-fat dairy and high-fat dairy intakes.

Conclusion:
Greater consumption of dairy products may be inversely ssociated with risk of becoming overweight or obese in women.