bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P175: Predictors of Long Term Blood Pressure Variability in Young Adulthood Through Middle Age: The Coronary Artery Risk Development in Young Adults Study
Authors: Tedla Yacob , Yano Yuichiro , Carnethon Mercedes , Greenland Philip , Lloyd-Jones Donald
Published: July 2021

Introduction:
Long-term blood pressure variability (BPV) refers to fluctuation in BP that occur over weeks, months and years. BPV has been identified as a risk factor for the development of subclinical and clinical cardiovascular events independent of mean BP. However, little is known about the factors associated with long-term BPV. We hypothesized that long-term BPV will vary by demographic, behavioral, anthropometric, lab, and clinical factors.

Methods:
Using data from the CARDIA study – a longitudinal population based cohort study, we investigated whether baseline demographics (age, sex, race, education); behavioral factors (smoking, alcohol intake, physical activity); anthropometric measures (height, weight, body mass index - BMI); lab markers (total cholesterol, high density lipoprotein cholesterol - HDL-C, low density lipoprotein cholesterol – LDL-C, triglycerides, fasting blood glucose, glomerular filtration rate - GFR); and history of asthma are associated with different indictors of long-term BPV. Variability independent of the mean (VIM) and coefficient of variation (CV) of BP were calculated to quantify within-individual long-term BPV from baseline to visit 9 across 30 years. A least absolute shrinkage and selection operator (lasso) linear regression was used to identify variables that may be associated with long-term BPV and multivariate linear regression models were used to assess magnitude of association.

Results:
Participants were 3,095 individuals who were not taking antihypertensive medication (mean age 24.6 years, 45.5% male and 56.9% white). Mean VIM was 8.5 mmHg (SD=3.7) for systolic and 7.1 mmHg (SD=3.2) for diastolic BP. Age, sex, race, education, physical activity, alcohol intake, pack-years of smoking, height, weight, triglyceride, LDL-C and asthma were potential correlates of VIM or CV of diastolic BP by the lasso model. In addition to those variables, total cholesterol, HDL-C, fasting glucose, and GFR were potential correlates of VIM or CV of systolic BP. Variables that significantly associated with VIM of systolic BP were: age (years) (β=0.11, p<0.001), white race (β= -0.94, p<0.001), female sex (β=1.36, p<0.001), alcohol intake (drinks/wk) (β=0.01, p=0.001), height (cm) (β= -0.03, p=0.001), and history asthma (β=-0.47, p=0.02). Consistent findings were observed when the outcome was CV of systolic BP. VIM of diastolic BP was also significantly associated with age (β= -0.09, p<0.001) white race (β= -0.47, p=0.26), pack-years (β=0.06, p<0.001), height (cm) (β= -0.03, p<0.001), and history asthma (β=-0.47, p=0.01). The same variables were significantly associated with CV of diastolic BP.

Conclusion:
Identifying factors associated with long-term BPV can be useful to detect individuals who may be at a greater risk for future higher long-term BPV, which in turn is associated with greater cardiovascular risk.
Abstract P181: Contribution of C-Reactive Protein to Racial Disparities in Incident Hypertension: The REasons for Geographic And Racial Differences in Stroke Study (REGARDS)
Authors: Plante Timothy B , Long D L , Howard George , Carson April P , Howard Virginia J , Judd Suzanne E , Jenny Nancy S , Zakai Neil A , Cushman Mary
Published: July 2021

Introduction:
In the US, blacks are at higher risk of hypertension than whites. The single largest contributor to this disparity is the Southern Diet pattern. Inflammation biomarkers are associated with risk of hypertension, and C-reactive protein (CRP) is higher in blacks than whites. We studied whether elevated CRP in blacks relative to whites contributes to the racial disparity in hypertension in blacks.

Methods:
We included 6,548 black and white men and women age ≥45 years from the REGARDS cohort without hypertension at baseline ('03-'07) and who completed visit 2 in '13-'16. Incident hypertension was defined as BP ≥140/90 mm Hg or hypertension medication use at visit 2. Using logistic regression, the black:white odds ratio (OR) for incident hypertension was calculated adjusting for age, sex, race, and baseline SBP. We assessed the percent change in the black:white OR for incident hypertension after adding CRP. The 95% CI was calculated using 1,000 bootstrapped samples. We determined the impact of known hypertension risk factors and anti-inflammatory medications on the percent mediation by CRP.

Results:
Hypertension developed in 46% of blacks and 33% of whites. Adjusting for demographics, the black:white OR (95% CI) was 1.51, which was reduced to 1.46, a 9.3% reduction (95% CI 5.4%, 13.2%) by CRP (Table). In models including exercise, waist circumference, BMI, and depressive symptoms, the percent mediation by CRP was 3.7% (1.0%, 6.4%). Similar patterns were seen for models incorporating socioeconomic factors and medication use. After adding Southern diet pattern and dietary Na/K ratio, CRP no longer attenuated the association (1.3% mediation; -1.5, 4.1).

Conclusions:
CRP significantly attenuated the black-white difference in incident hypertension; however, once dietary factors were accounted for, CRP had no impact on the black:white difference in incident hypertension. Thus, inflammation as measured by CRP, may be part of the reason that dietary factors influence the black:white disparity in incident hypertension.
Abstract P185: Racial Disparities in Statin Use Among Persons With HIV: The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)
Authors: Cowen Avery , Pawlowski Anna , Schneider Daniel , Lloyd-Jones Donald M , Feinstein Matthew J
Published: July 2021

Background:
Few studies have evaluated utilization of ASCVD-preventive therapies, such as statins, among PLWH. Although disparities by race, sex, and insurance status in statin utilization exist in the general population, the extent to which these disparities exist among PLWH - a population with a distinct demographic and risk factor profile - is unknown.

Methods:
We compared statin utilization rates by race for the 3252 black and white PLWH in HIVE-4CVD who received care at Northwestern Medicine between 1/1/2000 and 5/17/2017. Persons were considered as having an indication for statin therapy if they had one or more of the following: (1) diabetes mellitus; (2) coronary heart disease; (3) a total cholesterol level of ≥240 mg/dL; and/or (4) calculated 10-year ASCVD risk of ≥7.5%. We compared statin utilization between black and white PLWH overall and stratified by insurance status. Multivariable-adjusted logistic regression adjusted for age, sex, and insurance status then was used to compare statin utilization for black vs. white PLWH with statin indications.

Results:
Of 1680 white PLWH and 1572 black PLWH, 610 whites (36.3%) and 508 blacks (32.3%) had at least one indication for statin therapy. Among PLWH with statin indications, whites were significantly more likely than blacks to be taking statins (60.0% vs. 42.1%, p<0.001; Figure 1). This pattern persisted when analyses were stratified by insurance status. After adjustment for age, sex, and insurance status, black PLWH with statin indications were significantly less likely than their white counterparts to be taking statins (Odds ratio for blacks vs. whites = 0.56 , 95% CI 0.46-0.68, p<0.001).

Conclusions:
Among PLWH with indications for statin use, blacks were significantly less likely than whites to be taking statins, even after adjustment for age, sex, and insurance status. Further studies of real-world statin use among PLWH are needed to understand reasons for disparities.
Abstract P203: Serum Metabolites Associate With Blood Pressure Phenotypes in the Bogalusa Heart Study
Authors: He William , Li Changwei , Mi Xuenan , Li Shengxu , Bazzano Lydia , Chen Wei , He Jiang , Kelly Tanika
Published: July 2021

We conducted a metabolome-wide association study to identify blood pressure (BP)-related metabolites among 825 white and 436 African-American Bogalusa Heart Study (BHS) participants. After quality control, 1,202 metabolites were tested for association with systolic BP (SBP), diastolic BP (DBP), and hypertension in race-stratified analyses. Multiple regressions were used to adjust for age, sex, education, cigarette smoking, alcohol drinking, physical activity, and body mass index. Weighted correlation network analysis was utilized to identify modules of co-abundant metabolites that associated with covariable adjusted BP phenotypes. After Bonferroni corrections, 16 metabolites from amino acid, cofactor and vitamin, lipid, carbohydrate, and peptide pathways in whites and one from the carbohydrate pathway in African-Americans significantly associated with BP phenotypes. Two novel and one previously reported metabolite consistently associated with hypertension across race groups (
Table
). Among whites, modules consisting primarily of lipid metabolites including phosphatidylcholines, phosphatidylinositol and lysophospholipids (
P
=1.0х10
-3
and 6.0х10
-4
for SBP and DBP, respectively), monoacylglycerols and lysophospholipids (
P
=3.0х10
-4
and 7.0х10
-5
for SBP and DBP, respectively), and phosphatidylethanolamines, mono- and diacylglycerols, and lysophospholipids (
P
=4.0х10
-4
and 4.9х10
-4
for SBP and hypertension, respectively) were identified. In addition, modules consisting primarily of amino acids and peptides such as gamma-glutamyl amino acid metabolites and those involved in leucine, isoleucine and valine metabolism were significant in both African-Americans
(P=
2.0х10
-3
and 1.5х10
-3
for DBP and hypertension, respectively) and whites (
P
=7.1х10
-4
for hypertension). In aggregate, the current analysis identified novel metabolites and metabolite modules involved in BP regulation. These data add to the accumulating evidence that serum metabolites may play an important role in BP.
Abstract P209: Heterogeneity of Absolute/Relative Measures of Cardiovascular Mortality Among Cohorts in an Individual Participant Data Meta-Analysis: An EPOCH-JAPAN Study
Authors: Murakami Yoshitaka , Okamura Tomonori , Miura Katsuyuki , Ueshima Hirotsugu ,   EPOCH-JAPAN Rsch investigators
Published: July 2021

Introduction:
Individual participant data (IPD) meta-analyses involve participant-level data from multiple cohort studies. However, these cohorts have different periods (years) of follow-up, target regions, and distributions of risk factors (including patient age). It remains unclear if these variations affect the heterogeneity of absolute/relative measures of mortality in cardiovascular disease (CVD), stroke, and coronary heart disease (CHD) among cohorts.

Hypothesis:
There is diverse heterogeneity in absolute measures of mortality, but negligible heterogeneity in relative measures among cohorts in IPD meta-analyses.

Methods:
The Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN) study is an IPD meta-analysis of cardiovascular epidemiology. This project comprises 14 cohort studies with 105,945 Japanese subjects (total CVD deaths: 5,314). First, we examined the correlation between the follow-up periods of the baseline surveys and multivariate-adjusted mortality rates (CVD, stroke, and CHD) among the cohorts. Next, we estimated the cohort-specific mortality rates that adjusted for the stated follow-up periods, regions, age, and other risk factors using Poisson regression. Finally, we explored the heterogeneity of multivariate-adjusted mortality rates, mortality rate ratios, and rate ratios of 10-mmHg increases in systolic blood pressure using Higgins’s I
2
, which measures heterogeneity in meta-analyses.

Results:
High correlations were observed between the stated follow-up periods of the cohorts and their mortality rates (CVD [men, -0.70; women, -0.79], stroke [men, -0.65; women, -0.73], CHD [men, -0.24; women, -0.89]). In the multivariate-adjusted mortality rates, we observed clear heterogeneity in mortality rates among the cohorts (CVD [I
2
: men, 98.6%; women, 99.3%], stroke [I
2
: men, 98.5%; women, 98.3%], and CHD [I
2
: men, 98.2%; women 92.4%]). In the rate ratio comparison of 10-mmHg increases in systolic blood pressure, no heterogeneity was detected among the cohorts (CVD [I
2
: men, 0.0%; women, 17.9%]). Our results indicated that the ratio measure, which shows the magnitude of each risk factor, was stable even in the heterogeneity of absolute measures.

Conclusions:
A clear heterogeneity in mortality was observed in absolute measures, but not in relative measures, among cohorts after adjusting for the periods of follow-up, regions, and other risk factors.
Abstract P214: Dietary Adherence and Dietary Quality Are Associated With Weight Loss Success Among Those Following Low-fat and Low-carbohydrate Diets
Authors: Hauser Michelle E , Hartle Jennifer , Qin FeiFei , Rigdon Joseph , Del Gobbo Liana , Shih Cindy , Gardner Christopher D
Published: July 2021

Introduction:
Dietary modification is the cornerstone of most successful weight loss strategies. Low-fat and low-carbohydrate diets are among the most studied approaches, but neither has been shown to be consistently superior for weight loss in the general population. Previous studies suggest that eating a high-quality diet or adhering to a given dietary strategy may influence weight loss, however these two factors have not been examined concurrently for those following macronutrient-limiting diets.

Objective:
To determine whether improvement in dietary quality, change in dietary macronutrient composition or the combination of these factors leads to differential weight loss for those instructed to follow a healthy low-fat (HLF) or healthy low-carbohydrate (HLC) diet.

Methods:
Generally healthy, non-diabetic adults, aged 18-50 years, BMI 28-40 kg/m
2
, were randomized to HLF or HLC diets for 12 months (n=609) as part of the DIETFITS weight loss study. Participants that provided complete 24-hour dietary recall data at baseline and 12 months were included in this secondary analysis (n=448; n=224 HLF, n=224 HLC). Within each diet assignment arm, our analysis divided participants into four subgroups according to 12-month change in diet quality score (HEI-2010, above the median was defined as high quality (HQ); below the median was defined as low quality (LQ)) and 12-month change in macronutrient intake (below the median was defined as high adherence (HA) and above the median was defined as low adherence (LA) for fat (g) or digestible carbohydrate (g) for HLF and HLC, respectively). Multiple linear regression adjusted for age, sex, baseline weight and baseline fat (or digestible carbohydrate) intake was used to compare the primary outcome, baseline to 12-month change in mean BMI (kg/m
2
), for those in the HQ/HA, HQ/LA, LQ/HA subgroups versus the LQ/LA subgroup within HLF and HLC.

Results:
For HLF, changes (95% CI) in mean BMI were -1.11 kg/m
2
(-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup. For HLC, changes (95% CI) in mean BMI were -1.15 kg/m
2
(-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup.

Conclusions:
Within both the HLF and HLC diet arms, the 12-month decrease in BMI was significantly greater for those in the High Quality/High Adherence subgroups relative to the Low Quality/Low Adherence subgroups. Neither High Quality nor High Adherence alone were significantly different than the Low Quality/Low Adherence subgroups. While further investigation is needed, the results of this secondary analysis support the importance of the combination of dietary adherence and high-quality diets for weight loss.
Abstract P217: Dietary Habits Associated With 6- and 24-month Weight Loss Maintenance in Primary Care Patients
Authors: Barone Gibbs Bethany , Tudorascu Dana , Bryce Cindy , Comer Diane , Fischer Gary , Hess Rachel , Huber Kimberly , McTigue Kathleen , Simkin-Silverman Laurey , Conroy Margaret B
Published: July 2021

Introduction:
Though weight loss can improve health, weight regain is common. Primary care physicians are uniquely positioned to provide counseling for weight loss maintenance given their longitudinal care of patients, yet evidence of simple lifestyle recommendations for maintaining weight loss in primary care patients is lacking. Our objective was to characterize longitudinal associations between diet habits and weight change among primary care patients with recent, intentional weight loss of at least 5%.

Methods:
This was a secondary analysis of data from a weight loss maintenance clinical trial in a primary care setting that compared two interventions delivered through the electronic health record: continued coaching vs. tracking only. Dietary habits [fried foods, desserts, fruits and vegetables (F&V), and sugar-sweetened beverages (SSB)] were measured by the Connor Diet Habits Survey. Linear regression models were used to evaluate associations (overall and by randomized group) between changes in dietary habits and weight separately at 6- and 24-month follow-up, adjusted for baseline diet habit, age, gender and clinic location.

Results:
Participants (n=192) were 74% female, 87% white and had baseline mean (SD) age of 53 (12) years, body mass index of 30.4 (5.9) kg/m
2
, and recent weight loss of 11 (8) percent. Overall, participants had mean (SD) weight loss of 0.18 (5.04) kg at 6 months (n=169) and weight gain of 3.26 (7.60) kg at 24 months (n=140). At 6 months, a 1 serving per week increase in dessert intake was associated with 0.53 kg (p=0.030) greater weight gain. Fried foods, F&V, and SSB were not associated with 6-month weight changes. However, by 24 months, an increase of 1 serving per week was associated with greater weight gain of 0.54 kg (p=0.043) for fried foods, 0.80 kg (p=0.031) for desserts, and 2.01 kg (p=0.002) for SSB. A decrease of 1 F&V serving per day was associated with a 0.82 kg (p=0.008) greater weight gain at 24 months. When stratified by randomized group, associations were stronger in the continued coaching vs. tracking only arm.

Conclusions:
Increased consumption of desserts was associated with weight regain at 6 and 24 months, while increased fried foods and SSB, and decreased F&V were associated with weight regain at 24 months. These data suggest that simple strategies such as improving or at least maintaining dietary intake of fried foods, desserts, F&V, and SSB could help facilitate long-term weight loss maintenance in primary care patients.
Abstract P229: Cost-Effectiveness of a US National Sugar-Sweetened Beverage Tax Using a Multi-Stakeholder Approach
Authors: Wilde Parke , Huang Yue , Sy Stephen , Abrahams-Gessel Shafika , Jardim Thiago V , Paarlberg Robert , Mozaffarian Dariush , Micha Renata , Gaziano Tom A
Published: July 2021

Introduction:
Taxes on sugar-sweetened beverage (SSB) purchases have emerged as a policy tool to lower obesity, diabetes and CVD risks. Prior cost-effectiveness analyses included SSB tax administration costs yet ignored tax payments as mere transfers from a societal perspective. Yet, tax payments could count as revenues for the government and as costs for consumers and the SSB industry. Corresponding health and economic impacts for different stakeholders, essential to guide decision-making, are not established.

Aim:
To estimate the health impact and cost-effectiveness of a national penny-per-ounce SSB tax from the healthcare perspective, societal perspective, and across 9 stakeholder groups: 6 consumer categories classified by insurance status (and reflecting varying SSB intake and risk factors), the government, the beverage industry, and other private sector.

Methods:
A validated microsimulation model (CVD PREDICT) was used to estimate CVD reductions, quality-adjusted life-years (QALYs) gained, costs, and cost-effectiveness among US adults (35+ years), evaluating both 100% and 50% price pass-through to consumers. Model inputs included dietary and demographic data from NHANES, policy effects on consumer intake and SSB-disease effects from meta-analyses, policy costs for tax administration based on the Berkeley tax, and validated healthcare costs. Findings were evaluated over a lifetime, with costs inflated to constant 2017 US dollars and outcomes discounted annually by 3%.

Results:
With 100% pass-through, the tax prevented 518,000 CVD events among US adults 35+ years over a lifetime and was cost-saving from a societal perspective. Lifetime discounted healthcare cost savings ($31.5bn) were 24 times as large as tax implementation costs ($1.3bn). Evaluating cost-effectiveness by stakeholder, for the 6 consumer categories, the tax was not cost saving, but incremental cost-effectiveness ratios (ICERs) each were <$50,000/QALY. For the government, tax revenues and healthcare savings were positive, netting $73.7bn in savings. For the beverage industry, net costs were $0.63bn (limited to tax compliance costs). With 50% pass-through, the tax would prevent 279,000 CVD events over a lifetime and remained cost-saving from a societal perspective. Government healthcare savings were approximately half as large, while consumer ICERs all remained <$50,000/QALY. For the beverage industry, tax costs were $33.64bn, much larger than with 100% pass-through, reflecting lower producer revenue per unit sold. Findings were robust to a range of sensitivity analyses.

Conclusions:
A national SSB tax would improve health and be cost-saving nationally, with varying health impacts and costs across major stakeholders. These novel findings are relevant and timely for policy decisions on continuing expansion of SSB taxes.
Abstract P238: Remission/Cure of Autoimmune Diseases by a Lectin Limite Diet Supplemented With Probiotics, Prebiotics, and Polyphenols
Authors: Gundry Steven R
Published: July 2021

All autoimmune diseases are highly associated with increased rates of coronary artery and vascular disease secondary to immune cell attack on epithelial cells. The causes of autoimmune disease (AID) seem to be multifactorial. However, the idea that derangement of the microbiome, breaches of the intestinal barrier (leaky gut) and introduction into the human diet of plant defense molecules such as lectins, which are capable of molecular mimicry, prompted our group to investigate the application of a lectin limited diet, coupled with probiotics and prebiotics (The Pant Paradox Protocol) to impact biomarker proven autoimmune disease activity in humans and their impact on endothelial biomarkers of inflammation.

One hundred and two consecutive patients with immunoassay markers of autoimmune disease activity, i.e., RF, anti-CCP, ANA, Histone, etc, and signs and symptoms of RA, Lupus, Sjogrens, Crohns, Colitis, Scleroderma, Mixed Connective Tissue Disease, and biomarkers of endothelial inflammation, were enrolled into a program of elimination of major dietary lectins, consisting of all grains and pseudo grains, beans and legumes, peanuts, cashews, nightshades, squashes, and Casein A1 milk products (The Plant Paradox Program), supplemented with probiotics and prebiotics including resistant starches and polyphenol supplements. All pts initially low Vit D levels and low Omega 3 index and adiponectin levels above 16mg/dl. Biomarkers of inflammation, hs-CRP, TNF-alpha, IL-6, fibrinogen, myeloperoxidase and autoimmune markers were measured every 3 months.

95/102 patients achieved complete resolution of autoimmune markers and inflammatory markers within 9 months. The other 7/102 patients all had reduced markers, but incomplete resolution. 80/102 patients were weaned from all immunosuppressive and/or biologic medications without rebound.

We conclude that a lectin limited diet, supplemented with pro and prebiotics, and polyphenols are capable of curing or putting into remission most autoimmune diseases.
Abstract P239: Adipose Tissue Palmitoleic Acid is Inversely Associated With Nonfatal Acute Myocardial Infarction in the Costa Rica Heart Study
Authors: Luan Danny , Wang Dongqing , Campos Hannia , Baylin Ana
Published: July 2021

Background:
Animal models have shown that adipose-derived palmitoleic acid may act as a lipokine by conferring resistance to diet-induced obesity; however, human epidemiologic studies investigating this relationship thus far have not provided data in support of this hypothesis. Because metabolic syndrome and cardiovascular disease are intricately linked with the former being a major risk factor for the latter, we hypothesized that adipose-derived palmitoleic acid may be inversely associated with myocardial infarction.

Objective:
We examined whether adipose tissue palmitoleic acid was associated with nonfatal acute myocardial infarction in a representative population of Costa Rican adults.

Methods:
Odds ratios of nonfatal acute myocardial infarction by quintiles of adipose tissue palmitoleic acid were calculated using conditional logistic regression in a case-control study of 1,828 cases and 1,828 controls matched by age, sex, and area of residence.

Results:
We observed an inverse relationship between nonfatal acute myocardial infarction and adipose tissue palmitoleic acid (OR for highest quintile compared to lowest quintile of palmitoleic acid: 0.54; 95% CI: 0.37, 0.79;
P
for trend: 0.0007). We additionally observed a significant positive association between adipose tissue palmitoleic acid and high-density lipoprotein (HDL) cholesterol, an important cardiometabolic risk factor for myocardial infarction.

Conclusions:
These data support the conclusion that adipose-derived palmitoleic acid may behave as a lipokine in the context of human myocardial infarction. This protective association may be partially explained by the increase in HDL cholesterol across quartiles of palmitoleic acid in our population of Costa Rican adults.
Abstract P259: Improvements in Diet Quality Are Associated With Reduced Abdominal Adiposetissue: A Prospective Study
Authors: Hennein Rachel , Ma Jiantao , Long Michelle , Liu Chunyu , Levy Daniel
Published: July 2021

Objectives:
Visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) are associated with cardiometabolic diseases. The relationship between diet quality and abdominal fat accumulation, however, has not been well studied. We aimed to examine the long-term association of change in diet quality and change in abdominal adipose tissue.

Methods:
In 1,677 participants who attended two consecutive Framingham Heart Study examinations, we measured the volume of VAT and SAT using multi-detector computed tomography at two time-points (median interval of 6 years). The ratio of VAT/SAT was calculated to reflect the relative abundance of these two fat stores, i.e., abdominal fat distribution. We created two scores to represent overall diet quality, the Mediterranean-style diet score (MDS) and the Alternative Healthy Eating Index (AHEI) score, using food frequency questionnaires at baseline and follow-up exams. We analyzed the association between change in the dietary scores and change in VAT, SAT, and VAT/SAT ratio with adjustment for baseline covariates including sex, age, dietary score, VAT, SAT, or VAT/SAT ratio, BMI, energy intake, smoking status, physical activity score, and change in energy intake, smoking status, and physical activity.

Results:
For each standard deviation increase in ΔMDS (diet quality improved), VAT volume reduced by 53±19 cm
3
(P=0.005) and SAT volume declined by 52±20 cm
3
(P=0.01). Similarly, for each standard deviation increase in ΔAHEI (diet quality improved), VAT volume declined by 45±18 cm
3
(P=0.01) and SAT volume fell by 57±19 cm
3
(P=0.003). In addition, an increased MDS was associated with a decline in VAT/SAT ratio (P=0.04), but there was no association between ΔAHEI and change in VAT/SAT ratio (P=0.06). We also observed that improved intake of nuts (P=0.04), whole grains (P=0.02), and meat (P=0.005) for MDS and fruits (P=0.02) and meat (P=0.03) for AHEI were associated with a decline in VAT/SAT ratio.

Conclusions:
The present study demonstrates that longitudinal improvements in diet quality were associated with reduced abdominal fat accumulation, both VAT and SAT. In addition, improved dietary intake of fruits, nuts, whole grains, and meat may affect abdominal fat distribution, i.e., more likely to reduce fat accumulation in VAT relative to SAT.
Abstract P277: Exercise is Associated With Social Network Characteristics Among South Asian Immigrants
Authors: Thanawala Mitali , Siddique Juned , Cooper Andrew , Schneider John A , Dave Swapna , Kanaya Alka M , Kandula Namratha R
Published: July 2021

Objective:
Low physical activity increases cardiovascular disease (CVD) risk. Social context, operationalized through social networks, has been shown to drive health behaviors. This study examined the association between personal social networks and moderate-to-vigorous leisure-time physical activity (LTPA) among South Asian (Indian, Pakistani, Bangladeshi, Sri Lankan, Nepalese) immigrants, a group with high CVD rates.

Methods:
This study used cross-sectional data from an ancillary study of social networks (2014-2017) in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study cohort. Participants, free from CVD at baseline and living in the San Francisco Bay-area, CA and Chicago, IL, were administered a detailed social networks questionnaire and physical activity questionnaire adapted from the Cross-Cultural Activity Participation Study. Participants reported on the exercise behaviors of each social network member and if they exercised with the network member. Network members who exercised with a participant were categorized as exercise partners. Moderate-vigorous LTPA was calculated as Metabolic Equivalent of Task (MET) minutes per week. Sex-stratified, linear regression models were used to examine associations between social network characteristics and MET-min/week of LTPA, independent of age, marital status, and network size. The effect of having an exercise partner in the network, above simply having network members who exercised, was tested using a partial F-test to compare nested models.

Results:
Among the 700 participants, this analysis only included the 89% who reported any LTPA (n=623, 43% female). These individuals reported a median of 1335 MET-min/week of LTPA (IQR=735-2212 MET-min/week) and had an average of 4 network members (SD +/- 1). The proportion of network members who exercised was 0.89, and the proportion of exercise partners was 0.28. Exercise partners were most commonly spouses (56%) and friends (20%). Among South Asian men who exercised, having a social network member who exercised instead of having a non-exercising network member, significantly increased LTPA by 310 MET-min/wk (95% CI=152-470). For men, having a social network member who was an exercise partner instead of a non-exercising network member, was associated with an additional 520 MET-min/wk of LTPA (95% CI= 344-696). The effect on LTPA of having an exercise partner in the network was significantly greater than the effect of simply having a network member who exercised (p-value < 0.001). Results were similar for women, but not statistically significant (p-value=0.05).

Conclusions:
Among South Asian immigrants, having an exercise partner in one’s personal social network was associated with significantly more LTPA. Social network support, in the form of an exercise partner, may be an effective component of interventions to promote LTPA in South Asians.
Abstract P283: Resistance Exercise Reduces the Risk of Developing Excess Body Fat and Abdominal Obesity
Authors: Brellenthin Angelique G , Lee Duck-chul , Sui Xuemei , Blair Steven
Published: July 2021

Introduction:
Excess body fat and abdominal obesity have been associated with cardiovascular diseases. While aerobic exercise is often recommended to prevent fat accumulation, less evidence exists detailing the specific effects of resistance exercise, independent of or combined with aerobic exercise, on the development of excess body fat and abdominal obesity.

Hypothesis:
We hypothesized that resistance exercise would be associated with a lower incidence of developing excess body fat and abdominal obesity.

Methods:
Participants were 7,685 men and women aged 18 to 89 years (mean age, 46) who received a preventive medical examination during 1987-2005 in the Aerobics Center Longitudinal Study. Participants with a history of myocardial infarction, stroke, cancer, excess body fat, or abdominal obesity at baseline were excluded. Resistance exercise (RE) and meeting the 2008 US Physical Activity Guidelines (RE ≥2 days/week) for RE were determined by self-reported leisure-time exercise. Excess body fat was defined as % body fat (≥25 in men, ≥30 in women) based on underwater weighing or skinfold measurements and abdominal obesity as waist girth (>102 cm in men, >88 cm in women). Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident excess body fat and abdominal obesity by RE levels after adjusting for baseline age, sex, examination year, body weight, current smoking, heavy alcohol drinking, and meeting aerobic exercise (AE) guidelines (≥500 MET-minutes per week).

Results:
During an average follow-up of 5 years, 1517 (20%) developed excess body fat and 552 (14%) developed abdominal obesity. Individuals meeting the RE guidelines (30%; 2323 of 7685) had a 26% and 25% lower risk of developing excess body fat (HR: 0.74; 95% CI: 0.65 to 0.84) and abdominal obesity (HR: 0.75; 95% CI: 0.61 to 0.92), respectively, after adjusting for potential confounders including AE. The HRs (95% CIs) of incident abdominal obesity were 0.70 (0.48-1.01), 0.62 (0.44-0.87), 0.98 (0.67-1.42), and 0.62 (0.42-0.91), while the HRs (95% CIs) of incident excess body fat were 0.84 (0.69-1.03), 0.71 (0.59-0.86), 0.75 (0.59-0.96), and 0.56 (0.43-0.72), in weekly RE time of 1-59, 60-119, 120-179, and ≥180 minutes/week, respectively, compared with no RE. In the combined analysis of RE and AE, HRs (95% CIs) of incident excess body fat and abdominal obesity were 0.71 (0.53-0.95) and 0.62 (0.37-1.04) in meeting RE guidelines only, 0.86 (0.77-0.97) and 0.80 (0.66-0.97) in meeting AE guidelines only, and 0.65 (0.56-0.75) and 0.62 (0.49-0.79) in meeting both RE and AE guidelines, respectively, compared with meeting none of the guidelines.

Conclusions:
We found that RE, independent of and combined with AE, is associated with a reduced risk of developing excess body fat and abdominal obesity.
Abstract P285: Potential Direct Medical Cost-Savings Attributable to Physical Activity in Major Disease Categories
Authors: Rourk Zachary , Abraham Ivo , Olson Thomas , Snyder Eric
Published: July 2021

Introduction:
Physical activity (PA) is known to be effective in treating and preventing many lifestyle diseases including CVD, stroke, depression, type II diabetes, Alzheimer’s disease, as well as breast and colon cancer. To date the direct medical cost-savings of PA as a medical intervention are poorly understood.

Hypothesis:
We hypothesized that a 10% increase in the proportion of US citizens who meet the minimum weekly exercise requirements of 150 minutes per week would lead to savings in direct medical costs (DMC) and cases prevented, as related to the above diseases.

Methods:
Population Attributable Risk (PAR) was calculated as PAR= (1+Prf x (RR-1))/(Prf x(RR-1)), where Prf is the percentage of the U.S. population not meeting minimum exercise requirements and RR is the relative risk of disease for sedentary versus physically active individuals. Prf and RR data were retrieved from the most recent and comprehensive meta-analyses and systematic reviews. PAR was calculated for each disease under two conditions; first, Prf was equal to the current percent (9.6%) of the population estimated to achieve the minimum weekly PA requirements. Second, Prf was equal to the initial Prf plus 10 percent (19.6%). For each condition the following were calculated: Attributable DMC=(PAR x DMC), preventable cases=(PAR x Prevalence) and Savings=(Condition 2- Condition 1).

Results:
The Prevalence, RR, PAR and DMC are provided in Table 1. This table also describes the potential savings in DMC and new cases by improving the Prf by 10%. A 10% increase in US citizens who meet the minimum weekly exercise requirements could lead to a total savings of 10.78 billion USD in DMC and 2.1 million cases prevented related to the studied diseases.

Conclusion:
A healthcare system directed PA intervention that effectively leads to a 10% increase in US citizens that meet minimum weekly exercise requirements and costs less than 10.78 billion dollars has the potential to be cost-effective, and prevent and treat, millions of cases in the United States.
Abstract P303: Racial Differences in the Associations Between Food Insecurity and Fibroblast Growth Factor 23 (FGF23) in The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Pool Lindsay R , Kershaw Kiarri N , Montag Samantha E , Gordon-Larsen Penny , Gutiérrez Orlando M , Reis Jared P , Isakova Tamara , Wolf Myles , Carnethon Mercedes R
Published: July 2021

Introduction:
Elevated Fibroblast Growth Factor 23 (FGF23) - an endocrine hormone linked to cardiovascular and kidney disease outcomes - is a compensatory response to high dietary phosphate load or chronic kidney disease. Large quantities of inorganic phosphates additives are found in processed foods, and food insecurity is associated with higher consumption of processed foods.

Hypothesis:
We hypothesized that developing food insecurity is associated with an increase in FGF23.

Methods:
We included CARDIA study participants with a stored plasma sample available from at least two consecutive exams at years 20, 25, and 30 (N=3,421). Food insecurity was assessed through a single question about ability to afford quantity and quality of food. FGF23 levels were assessed using a commercial c-terminal ELISA. Due to a strong right skew in FGF23 levels, we divided FGF23 in quartiles and compared the highest quartile to the combined lower three quartiles using logistic regression. Econometric fixed effects models that adjust by design for all time-invariant covariates were used to model the longitudinal association between simultaneous within-person change in food insecurity and FGF23. Due to an interaction between food insecurity and race (
p
=0.002), we stratified by race.

Results:
About 29% of blacks and 14% of whites experienced change in food insecurity during follow-up. Developing food insecurity was associated with a 1.46 greater odds of increasing to the highest quartile of FGF23 (95% CI: 1.02,2.10) among blacks; however, there was no significant longitudinal association among whites (OR=1.05; 95% CI: 0.62,1.77).

Conclusions:
Using models that tightly control for all time-invariant confounding, we found that developing food insecurity was associated with increases in FGF23 among blacks. The differential increases in blacks as compared to whites may be due to differences in dietary changes in response to developing food insecurity. Previous research has shown racial differences in dietary quality by food insecurity.
Abstract P310: Physician Trust and Home Remedy Use Among Low Income Blacks and Whites With Hypertension: Findings From the TRUST Study
Authors: Payne Foster Pamela , Cuffee Yendelela , Alwatban Noof , Minton Maury , Lewis Dwight , Allison Jeroan
Published: July 2021

Introduction:
Home remedies are used for the treatment of hypertension, despite unsubstantiated claims of their effectiveness. Home remedy use is often attributed to mistrust towards healthcare providers. Few studies have examined the relationship between HR use and physician trust. The objective of this study was to examine the correlates of home remedy use and the relationship between trust in physicians in a cohort of low-income Blacks and Whites with hypertension living in an inner-city in the Deep South.

Hypothesis:
We hypothesized that White and Black home remedy users with hypertension would report greater mistrust towards physicians than individuals that were not using home remedies.

Methods:
A cross-sectional examination was conducted among 925 Black and White patients with hypertension receiving care at an urban hospital in the southeastern US. Trust in physicians was self-reported using the Hall General Trust Scale and home remedy use was self-reported using the Brown and Segal scale.

Results:
Twenty-eight percent (219 of 788) of Black and 15% (20 of 137) of White participants reported home remedy use (p=0.001). Black home remedy users and nonusers had similar trust scores (p=0.582). Whites home remedy users reported lower trust in physicians than white nonusers and Black home remedies users and nonusers (p=0.026).

Conclusions:
Black home remedy users, non-users, and White non-users reported similar trust scores. The lowest trust scores were found among White home remedy users. Home remedy use was higher among Black than White participants. This study highlights the importance of examining topics of home remedy use and physician trust among low-income White and Black populations. In conclusion, mistrust towards physicians was associated with greater use of home remedies among White participants with hypertension. Home remedy users may benefit from interventions that bolster trust between patients and providers, and facilitate discussion about home remedy use.
Abstract P338: Adults With Obstructive Sleep Apnea Have Lower Adherence to Weight Loss Behaviors in a Behavioral Weight Loss Intervention
Authors: Kline Christopher E , Burke Lora E , Zheng Yaguang , Sereika Susan M , Imes Christopher C , Mendez Dara D , Rockette-Wagner Bonny J , Strollo Patrick J , Rathbun Stephen L , Chasens Eileen R
Published: July 2021

Introduction:
Obesity is a primary risk factor for obstructive sleep apnea (OSA), and weight loss is a common recommendation for adults with OSA. However, we previously found that adults with OSA lost less weight than those without OSA during a 12-month behavioral weight loss intervention. The potential mechanisms underlying the blunted weight loss among those with OSA are currently unclear; however, one potential explanation may be lower adherence to the intervention and its prescribed behaviors.

Purpose:
These analyses examined whether measures of adherence to a behavioral weight loss intervention differed between adults with and without OSA.

Methods:
The sample was comprised of adults who were overweight or obese (N=114; 50.4±10.5 y, body mass index [BMI]: 34.0±4.6 kg/m
2
; 90.4% female, 82.5% white) who participated in a 12-mo behavioral weight loss intervention study. Participants wore a home sleep testing device (ResMed ApneaLink Plus) for one night at baseline (BL), 6 mo (6M), and 12 mo (12M). Those with an apnea-hypopnea index ≥ 5 were categorized as having OSA. Adherence to the intervention was assessed by: 1) attendance at group intervention sessions over 12 mo; 2) frequency of meeting daily caloric intake goals over 12 mo; 3) objectively-measured changes from BL in physical activity (steps/day, sedentary time, moderate-vigorous physical activity [MVPA]). Linear mixed models estimated the impact of OSA on these measures of intervention adherence following adjustment for sex, age, race, marital status, smoking status, and baseline BMI, while considering participant to be a random effect.

Results:
About half (52%) of the participants had OSA at BL, while 41 % had OSA at 6M. Attendance at group sessions did not differ between those with and without OSA over 12 mo (74.5 vs. 75.7%; P=.72). However, adults with OSA met their caloric intake goal less frequently than those without OSA (25.2 vs. 34.8%; P=.006), and adults with OSA increased their steps/day (+378.3 vs. 1060.1; P=.047) and MVPA min/day (+2.1 vs. +6.4; P=.056) less than those without OSA. Reductions in sedentary behavior (min/day) did not differ between those with and without OSA (-7.1 vs. -9.1; P=.81).

Conclusions:
These data suggest that the blunted weight loss observed among adults with OSA may be at least partially attributable to lower levels of adherence to prescribed goals for caloric intake and physical activity. Additional strategies (e.g., OSA screening and treatment referral, supplemental sessions on diet and MVPA) may be needed to achieve improved adherence to the lifestyle behaviors that lead to weight loss among adults with OSA.
Abstract P342: Associations Between Sleep Duration and Sleep Quality and Long-Term Weight Status in Post-Bariatric Surgery Patients
Authors: Thomas Elsa , Roeshot Devon , Gallagher Dympna , St-Onge Marie-Pierre
Published: July 2021

Introduction:
The prevalence of obesity continues to rise since 1980. This obesity epidemic has been paralleled by a trend of reduced sleep duration and sleep quality throughout the years. However, there is limited research on the relation between sleep duration and quality and its association with weight loss maintenance. The purpose of this study was to examine the association between sleep duration and quality and weight status in post-bariatric surgery patients at 9-y post-surgery. We tested the hypothesis that participants’ post-surgical weight change would be related to sleep duration and quality at 9-y.

Methods:
Sleep data were collected on a subset of participants (mean body weight = 94.1 kg ± 18.9) enrolled in an ancillary study to the Longitudinal Assessment for Bariatric Surgery trial. Self-reported hours of sleep per night and overall sleep quality were assessed once, at the 9-y visit using the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

Results:
Complete data were available on 14 participants (10 females and 4 males, age 52.1 ± 15.6 y), current weight 94 kg ± 18.9. Average total weight loss from pre-surgery was 28.5% ± 10.6, with an average weight gain of 0.3 ± 6.2 % over the last 2 y of follow-up. Participants reported average sleep duration of 6.8 ± 2.0 h/night at the 9-y evaluation visit and an average score of 7.9 ± 3.7 on the PSQI. There was no relation between sleep duration and current weight or percent weight change after maximum weight loss, which occurred around 2-y post-surgery. However, there were trends for an association between sleep quality and percent weight change after maximum weight loss (p=0.057) and percent weight change in the last 2-y of follow-up (p=0.066). In general, participants who lost more weight over the last 2 y of the study had lower scores on the PSQI, indicating better quality of sleep.

Conclusion:
Our results showed no association between sleep quality or duration and long-term changes in weight for patients who underwent bariatric surgery. However, those with better sleep quality tended to have more beneficial changes in weight over the latest 2-y. It is important to note that this study cannot address causality and whether improved weight influenced sleep quality or whether sleep quality influenced weight change. Further studies should examine the temporality of these association. Sleep quality may be an important sleep metric to consider for long-term weight loss maintenance.