bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P050: Natural History Of Prediabetes In Middle-aged Adults
Authors: Wallace Amelia S , Rooney Mary R , Echouffo Tcheugui Justin , Grams Morgan , Selvin Elizabeth
Published: May 2021

Background:
Few studies have examined the natural history of prediabetes, specifically, regression to normoglycemia as well as progression to clinical diabetes. Furthermore, there are several definitions of prediabetes in current use.

Methods:
We conducted a prospective cohort analysis of 8214 participants without diabetes who attended visit 2 (1990-1992) and visit 4 (1996-1998) of the Atherosclerosis Risk in Communities (ARIC) Study. We used multinomial logistic regression to compare cumulative incidence of diabetes and regression to normoglycemia among persons meeting different definitions of prediabetes (American Diabetes Association criteria): fasting glucose (FG) 100-125 mg/dL; A1C 5.7-6.4%; or elevations in both tests (single-sample confirmatory). Incident diabetes was defined as a self-reported diagnosis, medication use, or both FG ≥ 126 mg/dL and A1C ≥ 6.5%; normoglycemia was defined as both FG < 100mg/dL and A1C < 5.7% and no diabetes diagnosis or medication use. Analyses were adjusted for age, sex, and race-center.

Results:
The prevalence of prediabetes at visit 2 (age range, 46-69; 57% female; 17% black) was 37.6% (n=3089) based on FG criteria, 17.4% (n=1427) based on A1C criteria, and 10.6% (N=867) by both FG and A1C criteria. The 6-year cumulative incidence of diabetes was 7.2% in participants with FG-defined prediabetes, 17.1% in participants with A1C-defined prediabetes, and 22.4% in participants meeting both criteria. Among participants with prediabetes by FG criteria, regression to normoglycemia was 1.9 times as likely as progression to diabetes (14.0% vs. 7.2%). However, when prediabetes was defined by A1C and by confirmatory criteria, progression to diabetes was 1.5 times and 3.5 times more likely than regression to normoglycemia, respectively.

Conclusions:
Risks of progression to diabetes and regression to normoglycemia differed by prediabetes definition. Prediabetes identified by A1C criteria and single-sample confirmatory criteria identified people at highest risk for diabetes.
Abstract P053: Increment And Stabilization Of Diabetes Prevalence In The Province Of Quebec, Canada: A Combination Of Lower Mortality And Incidence In Older Adults Only
Authors: O'Connor Sarah , Blais Claudia , Leclerc Jacinthe , Hamel Denis , Dubé Marjolaine , Poirier Paul
Published: May 2021

Introduction:
In the last decade, an increase in the prevalence and a reduction in the incidence of diabetes have been observed in many countries including Canada. Yet, some Canadian provinces depicted an elevation in incidence rates among younger age groups. Our objective was to document these trends in the province of Quebec from fiscal years 2001 to 2017.

Hypothesis:
Prevalence is increasing because of raising incidence in individuals aged <50 years.

Methods:
Prevalence, incidence and all-cause mortality among cases of diabetes ≥20 years were assessed using the Quebec Integrated Chronic Disease Surveillance System (n=6,551,045 in 2017). Estimations were age-standardized or stratified by 10-year age groups.

Results:
In 2017, the crude prevalence and incidence of diabetes were 9.9% [99% confidence interval: 9.9-10.0] (n=651,370) and 6.0 per 1,000 inhabitants [5.9-6.0] (n=35,355), respectively. Between 2001 and 2017, the age-standardized prevalence increased by 43% (6.3% [6.3-6.3] to 9.0% [9.0-9.1]), while age-standardized incidence decreased by 29% (8.3 per 1,000 [8.2-8.4] to 5.9 per 1,000 [5.9-6.0]). In every age group, the prevalence increased steadily with progressive stabilization from 2011 and onward, except for the 60-69 years old group who depicted a reduction from 2012 to 2017. Incidence remained stable among <50 years old, while it decreased for ≥50 years (-26%, -33%, -36% for 50-59, 60-69 and ≥70 years old, respectively) (Figure 1). Age-standardized mortality among adults with diabetes decreased by 24% (20.7 per 1,000 [20.1-21.3] to 15.8 per 1,000 [15.4-16.3]). Mortality rates decreased by 27% among the 40-49 years old, with greater reductions in older age groups (-28%, -35%, -34% in the 50-59, 60-69 and ≥70 years, respectively).

Conclusions:
The rise and stabilization of diabetes prevalence could be due to a reduction in incidence in patients aged ≥50 years and mortality among all age groups. Prevention of diabetes should be a priority among individuals aged <50 years as diabetes incidence is not decreasing.
Abstract P059: Prevalence And Correlates Of Co-occurring Metabolic Syndrome And Chronic Kidney Disease: Findings From The Hispanic Community Health Study/study Of Latinos (hchs/sol)
Authors: Missikpode Celestin , Rosas Sylvia E , Ricardo Ana , Lash James , Khan Unab I , Klein Oana , Raij Leopoldo , Schneiderman Neil , Daviglus Martha L
Published: May 2021

Introduction:
Metabolic syndrome (MetS) and chronic kidney disease (CKD) are highly prevalent among Hispanics/Latinos, yet data on co-occurring MetS and CKD are not available. Understanding the prevalence and correlates of MetS-CKD overlap may inform intervention programs for such subgroups.

Methods:
Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Visit 1 (2008-2011) was used. MetS was defined as the presence of three or more of the following risk factors: abdominal obesity, high triglyceride, low high-density lipoprotein cholesterol level, elevated blood pressure, and elevated glucose level. CKD was defined as eGFR <60 mL/min per 1.73 m
2
or the presence of albuminuria (urine albumin-creatinine ratio ≥17 mg/g in men and ≥25 mg/g in women). Of 16,415 HCHS/SOL participants, data from 14,527 persons with complete information on kidney function measures and covariates were analyzed using logistic regression. Potential correlates included age, sex, Hispanic/Latino background, acculturation, education, income, physical activity, alcohol use, cigarette smoking, cardiovascular disease, hemoglobin, high-sensitivity C-reactive protein, and homeostasis model assessment of insulin resistance (HOMA-IR). Analyses accounted for complex sampling design.

Results:
Average age was 41 years, 52% were women, 33% had prevalent MetS, and 14% had prevalent CKD. MetS and CKD co-occurred in 7.8% of the study population, 8.5% in men and 7.2% in women. The prevalence of co-occurring MetS and CKD was 10.4% in Puerto Rican, 9.2% in Cuban, 7.2% in Central American, 7.2% in Mexican, 6.5% in Dominican, and 5.3% in South American. Factors independently related to those co-occurring conditions were age, sex, physical activity levels, cardiovascular disease, high-sensitivity C-reactive protein, and HOMA-IR (
Table
).

Conclusions:
Targeted prevention efforts that address key modifiable overlapping risk factors may be especially effective in reducing metabolic syndrome and improving kidney health.
Abstract P064: Reducing Diabetes Disparities: Diabetes Screening In Asian Americans Should Begin At A Lower Body Mass Index Threshold
Authors: Aggarwal Rahul , Bibbins-domingo Kirsten , Chiu Nicholas , Wadhera Rishi , Yeh Robert W , Kazi Dhruv
Published: May 2021

Introduction:
Current guidelines recommend diabetes screening in all US adults 40 to 70 years of age who have a body mass index (BMI) ≥25kg/m
2
. Asian Americans are at increased risk of developing diabetes at lower BMIs compared with non-Hispanic Whites, yet the optimal BMI threshold for diabetes screening in Asian Americans is undetermined.

Hypothesis:
Asian Americans aged 40 to 70 years should be screened for diabetes starting at a BMI threshold of lower than 25 kg/m
2
.

Methods:
Using 2013-2018 cycles of NHANES data, we determine the prevalence of diabetes in normal-weight individuals, stratified by race/ethnicity (n = 8,496). Diabetes was diagnosed based on A1c or a health-care diagnosis. We then evaluate the proportion of individuals with diabetes that would be identified by universal screening at different BMI thresholds (sensitivity) and proportion of individuals without diabetes who would be tested based on universal screening at or above a BMI threshold. Analyses were done accounting for complex survey weights to determine national projections.

Results:
Compared with non-Hispanic Whites, normal-weight Asian Americans were more likely to have diabetes (15.3% vs 3.4%, prevalence ratio (PR): 4.5 [95% CI: 2.8-7.4], p<0.001) and undiagnosed diabetes (24.1% vs 11.9%, PR: 2.02 [1.34-3.05], p = 0.002). Universal screening for diabetes in U.S. adults with BMI ≥25 kg/m
2
has a sensitivity of 94.2% [95% CI: 92.8%-95.5%] in non-Hispanic Whites but lower sensitivity of 62.3% (59.0%-65.7%) among Asian Americans (p<0.001). Diabetes screening in Asian Americans with a BMI ≥22 kg/m
2
would have a sensitivity of 91.2% (89.3%-93.1%) and would subject 70.4% (68.2%-72.5%) of adults without diabetes to screening, which is comparable to the performance of the BMI ≥25kg/m
2
threshold in non-Hispanic Whites.

Conclusions:
Lowering the diabetes screening threshold in Asian Americans aged 40 to 70 years from BMI ≥25 kg/m
2
to BMI ≥22 kg/m
2
would provide screening parity between Asian Americans and non-Hispanic Whites.
Abstract P066: Rationale And Design Of A Study To Test The Effect Of Personal Protective Aids On Hypertension And Diabetes In People Exposed To High Levels Of Air Pollution
Authors: Barbhaya Dweep , Khetan Aditya , Tran Jennifer , Jain Supreme , Goel Anubha
Published: May 2021

Background:
Air pollution is the largest environmental cause of disease and premature death in the world today, disproportionally affecting low- and middle-income countries (LMICs) such as India. Numerous studies have shown that exposure to particulate matter <2.5 μm (PM2.5) can contribute to cardiovascular disease and mortality, which is partially attributable to the development of cardiometabolic conditions such as hypertension and diabetes. We hypothesize that the use of personal protective aids (home air-purifier and N-95 mask) can decrease systolic blood pressure (SBP) in people with hypertension and decrease fasting blood glucose (FBG) in those with diabetes.

Method:
This is a prospective randomized cross-over study in Dalkhola, India- an area of high ambient PM2.5 levels. Participants between 18 and 70 years of age with hypertension (n=130) and diabetes (n=33) will be invited to participate in the study. They will be randomized to either an intervention or control arm for 4 weeks, after which they will cross over to the other arm following a 2-week washout period. The intervention period will consist of using an indoor air-purifier at night and an N-95 mask when outdoors. Control period will involve using an identical air purifier and facemask, with the filter removed (sham filtration). Participants and outcome assessors will be blinded.

Outcome evaluation:
The primary outcome of the study is the absolute reduction in SBP among people with hypertension and absolute reduction in FBG among people with diabetes.

Discussion:
This is the first randomized controlled trial to evaluate personal protective aids as a therapeutic measure in people with hypertension and diabetes exposed to high levels of PM2.5. Given the high burden of air pollution in LMICs, there is an urgent need for adaptation measures targeting people at high risk for mortality from this exposure. The results of our study will demonstrate if personal protective aids can be a viable adaptation measure for people living with hypertension and diabetes in areas with a high burden of air pollution.
Abstract P070: Longer Sleep Duration Is Associated With Less Myosteatosis In African Caribbean Adults
Authors: Acevedo-Fontanez Adrianna I , Cvejkus Ryan , Kuipers Allison L , Zmuda Joseph , Wheeler Victor , Miljkovic Iva
Published: May 2021

Introduction:
Skeletal muscle is the largest organ in the human body and vital to maintaining metabolic homeostasis. Increased skeletal muscle fat infiltration (i.e. myosteatosis) is now recognized as a major risk factor for cardio-metabolic diseases, independent of general obesity. Modifications in lifestyle, such as sleep, to reduce myosteatosis would be of great public health importance. However, studies of this relationship often use subjective data and are lacking in minority populations. The aim of this study was to examine the relation between objectively measured sleep duration and myosteatosis at the calf among African Caribbeans.

Methods:
Data were collected on men (n=393) and women (n=438) from the Tobago Health Study. Sleep duration and physical activity was collected using a SenseWear Pro Armband (BodyMedia, Inc.). Participants were instructed to wear the armband at all times, except in water, for 4-7 days. Measures of muscle density, intermuscular adipose tissue (IMAT), and area were obtained by peripheral QCT scans of the calf (Stratec XCT-2000). Model covariates included age, sex, BMI, diabetes, alcohol intake, smoking, and moderate to vigorous physical activity (MVPA). Linear regression was used to assess the relationship of sleep duration on skeletal muscle.

Results:
Mean sleep duration was 5.5 hours/day (Min 2.2, Max 11.6). Overall, participants were aged 58.7 years, had a BMI of 30.2 kg/m
2
, spent an average of 42 min/day in MVPA, and 18% were diabetic. In fully adjusted models, longer sleep duration was associated with smaller muscle area, but greater muscle density and less IMAT (all P<0.03). There was no interaction of sleep and sex on muscle density, area and IMAT (p-value=0.5184; 0.2730; 0.0954).

Conclusions:
In African Caribbean men and women, longer sleep duration was associated with less myosteatosis, as well as, less muscle area at the calf. Further research is warranted to understand this relationship longitudinally in order to determine how it may inform lifestyle guidelines in the Caribbean.
Abstract P075: Genetic European Ancestry And Incident Diabetes Mellitus In Black Individuals-Insights From The SPRINT Trial
Authors: Parcha Vibhu , Heindl Brittain F , Kalra Rajat , Rao Shreya , Pandey Ambarish , Gower Barbara , Li Peng , Arora Garima , Arora Pankaj
Published: May 2021

Background:
A metabolic paradox of lower triglyceride (TG) and higher high-density lipoprotein cholesterol (HDL-C) levels but a higher incidence of diabetes has been described in Blacks. We evaluated the association of genetic ancestry-related variants with the risk of incident diabetes in self-identified Black individuals in the Systolic Blood Pressure (BP) Intervention Trial (SPRINT).

Methods:
The genetic European ancestry proportions were estimated using 106 biallelic genotype markers in non-diabetic Black participants. Participants were stratified into tertiles (T1-T3) of European ancestry proportions. Multivariable-adjusted association of baseline metabolic syndrome indices (fasting plasma glucose [FPG], TG, HDL-C, body mass index [BMI], and BP) with the ancestry proportion was assessed. Multivariable-adjusted Cox regression was used to assess the risk of incident diabetes (FPG ≥126 mg/dL or self-reported diabetes treatment) across tertiles.

Results:
In 2,466 participants with median European ancestry 19% (13 - 27%), those in T1 were relatively younger, with lower Framingham risk score, and worse renal function (p<0.05 for all). At baseline, higher European ancestry proportion was associated with higher TG and lower HDL-C levels after controlling for clinical and demographic factors (p<0.05 for both). FPG, BMI, and BP were not significantly associated with ancestry proportion. Compared with T1, those in second (HR: 0.64 [95% CI: 0.45-0.90]) and third tertiles (HR: 0.61 [0.44-0.89]) had a lower risk of incident diabetes after controlling for covariates. Specifically, a 5% increment in European ancestry was associated with a 29% lower risk of incident diabetes (HR: 0.71 [0.55-0.93]). No interaction was observed between intensive BP control strategy and European ancestry proportion tertiles on incident diabetes.

Conclusions:
Genetic factors may account for racial differences in TG and HDL-C levels. The higher risk of incident diabetes in Blacks may similarly be genetically determined.
Abstract P085: Racism, Resilience, And Quality Of Life In Black Stroke Survivors: A Mixed-methods Cohort Study Protocol
Authors: Love Mary F , Brooks Andrea N , Cox Sonya , Sharrief Anjail Z
Published: May 2021

Introduction:
Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, which operates at structural, cultural and interpersonal levels, exerts significant stress on Black Americans and contributes to health disparities, including those related to stroke. Health-related quality of life (HRQoL) encompasses an individual’s self-perception of physical, mental, and social health. The combined effects of racism, stroke-related stress, and psychosocial stressors can result in negative outcomes, including poor HRQoL for Black stroke survivors. Resilience refers to maintaining relatively stable, healthy psychological and physical functioning in the aftermath of a stressful event like stroke. The purpose of this study will be to examine the effects of racism, resilience, and key psychosocial variables on Black stroke-survivor HRQoL.

Hypothesis:
We hypothesize racism and lower resilience will be associated with lower HRQoL.

Methods:
We will conduct a mixed-methods cohort study to examine the effects of racism and resilience on HRQoL of Black stroke survivors recruited from a stroke clinic in a large metropolitan area in the southeast US. Adult community-dwelling stroke survivors who self-identify as Black or African American and who have experienced a stroke event in the past 1 to 2 months will be eligible for study inclusion. Baseline quantitative data collection will occur at the initial clinic visit, with follow-up data collection at 5 to 6 months’ post-stroke. The exposure variables will be racism and resilience, and the outcome variable will be physical, mental, and social HRQoL. Qualitative data will be collected via focus groups. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines will be followed to report study results.

Results:
Power calculations for a two-tailed linear regression analysis with α ≤ .05, β .80, and an effect size of .15 (medium) resulted in a required sample size of 68. Our targeted sample size of 82 participants (41 males and 41 females) accounts for an attrition rate of 20%. The statistical approach to test the direct effects of each exposure variable on HRQoL will be multiple-level models. An interaction term for resilience will be included in the racism model. Qualitative data will be audio recorded, transcribed, and analyzed for themes regarding racism and resilience.

Conclusions:
Studies of the effects of racism on outcomes for Black stroke survivors are largely absent. This study will provide a first step toward identifying Black stroke survivors at risk for poor HRQoL in early stroke recovery.
Abstract P094: Food Insecurity And Elevated Blood Pressure In The Eastern Caribbean
Authors: Oladele Carol R , Martinez Josefa , Nunez-Smith Marcella
Published: May 2021

Background:
Food insecurity (FI), an economic or social condition of limited or uncertain access to adequate food, has emerged as a contributing factor in the development and poor management of chronic diseases. The Caribbean region faces serious challenges from FI that threaten the sustainability of food systems and health of populations. Increased FI has led to greater consumption of unhealthy, cheap, and calorie dense foods that are associated with elevated blood pressure. The demonstrated challenges with FI, increased prevalence of elevated blood pressure, and dearth of evidence in part of the region make it imperative to understand the relationship between FI and elevated blood pressure.

Methods:
We used baseline data (2013-2018) from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), a population-based cohort of 2,961 community-dwelling individuals 40 years or older residing in Barbados, Puerto Rico, Trinidad and Tobago, or U.S. Virgin Islands. Participants with complete FI and blood pressure data were included. Household FI within the past 90 days was measured using the 9-item Latin American and Caribbean Food Security Scale. Responses were summed for participants to create a score (0-8) and create four categories: 0 no FI, 1-6 -mild FI, and 7-8 severe FI. The outcome, elevated blood pressure, was defined as self-report of hypertension diagnosis or systolic blood =>140 mm Hg or diastolic pressure =>90 mm Hg. Chi-square tests, analysis of variance, and multivariable logistic regression was used for analyses. We hypothesized that FI was greater among women compared to men, those with lower versus higher educational attainment, and that FI was associated with elevated blood pressure.

Results:
A total of 2942 participants were included in analyses. Mean age of participants was 57, 65 percent were women, and 36 percent had less than a high school education. Results showed that 27 percent of participants experienced FI, women, younger persons, and those with lower educational attainment were more likely to experience low, moderate or severe FI. Forty-one percent of those with low FI had elevated blood pressure compared to 40 percent among those with moderate, and 40 percent with severe FI. Logistic model results showed that mild (OR=1.04, CI=0.74-1.47), moderate (OR=1.01, CI=0.60-1.7), and severe FI (OR=1.38, CI=0.64-2.95) was not associated with elevated blood pressure after adjusting for demographic and clinical covariates. Post-hoc analysis showed that that moderate/severe FI was associated elevated blood pressure among women (OR=1.50, CI=1.02-2.20).

Conclusions:
Findings for FI and elevated blood pressure among women is consistent with prior research conducted in other contexts. Findings have implications for safety net programs and targeted efforts to reduce FI overall and among women.
Abstract P106: Stabilization Muscles Drive Associations Between Lipoproteins And Total Abdominal Muscle And Intermuscular Adipose Tissue In The Multi-ethnic Study Of Atherosclerosis
Authors: Marron Megan M , Allison Matthew , Larsen Britta A , Ix Joachim H , Wood Alexis C , Herrington David M , Greenland Philip , Miljkovic Iva
Published: May 2021

Introduction:
Quality and quantity of skeletal muscle decrease with age, largely due to adipose tissue infiltration, and are important determinants of metabolic health. To inform efforts to slow aging-related decline in muscle mass and prevent myosteatosis, a better understanding of the biological determinants of muscle atrophy and quality is needed. We used targeted lipidomics to identify, with a greater specificity, lipoproteins associated with muscle and intermuscular adipose tissue (IMAT) area (quantity) and density (quality) of the total abdominal, locomotion, and stabilization muscles in the Multi-Ethnic Study of Atherosclerosis.

Hypothesis:
Lower density lipoproteins will be positively associated with muscle and IMAT quantity, but negatively associated with quality.

Methods:
At visit one, 105 serum lipoproteins were measured by Bruker lipoprotein subclass analysis with
1
H-Nuclear Magnetic Resonance spectroscopy. Muscle and IMAT area (cm
2
) and density (Hounsfield units) were estimated 2.6 years, on average, after visit 1 for the total abdominal, locomotion (psoas), and stabilization (paraspinal, oblique, and rectus abdominis) muscles from computed-tomography scans at the L4/L5 spinal junction. We identified lipoproteins associated with body composition using linear regression adjusting for age, gender, race, diet, physical activity, lipid-lowering medication, and multiple comparisons using a 1% false discovery rate.

Results:
Participants (N=947) were 44-84 years old (mean: 63), 51% men, 40% White, 16% Black, 16% Chinese American, and 27% Hispanic American. Among 105 lipoproteins, 24 were associated with total muscle area, whereas none were associated with muscle density. When examining specific muscle groups, 25 lipoproteins were associated with stabilization muscle area, driven by the oblique muscles. As for total IMAT area, there were 27 associations with lipoproteins. Specifically, 27 lipoproteins were associated with stabilization muscle IMAT area, driven by oblique and rectus abdominis muscles. Last, 39 lipoproteins were associated with total IMAT density, with 28 and 33 associated with locomotion and stabilization (driven by obliques) IMAT density, respectively. Higher VLDL: cholesterols, free cholesterols, phospholipids, and triglycerides
and
lower HDL: cholesterols and free cholesterols were associated with higher muscle area and IMAT area, but lower IMAT density (
Abstract P107: Differences In Hypercholesterolemia Prevalence Between African Americans And Whites: A Cross-sectional Study Using 2017-2018 National Health And Nutrition Examination Surveys Data
Authors: Sajdeya Omar , Sajdeya Ruba , Taha Mohamad B , As Sayaideh Mohammad , Dasa Osama
Published: May 2021

Importance:
African Americans (AA) have a 20% higher risk of CVD death than Whites. Treating hypercholesterolemia (HC) is paramount in CVD primary prevention. Some evidence showed that AA have a lower risk of HC compared to whites.

Methods:
A cross-sectional study using the 2017-18 National Health and Nutrition Examination Surveys data. Logistic regression analysis was used to compare the prevalence of diagnosed HC in AA and whites aged 18-80 years old. Serum total cholesterol (TC) and high-density lipoprotein (HDL) levels were compared by multiple linear regression.

Results:
Among 2549 participants, 51.7% were females, and 63.4% were white. The mean (SD) age was 51.6 (19.1) years. AA had a 24 % reduced risk of HC diagnosis than whites after adjusting for age, Body Mass Index (BMI), diabetes, hypertension, and smoking; OR [95%CI]= 0.767 [0.621, 0.923]. There was no difference in TC level (p=0.7242), while HDL was higher among AA (p<0.0001, β=3.83), adjusting for age, gender, BMI, smoking, diabetes, education level, and use of cholesterol medications.

Conclusion:
Consistent with some evidence, AA had a lower prevalence of HC diagnosis and higher HDL levels.
Abstract P111: Untargeted Metabolomics Study And Bidirectional Mendelian Randomization Analyses Identified Novel Metabolites Mediating The Effect Of Current Smoking On Body Mass Index
Authors: Zhang Ruiyuan , Kelly Tanika N , Bazzano Lydia A , Chen Wei , He Jiang , Li Shengxu , Li Changwei
Published: May 2021

Introduction:
Many studies identified that smokers had lower body mass index (BMI) than non-smokers, but the underlying mechanisms are not well understood.

Hypothesis:
An untargeted metabolomics study will identify novel mechanisms underlying smoking associated weight loss.

Methods:
We performed cross-sectional analyses among all 248 current smokers and 637 never smokers participated in the Bogalusa Heart Study 2016 survey. After stringent quality control and normalization, 1,202 plasma metabolites were assessed for mediation effects on smoking-BMI association after controlling for age, gender, race, education, drinking and physical activity. The collective mediation effects of metabolites were estimated by comparing the smoking-BMI associations before and after controlling for all significant metabolites after Bonferroni correction. Bidirectional Mendelian randomization analyses were then performed on a subset of participants (n=654) to delineate causal directions among smoking, BMI, and significant metabolites. We constructed multi-locus genetic risk scores (GRS) for smoking and BMI based on findings from published GWASs with a sample size of more than 250,000. Multivariable linear regression controlling for the same covariates as in the mediation analyses was used to estimate associations between smoking- and BMI-GRSs and the significant metabolites.

Results:
Compared to never smokers, current smokers had a 3.31 kg/m
2
(95% confidence interval [CI]: 2.15-4.47) lower BMI after adjusting for all covariables. A total of 40 metabolites significantly mediated and explained 90.7% of the smoking-BMI association. Seven of the significant metabolites were associated with smoking GRS but not BMI GRS, suggesting a true mediation role in the smoking-BMI association. The seven metabolites, including
homoarginine
(mediation beta=-0.49 kg/m
2
, 95% CI: -0.78 to -0.26),
1-oleoyl-GPE (18:1)
(mediation beta=-0.44 kg/m
2
, 95% CI: -0.72 to -0.22),
1-linoleoyl-GPE (18:2)*
(mediation beta=-0.59 kg/m
2
, 95% CI: -0.90 to -0.32),
beta-cryptoxanthin
(mediation beta=0.53 kg/m
2
, 95% CI: 0.27 to 0.83),
1-stearoyl-2-arachidonoyl-GPE (18:0/20:4)
(mediation beta=0.39 kg/m
2
, 95% CI: 0.18 to 0.65),
sphingomyelin (d18:2/21:0, d16:2/23:0)*
(mediation beta=-0.54 kg/m
2
, 95% CI: -0.84 to -0.28), and
sphingomyelin (d17:2/16:0, d18:2/15:0)*
(mediation beta=-0.92 kg/m
2
, 95% CI: -1.30 to -0.59), mediated 36.3% of the association between current smoking and BMI. We also identified 6 metabolites significantly associated with BMI GRS but not with smoking GRS, and 2 significantly associated with both smoking- and BMI-GRSs.

Conclusions:
We identified 7 plasma metabolites that mediated a large proportion of the association between smoking and BMI.
Abstract P115: Older Age And Health Status Are Associated With Smartwatch Use Over 12 Months In The Electronic Framingham Heart Study
Authors: Pathiravasan Chathurangi H , Trinquart Ludovic , Zhang Yuankai , Benjamin Emelia J , Borrelli Belinda , McManus David D , Kheterpal Vik , Lin Honghuang , Sardana Mayank , Hammond Michael M , Spartano Nicole L , Dunn Amy L , Schramm Eric , Nowak Christopher , Manders Emily S , Liu Hongshan , Kornej Jelena , Liu Chunyu , Murabito Joanne
Published: May 2021

Introduction:
Long-term use is critical for successful clinical or research applications of digital devices, but digital health studies are challenged by significant early discontinuation of use.

Hypothesis:
We sought to identify factors associated with long-term use of a smartwatch among participants enrolled in the electronic Framingham Heart Study (eFHS). We hypothesized that sociodemographic and health variables are associated with watch use.

Methods:
Participants were provided with a study smartwatch and were asked to wear the watch daily. We examined watch use over 12 months. Weekly watch use was defined as a binary response (yes=watch wear for ≥1 days for ≥ 5 hours per day, vs. no). We considered 19 different predictors including sociodemographic, health behaviors, and family relationship. We selected an individual predictor for watch use (
P
<0.05) using generalized linear mixed models (GLMM) adjusted for age, sex, and weeks of watch use. We further built a model with all predictors selected from initial testing adjusted for age, sex, and weeks. We report odds ratios (OR) and 95% confidence interval (95%CI).

Results:
Among 1243 participants (mean age 53 years, 59% women), watch use was highest in the age-group ≥65 years, and decreased linearly over time in all participants (Figure). In GLMM adjusted for age, sex, and weeks, we found that self-reported health status (excellent vs good, fair or poor) (OR=2.7; 95%CI, 1.6-4.8), BMI (OR=0.9; 95%CI, 0.9-1.0) per 1 kg/m
2
increase, and depressive symptoms (OR=0.5; 95%CI, 0.3-0.8) were associated with watch use. In the model with all selected predictors, age-group
>
65 (OR=4.0; 95%CI, 1.4 -11.6), excellent health (OR=2.3; 95%CI, 1.3-4.1), and depressive symptoms (OR=0.5; 95%CI, 0.3-0.9) remained significant.

Conclusions:
Older age, lack of depressive symptoms, and self-reported excellent health were associated with greater use of the smartwatch over the 12-month follow-up. Consideration of these factors in planning future digital studies may improve participation.
Abstract P120: Association Of Carotid Intima-Media Thickness With Brain MRI Markers In The Atherosclerosis Risk In Communities Neurocognitive Study (ARIC-NCS)
Authors: Wang Wendy , Norby Faye L , Alonso Alvaro , Gottesman Rebecca F , Meyer Michelle , Knopman David , Sullivan Kevin J , Jack Clifford R , Hughes Timothy M , Lakshminarayan Kamakshi , Lutsey Pamela L
Published: May 2021

Background:
Elevated carotid intima-media thickness (cIMT) and presence of carotid plaque are markers of atherosclerosis, which may be linked to structural brain injury. Using data from the ARIC-NCS cohort, we tested the hypotheses that greater cIMT and presence of carotid plaque at late midlife were each associated with presence of infarcts (lacunar and cortical) and cerebral microbleeds (lobar and subcortical), greater white matter hyperintensity (WMH) volume, and smaller regional brain volumes in late life.

Methods:
We included 1,795 ARIC participants who had carotid ultrasounds in 1990-92 and brain MRI scans in 2011-13. Weighted linear regression was used for continuous (brain volume) outcomes, and weighted logistic regression for dichotomous outcomes (infarcts and cerebral microbleeds).

Results:
Participants were aged 57±6 years at baseline, 57% were female, and 23% were Black. Mean ± SD follow-up was 21±1 years. After multivariable adjustments, the highest quintile of cIMT in late midlife was associated with smaller deep grey matter volume (β [95% CI]: -0.11 [-0.22, -0.01]) and cortical volume in a temporal-parietal meta region of interest (ROI) (β [95% CI]: -0.10 [-0.20, -0.01]) in late life (Table). At baseline, 473 (26%) participants had carotid plaque present on their carotid ultrasound. Similar to cIMT, those with carotid plaque had smaller regional brain volumes than those without carotid plaque present (βs [95% CIs]: -0.05 [-0.12, 0.03] and -0.06 [-0.13, 0.01] for deep grey matter and temporal-parietal meta ROI volumes, respectively). No significant relations were observed with WMH volume, or the presence of any infarcts or cerebral microbleeds.

Conclusion:
Greater midlife cIMT and presence of carotid plaque were associated with smaller deep grey matter volume and cortical volume in a temporal-parietal meta ROI in later life. Contrary to our hypothesis, associations between midlife subclinical atherosclerosis and markers of vascular brain injury in later life were null.
Abstract P122: Cardiovascular Fat And Cognitive Function Among Perimenopausal Women: The Study Of Women’s Health Across The Nation Cardiovascular Fat And Heart Ancillary Studies
Authors: Qi Meiyuzhen , Budoff Matthew , Janssen Imke , Shields Kelly , Barinas-Mitchell Emma , El Khoudary Samar R
Published: May 2021

Objective:
Women experienced disproportionated prevalence of dementia and higher risk of cardiovascular disease (CVD) after menopause. Cardiovascular fat (CF) which is associated with CVD may impact cognitive function through vascular pathology. Perimenopausal women had more CF compared with pre/early perimenopausal women. However, research on the association between CF volume, density and cognitive function among perimenopausal women is limited. We aimed to assess associations of CF volume and density with future cognitive function among midlife women.

Design:
Midlife women with measures of CF volume and density along with cognitive function measured 1.46 (SD=0.68) years later were evaluated. Computed tomographic scans were used to quantify volume and density of total heart adipose tissue (TAT), EAT, and perivascular adipose tissue (PVAT) of the descending aorta. Digit span backward test, East Boston memory test, and symbol digit modalities test were used to test working memory, verbal episodic memory, and processing speed, respectively. The relationship between each CF measurement and each cognitive function metric was assessed separately with linear regression models. Final models included age, education level, race, menopausal status, waist hip ratio, number of cognitive tests conducted before the included test, and fat density for corresponding fat volume or fat volume for corresponding fat density.

Results:
Three hundred and eighty-five women (mean age of 50.6 (SD=2.4) years old; 29.2% post-menopausal) were included. In the final models (Table), higher EAT and TAT density were significantly associated with a higher processing speed and immediate episodic memory, respectively. However, there was a significant negative association between PVAT density and working memory.

Conclusion:
Our findings suggest an association between CF radio-density and future cognitive function in midlife women, which may differ by cardiovascular fat location (heart vs. vasculature).
Abstract P126: Identifying Successful Predictors Of Body Fat Reduction In The Dietfits Trial
Authors: Crimarco Anthony , Fielding-Singh Priya , Landry Matt , Gardner Christopher D
Published: May 2021

Background:
Reducing excess body fat is important for overall health, but individual success at reducing body fat varies considerably. Because dietary modification plays a key role in reducing body fat and maintaining a healthy body weight, there has been speculation if one particular dietary pattern is superior to another for losing weight. Previously we reported no significant differences in the effectiveness of either a low-carbohydrate diet or a low-fat diet for weight loss in the DIETFITs Trial. However, there is less literature that has specifically focused on body fat reduction. Therefore the purpose of this study was to assess if 12-month dietary changes were associated with body fat reduction.

Methods:
Participants were men and women with overweight or obesity that participated in the DIETFITS trial, a randomized clinical trial comparing the effectiveness of a healthy low-fat diet to a healthy low-carbohydrate diet for weight loss. The primary outcome was body fat percent loss, which was measured with dual-energy x-ray absorptiometry (DEXA) scans. Demographic information was collected from online surveys at baseline, dietary data were assessed from participants 24-hour recalls, and physical activity was assessed with the Stanford Seven-Day Physical Activity Recall questionnaire. Linear regression models were conducted to assess the association between changes in energy intake, dietary fat, and carbohydrates with body fat reduction, while controlling for demographic variables and physical activity.

Results:
Data were available for 272 participants with DEXA scans and dietary data. In the main model both baseline physical activity (coef = -0.26, p = 0.016) and changes in physical activity (coef = -0.36, p < 0.01) were significantly associated with body fat reduction. When stratified by dietary assignment, changes in physical activity remained significant for each group (low-carb group: coef = -0.30, p = 0.002 and low-fat group coef = -0.35, p = 0.006), while changes in dietary fat, as a percentage of energy intake, was associated with body fat reduction in the low-fat group only (coef = 0.15, p = 0.006). Race was also significantly associated with body fat reduction in all models, indicating non-White participants gained more body fat at the end of the intervention compared to Whites.

Conclusions:
The reduction in body fat appears to be mostly driven from participants increasing their physical activity levels. Identifying other predictors of body fat reduction warrant further study.
Abstract P133: Added Sugar Intake Is Associated With Greater 2-hour Glucose And Lower Muscle Quality In Adults Free Of Diabetes: Coronary Artery Risk Development In Young Adults Study
Authors: Yi So-Yun , Steffen Lyn M , Terry James G , Duprez Daniel A , Steffen Brian , Shikany James M , Zhou Xia , Odegaard Andrew O , Lewis Cora E , Carr John J , Jacobs David R
Published: May 2021

Background:
- Excess added sugar (AS) intake was shown to promote insulin resistance in skeletal muscle in animal studies, while sugar sweetened beverage (SSB) intake was associated with insulin resistance and lipids in skeletal muscle in humans. However, SSBs account for only 40% of AS intake. US adults consume excessive AS from foods and beverages relative to the 2015-2020 Dietary Guidelines recommendation which limit AS intake to <10% of energy intake per day. We evaluated the hypothesis that AS intake is adversely associated with glucose metabolism, insulin, and lean muscle attenuation (MA) in Black and white men and women aged 18-30 years at baseline (Y0).

Methods:
- After exclusions for diabetes defined as MD diagnosis, insulin or oral agent use, fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%, outlying energy intake, and missing 2-hour glucose, 2,016 adults were included in the analyses. Dietary intake was assessed by Diet History at Y0, Y7 and Y20. At Y25 follow-up, participants free of diabetes underwent a fasting blood draw for glucose, insulin, and triglycerides, an oral glucose tolerance test for 2-hour post-challenge glucose, and an abdominal CT scan for lean MA (an indicator of muscle quality). AS intake was averaged across Y0, Y7, and Y20 and divided into tertiles. General linear regression models estimated the associations across tertiles of AS intake with 2-hour glucose, fasting glucose, insulin, and triglycerides, and lean MA adjusted for potential confounders.

Results:
- AS intake (Table) was positively associated with 2-hour glucose and fasting insulin and triglycerides (p
trend
=0.004, 0.04, and 0.01, respectively) and inversely associated with lean MA (p
trend
=0.02). AS intake was not associated with fasting glucose (p
trend
=0.57).

Conclusions:
- Among adults free of diabetes, greater long-term AS intake was associated with higher 2-hour glucose and fasting insulin and triglycerides, and lower muscle quality. Our findings are consistent with the US Dietary Guidelines for Americans recommendation to limit AS intake.
Abstract P148: Initiation And Switching Of Direct Oral Anticoagulants Among Medicare Beneficiaries With Cancer And Atrial Fibrillation
Authors: Ardeshirrouhanifard Shirin , An Huijun , Goyal Ravi , Raji Mukaila , Alexander Caleb , Mehta Hemalkumar
Published: May 2021

Objective:
Despite population-level increases in use of direct oral anticoagulants (DOACs) over the last decade, less is known about their use among individuals with cancer and non-valvular atrial fibrillation (NVAF). We quantified DOAC initiation and switching among such individuals.

Methods:
We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2009 to 2016 and included patients aged ≥66 years diagnosed with cancer (breast, bladder, colorectal, esophagus, lung, ovary, kidney, pancreas, prostate, stomach or uterus). We limited the cohort to continuously enrolled beneficiaries with newly diagnosed NVAF following cancer diagnosis (from 2010 to 2016) who did not have any oral anticoagulant use during the 12-months prior to their NVAF diagnosis. We evaluated the initiation of warfarin or DOACs within 3 months of the incident NVAF diagnosis. Among warfarin users, we determined switching rates to DOACs and among DOACs users, we determined switching rates to warfarin. Descriptive statistics were used for all the analyses.

Results:
Of 1,028,784 Medicare beneficiaries with cancer, 158,744 (15.4%) were diagnosed with atrial fibrillation. After applying all inclusion criteria, the final study cohort included 19,513 cancer patients diagnosed with incident NVAF. Lung (20.2%), Breast (19.2%), prostate (19.2%) and colorectal (16.0%) cancer accounted for over three-fourths of the cohort. Overall, 7,604 patients (39%) initiated oral anticoagulants. Among these patients, 4,223/7,604 (55.5%) and 3,381/7,604 (44.5%) initiated DOACs and warfarin, respectively. Patients who initiated DOACs had lower Charlson comorbidity score (1.0 ± 1.4 vs. 1.3 ± 1.5) and CHA
2
DS
2
-VASc score (4.4 ± 1.7 vs. 4.8 ± 1.7) compared to warfarin users. Initiation of DOACs varied by cancer type; for example, 13.6% (55/405) of patients with stomach cancer initiated DOACs, whereas 29.8% (1120/3755) of patients with prostate cancer initiated DOACs. Among patients who initiated any oral anticoagulants, the use of DOACs increased from 22% (110/501) in 2011 to 75.3% (1335/1772) in 2016, whereas warfarin use declined from 78% (391/501) to 24.7% (437/1772). The switching rate among warfarin initiators to DOACs (623/3381, 18.4%) was higher than the switching rate among DOACs initiators to warfarin (281/4223, 6.7%).

Conclusion:
Among cancer patients with newly diagnosed NVAF, the use of DOACs has markedly increased from 2011 to 2016, with a corresponding decline in the use of warfarin. Moreover, cancer patients are more likely to switch from warfarin to DOACs. Our findings highlight the dynamic life cycle of these products and the value of real-world assessments of their comparative safety and effectiveness among Medicare beneficiaries.
Abstract P150: Association Of Leisure Time Physical Activity (LTPA) With Left Atrial Function In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study
Authors: Parikh Romil , Inciardi Riccardo M , Wang Wendy , Hegde Sheila M , Norby Faye L , Zhang Michael J , Reyes Jorge L , Alonso Alvaro , Shah Amil M , Solomon Scott , Chen Lin Y
Published: May 2021

Introduction:
Prior research indicates that higher LTPA is associated with better left ventricular (LV) diastolic function, but not with left atrial volume index (LAVI). Left atrial (LA) strain is a more sensitive marker of LA pathology. Hence, we evaluated association of LTPA with LA strain in the ARIC study, a community-based cohort study.

Hypothesis:
Higher LTPA is associated with better LA reservoir, conduit and contractile function.

Methods:
We included 4005 participants (mean age 75 years, 63% female, 21% black) with 2D echocardiographic (2DE) LA % strain data, LTPA data, and without prevalent coronary heart disease, valvular heart disease, heart failure, atrial fibrillation, and stroke at Visit 5 (V5, 2011-13). We estimated LTPA as metabolic equivalent-minutes per week from validated Baecke questionnaire and categorized it as poor, intermediate, or ideal as per AHA recommendation. We categorized change in LTPA from V3 (1993-95) to V5 as persistently poor (referent), decreasing, increasing, or persistently active. LA reservoir, conduit, and contractile % strain were measured from speckle-tracking 2DE. Linear regression was used to evaluate association of LTPA with LA function. We modeled LTPA (1) cross-sectionally at V5 as a continuous variable and (2) change from V3 to V5, as continuous and categorical variables (referent- persistently poor).

Results:
Higher LTPA at V5 (Table) and persistently high (vs poor) LTPA from V3 to 5 (β estimate -0.89, 95% CI -1.40, -0.38) were significantly associated with better LA conduit function after adjusting for CV risk factors, LV function, and LAVI. The same associations with LA reservoir function were no longer significant after adjusting for CV risk factors. LTPA was not associated with LA contractile function (Table).

Conclusions:
Consistent with LTPA’s salutary effect on LV diastolic function, higher LTPA is associated with better LA conduit function. Maintaining high LTPA from midlife to late-life may be beneficial in mitigating age-related changes in cardiac function.