bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P194: Proteomic Profiling of Pulmonary Function Decline and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lee Yura , Ladd-Acosta Christine , Morrison Alanna C , North Kari E , Boerwinkle Eric , Shah Amil M , London Stephanie J , Yu Bing
Published: March 2023

Introduction:
Measures of pulmonary function are associated with cardiovascular disease risk; however, the underlying mechanism remains unclear.

Hypothesis:
We hypothesize that protein biomarkers are associated with pulmonary function decline, as well as the risk of subsequent incident coronary heart disease (CHD), heart failure (HF), and mortality.

Methods:
We included participants from the Atherosclerosis Risk in Communities (ARIC) study with plasma proteome measured by SOMAscan and spirometric measures (forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC)) at both visits 2 (1990-1992) and 5 (2011-2013). Cross-sectional associations of protein levels with FEV1 and FVC at both visits were assessed using multivariable linear regression. The decline of FEV1 was evaluated among proteins related to cross-sectional FEV1 and FVC measures. The FEV1-decline-related proteins were further probed into the effects on incident CHD, HF, and mortality, using Cox proportional hazard models post-visit 2.

Results:
Out of 4,677 proteins, 364 were cross-sectionally associated with both FEV1 and FVC at visit 2 (n=11,354, age 57, 23% blacks, and 56% women) and 5 (n=3,517, age 75, 17% blacks, and 58% women) at FDR <0.05. Twenty-seven of 364 proteins were associated with FEV1 decline between visits (FDR <0.05). The protein effects were more predominant in women than men (p <0.001). Among 27 FEV1 decline-related proteins, 25 and 27 were associated with incident HF and mortality during an average of 29 years follow-up (FDR <0.05,
Figure
). Gamma-aminobutyric acid receptor-associated protein showed the greatest effect with FEV1 decline, and its per SD increase was associated with 20% higher risk of HF and mortality. Compared to HF and mortality, FEV1 decline-related proteins were less associated with incident CHD.

Conclusions:
Twenty-seven proteins related to pulmonary function decline were heavily associated with the risk of HF and mortality, suggesting shared etiology between those conditions.
Abstract P196: Metabolomic Associations With Cardiac Function and Incident Heart Failure in Multi-Ethnic Populations
Authors: Moon Eun Hye , Alkis Taryn , Liu Guning , Matsushita Kunihiro , Hoogeveen Ron C , Ballantyne Christie M , Claggett Brian , Qi Qibin , Kaplan Robert C , Rodriguez Carlos J , Shah Amil M , Yu Bing
Published: March 2023

Introduction:
Measures of cardiac structure and function provide important diagnostic and prognostic information for heart failure (HF). Few studies have assessed the associations of circulating metabolites with cardiac structure and function.

Hypothesis:
We hypothesize that circulating metabolites that reflect aging process are associated with cardiac structure and function measures and incident HF.

Methods:
Participants from the Atherosclerosis Risk in Communities (ARIC) study visit 5 and the Hispanic Community Health Study / Study of Latinos (HCHS/SOL) study visit 1 who had serum metabolite measures but not prevalent HF were included. Linear regressions were used to examine the associations of metabolites with ten cardiac structure and function variables adjusting for clinical risk factors in each race and study strata, followed by random-effect meta-analyses. The Cox regression was applied to examine the relationship between those identified metabolites and incident HF post visit 5 in ARIC.

Results:
Among 589 analyzed metabolites, 179 were associated with cardiac structure or function measures in 706 Blacks, 3,358 Whites, and 1,380 Hispanics (FDR < 0.05). Forty-one metabolites were related to two or more measures, where 22 were associated with incident HF (308 HF cases, p<0.05, Figure). Metabolites were more associated with cardiac size or diastolic function compared to systolic function measures, i.e., C-glycosyltryptophan, an amino acid that is strongly correlated with age, was positively associated with left ventricular mass index (LVMI) and left atrial volume index(LVAI), as well as an increased risk of HF (HR=1.48); and dodecadienoate (12:2), a dicarboxylate that may have anti-aging property, was negatively associated with LVMI and LVAI, as well as a decreased risk of HF (HR=0.84).

Conclusions:
We identified multiple metabolites associated with cardiac structure and function measures in multi-ethnic populations, highlighting metabolic pathways in aging and their impact on HF.
Abstract P200: Cumulative Circulating Branched Chain Amino Acid Exposure in Young Adulthood and Incident Atherosclerotic Cardiovascular Disease (ASCVD) in Later Life: The CARDIA Study
Authors: Sawicki Konrad T , Ning Hongyan , Fine Keenan , Otvos James D , Carnethon Mercedes R , Shah Ravi V , Murthy Venkatesh L , Wilkins John T
Published: March 2023

Introduction:
Circulating branched chain amino acid (BCAA) levels are associated with the development of diabetes mellitus (DM) and downstream ASCVD in middle-aged women. It is unknown if BCAAs in young adult men and women are associated with ASCVD events. BCAA levels may be dynamic in middle-aged adults prior to the development of DM or ASCVD events, thus cumulative BCAA measures in early life may better quantify exposure risk than a single measure at mid-life.

Methods:
We measured plasma BCAA levels in 3110 Coronary Artery Risk Development in Young Adults study participants using nuclear magnetic resonance (NMR) at Years (y) 2, 7, 15, and 20. To minimize missingness bias, BCAA levels were imputed for the residual 1835 participants without NMR measures. Cumulative BCAA exposure from 19-40y of age was calculated as the area under the curve using a spline-based mixed-effects model to estimate subject-specific BCAA trajectories from 19-40y. Sex-specific associations between cumulative BCAA exposure and incident ASCVD events after 40y of age were assessed by multivariable (Table) Cox proportional hazards regression models including BCAA levels and fasting blood glucose (FBG) at age 40y and further stratified by DM status.

Results:
Among 4945 participants (55.3% female), there were 255 ASCVD events and 675 DM cases over a median of 18.8 years of follow-up after age 40y. In adjusted models, cumulative BCAA exposure from 19-40y was associated with ASCVD events after 40y of age in women, but not men (Table). The associations in women were robust to adjustment for BCAAs and FBG at age 40y. There was no significant difference in the cumulative BCAA-ASCVD association among men or women who developed DM before ASCVD versus those who did not.

Conclusions:
Cumulative BCAA exposure in early adulthood is associated with ASCVD in women independent of mid-life BCAA levels. Elevated BCAA levels in women during early adulthood may reflect behaviors and/or metabolic pathways that increase risks for ASCVD independent of the development of hyperglycemia.
Abstract P202: Proteomic Markers Associated With the Risk of Incident Hypertension in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mathews Lena M , Hu Xiao , Wang Frances , Chen Jingsha , Yu Bing , Hoogeveen Ron C , Ballantyne Christie M , Selvin Elizabeth , Shah Amil M , Ndumele Chiadi E , Coresh Josef , Matsushita Kuni
Published: March 2023

Introduction:
Proteins are involved in the pathophysiology of hypertension (HTN), but there are no large scale prospective proteomic analyses of incident HTN.

Hypothesis:
To identify and validate plasma proteins associated with incident HTN among a bi-racial cohort in the US.

Methods:
We quantified the associations of 4,955 plasma proteins (measured by SomaScan version 4 assay) with incident HTN over median follow-up of 11 years among 5,080 participants without baseline hypertension at ARIC visit 3 (1993-95). We then validated significant proteins from the primary analysis with incident HTN between visit 2 (n=6,810 during 1990-92) and visit 3 (median follow-up of 3.1y), to avoid including the same incident HTN cases in both analyses. Incident HTN was defined as systolic blood pressure (BP) ≥140, diastolic BP ≥90 mmHg, or HTN medication use. We ran multivariable Cox models and applied Benjamin-Hochberg procedure, with false discovery rate of 0.05, to account for multiple comparisons.

Results:
In the primary analysis with visit 3 as baseline (mean age 59y, 54% women, 13% Black), 3,828 participants (75%) developed HTN, and we found 55 proteins significantly associated with incident HTN. Among them, 14 proteins were validated using visit 2 data (Figure). Of those, 11 showed positive associations with HTN, and they are involved in glycoprotein degradation (e.g., MMP7, HTRA1, ASGR1, GUSB, CPM), cell adhesion (e.g., LGALS3BP and RET), and inflammation (e.g., CRP). In contrast, 3 proteins, renin ([REN]), netrin receptor ([UNC5D] apoptosis) and secretogranin-3([SCG3] endothelial cell growth), had inverse relationships with incident HTN. Further exploration showed a U-shaped association between renin and incident HTN.

Conclusion:
We identified several proteins associated with incident HTN, with plausible functions contributing to the development of HTN. These findings have implications on understanding mechanisms of HTN and potential targets for prevention and treatment.
Abstract P209: Late-Life Dietary Intake and Risk of All-Cause Mortality in the Atherosclerosis Risk in Communities Study (ARIC) Study
Authors: Du Shutong , Rivera Nikolaos , Steffen Lyn , Coresh Josef , Rebholz Casey M
Published: March 2023

Introduction:
Older populations have been growing dramatically worldwide. Aging may lead to changes in diet quality. There is a need to better understand dietary intake during late-life and the impact on health outcomes.

Hypothesis:
We hypothesized that adherence to healthy dietary patterns, i.e., the Dietary Approaches to Stop Hypertension (DASH) and the alternate Mediterranean (aMED) diets, would be associated with lower risk of all-cause mortality.

Methods:
Atherosclerosis Risk in Communities (ARIC) study participants aged 60-83 years who attended a study visit in 2005-2006 were included (n=1,069). Dietary intake was assessed with a 131-item Willett food frequency questionnaire. Adherence to healthy dietary patterns was assessed using a priori scores for DASH and aMED. We used Cox proportional hazards models to study the association between tertiles of healthy dietary patterns and all-cause mortality through December 31, 2019.

Results:
There were 452 deaths observed over a median follow-up of 13 years (12,564.3 person-years). Incidence rates were lower in the third tertile, indicating high adherence to healthy dietary patterns (DASH: 32.9 per 1,000 person-years; aMED: 28.5 per 1,000 person-years), compared to the first tertile (DASH: 39.6 per 1,000 person-years; aMED: 40.0 per 1,000 person-years). Participants in the third vs. first tertile for adherence to the DASH and aMED diets had a 22% and 37% lower risk of all-cause mortality, respectively [hazard ratio for DASH: 0.78 (95% CI, 0.62 - 0.98); aMED: 0.63 (95% CI, 0.49 - 0.83)] after adjusting for age, sex, race, study centers and total energy intake. An approximately linear, inverse relationship was observed between healthy dietary patterns and risk of all-cause mortality for both DASH and aMED (
Figure
).

Conclusion:
Higher adherence to healthy dietary patterns, specifically the DASH and aMED diets, is associated with lower risk of mortality among older adults. Following a healthy diet may improve survival in the aging population.
Abstract P213: A Behavioral Economics Workplace Healthy Eating Intervention Similarly Benefits Employees With and Without Chronic Disease Risk
Authors: Cheng Jessica , Levy Douglas , McCurley Jessica , Rimm Eric B , Thorndike Anne N
Published: March 2023

Introduction:
Workplace interventions using behavioral economics approaches may provide low-cost opportunities for promoting healthy lifestyle. It is unknown if employees at higher chronic disease risk are more likely to benefit from workplace health promotion programs than employees at lower risk. This analysis assessed the differential effect of a 12-month behavioral workplace healthy eating intervention on improving dietary choices of employees’ with and without chronic disease risk.

Hypothesis:
We hypothesized that the intervention effect on cafeteria food purchases and diet quality would be stronger among employees with chronic disease risk compared to those without.

Methods:
This was a secondary data analysis of the ChooseWell 365 RCT conducted among hospital employees to test the effect of personalized feedback, peer comparisons, and financial incentives on improving cafeteria purchases, dietary intake, and weight. All hospital cafeterias used traffic-light food labeling. Published main results showed an intervention effect on cafeteria purchases but not overall diet quality or weight change. Diet quality was calculated from dietary recalls and measured via the Healthy Eating Index (HEI-2015), scored 0-100 (healthiest). Healthy purchasing scores (HPS) were calculated for each participant, weighting purchases’ color categories (red=0, yellow=0.5, green=1), scaled from 0-100 (healthiest). HEI-2015 and HPS were calculated at baseline, 6, 12, and 24 months. Participants were classified as having chronic disease risk if they self-reported hypertension, hyperlipidemia, heart disease, stroke, pre-diabetes, diabetes, cancer or another serious illness at baseline. Mixed models with random effects were used to compare dietary changes by study arm and risk categorization adjusted for body mass index, age, and race.

Results:
Participants (N=562) were mostly female (80.3%) and white (81.1%) with a median (p25, p75) age of 42 (33, 55) years; 38.1% reported at least one chronic disease risk condition. There was no differential intervention effect on HPS at any timepoint by chronic disease risk (all p-interaction>0.05): Among those with chronic disease risk, intervention participants increased HPS (unadjusted mean [SD]) from baseline through 24 months (68 [13] to 74 [13]) compared to control (68 [14] to 68 [16]). This was similar to the difference between intervention (67 [12] to 72 [13]) and control participants (69 [12] to 72 [12]) without risk. There was no differential intervention effect on HEI by chronic disease risk (all p-interaction>0.05).

Conclusions:
The ChooseWell 365 behavioral intervention improved the healthfulness of cafeteria purchases of employees with and without chronic disease risk, suggesting that workplace health promotion programs can improve lifestyle behaviors that contribute to both the prevention and treatment of chronic disease.
Abstract P214: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease in US Adults
Authors: Glenn Andrea J , Guasch Marta , Malik Vasanti , Kendall Cyril , Manson Joann E , Rimm Eric B , Willett Walter , Sun Qi , Jenkins David , Sievenpiper John L , Hu Frank B
Published: March 2023

Introduction:
The plant-based portfolio dietary pattern includes recognized cholesterol-lowering foods shown to improve several cardiovascular disease (CVD) risk factors in clinical trials. Epidemiological evidence on the association between longer-term adherence to the portfolio dietary pattern and CVD risk remains more limited.

Objective:
To examine whether the portfolio dietary pattern is associated with the risk of total CVD, coronary heart disease (CHD, including myocardial infarction and fatal coronary deaths), and stroke.

Methods:
Participants included 73,925 women in the Nurses’ Health Study (NHS) (1984-2014), 92,354 women in the NHS2 (1991-2017) and 43,970 men from the Health Professionals Follow-up Study (HPFS) (1986-2016) without CVD and cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every four years using a portfolio diet score (PDS) which positively ranks plant protein (soy & pulses), nuts, viscous fiber sources, phytosterols (mg/day) and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and dietary cholesterol. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for covariates.

Results:
During up to 30 years of follow-up, 16,917 incident CVD cases, including 10,666 CHD cases and 6,473 stroke cases, were documented. After multivariable adjustment of lifestyle and other dietary factors, comparing the highest to the lowest quintile, participants with a higher PDS had a lower risk of total CVD (pooled HR: 0.84; 95% CI: 0.80-0.89,
P
trend<0.001), CHD (pooled HR: 0.82; 95% CI: 0.76-0.87,
P
trend<0.001) and stroke (pooled HR: 0.88; 95% CI: 0.81-0.97,
P
trend=0.001). In addition, a 25-percentile higher PDS was associated with a lower risk of total CVD (pooled HR: 0.91; 95% CI: 0.88-0.93), CHD (pooled HR: 0.89; 95% CI: 0.86-0.92) and stroke (pooled HR: 0.93; 95% CI: 0.89-0.97). Results remained largely consistent across sensitivity and subgroup analyses.

Conclusions:
Greater adherence to the portfolio dietary pattern was consistently associated with lower risk of CVD, including CHD and stroke, in three large prospective cohorts of U.S. men and women.
Abstract P216: Carbohydrate Quantity and Quality, and Risk of Type 2 Diabetes: Results From Three Large Prospective US Cohorts
Authors: Sawicki Caleigh M , Braun Kim V , Haslam Danielle E , Alessa Hala B , Willett Walter C , Hu Frank B , Bhupathiraju Shilpa N
Published: March 2023

Background:
High-quality carbohydrate sources, such as whole grains, have been associated with a lower risk of type 2 diabetes (T2D), whereas low-quality carbohydrate sources, such as refined grains and added sugar, have been associated with a higher T2D risk. However, few studies have considered how replacing dietary carbohydrate with other macronutrients may influence T2D risk.

Objective:
We examined whether isocaloric substitution of high- or low-quality carbohydrate for fat, protein, and their subtypes is associated with T2D risk.

Methods:
We included 75,430 women from the Nurses' Health Study (1984-2016), 85,630 women from the Nurses' Health Study II (1991-2017), and 40,261 men from the Health Professionals Follow-Up Study (1986-2016) who were free of T2D, CVD, and cancer at baseline. Dietary data were collected every 2-4 years using a validated, semi-quantitative food frequency questionnaire. High-quality carbohydrate was defined as carbohydrate from whole grains, fruits, vegetables, and legumes. Low-quality carbohydrate was defined as carbohydrate from refined grains, added sugars, and potatoes. We used Cox proportional hazards regression with time-varying covariates to model the substitution of 5% of energy intake from high- and low-quality carbohydrate for isocaloric amounts of fat, protein, and their subtypes [polyunsaturated fat (PUFA), animal and plant monounsaturated fat (MUFA), saturated fat, trans fat, and animal and plant protein]. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.

Results:
During 4,859,845 years of follow-up, we documented 20,141 incident T2D cases. In multivariable-adjusted meta-analyses, isocaloric substitution of high-quality carbohydrate for total fat [HR (95% CI) 0.94 (0.93, 0.96)], total MUFA [0.95 (0.91, 0.98)], MUFA from animal sources [0.92 (0.88, 0.95)], total protein [0.91 (0.89, 0.94)], or animal protein [0.94 (0.91, 0.97] was associated with a lower T2D risk. On the other hand, the substitution of low-quality carbohydrate for plant MUFA [1.06 (1.02-1.10)] or plant protein [1.06 (1.02-1.11)] was associated with a higher risk of T2D. When we restricted high-quality carbohydrate sources to whole grains, the results were similar or stronger. Additionally, substitution of whole grain carbohydrate for saturated fat [0.87 (0.84, 0.91)], trans fat [0.87 (0.83, 0.92)], PUFA [0.88 (0.84, 0.92)], plant MUFA [0.92 (0.87, 0.96)], or plant protein [0.91 (0.86, 0.97)] was associated with lower T2D risk.

Conclusions:
The effect of carbohydrate substitution on T2D risk depends not only on the nutrient being substituted but also on the quality of the carbohydrate. Substitution of high-quality carbohydrate, especially carbohydrate from whole grains (i.e. whole wheat bread, oatmeal), for fat or protein, especially animal sources (i.e. beef, poultry), may lower T2D risk.
Abstract P219: An Elevated Consumption of Ultra-Processed Food Modifies the Association of Body Mass Index With All-Cause Mortality: Prospective Analyses From the Moli-Sani Study
Authors: Bonaccio Marialaura , Di Castelnuovo Augusto F , Ruggiero Emilia , Costanzo Simona , Esposito Simona , Ghulam Anwal , Cerletti Chiara , Donati Maria Benedetta , de Gaetano Giovanni , Iacoviello Licia
Published: March 2023

Introduction:
Body mass index (BMI) has J-shaped associations with all-cause mortality, but it is unclear whether diet can modify the impact of BMI on mortality.

Hypothesis:
We tested the hypothesis that a large dietary share of ultra-processed food (UPF) can act as an effect modifier of this association.

Methods:
Longitudinal analysis on 22,836 women and men (mean age 55±12 y) from the Moli-sani Study (2005-2010) with BMI values ≥18.5 kg/m
2
. Food intake was assessed by a 188-item FFQ. UPF was defined by the NOVA classification, and calculated as the proportion (%) of UPF in the total weight of food eaten (g/d). The Food Standards Agency nutrient profiling system (FSAm-NPS) dietary index was used to evaluate participants’ diet quality. To test for a non-linear, continuous relationship of BMI with mortality, we used multivariable Cox regression analysis with BMI modelled as restricted cubic splines and used the value of 25 kg/m
2
as the reference value. Main analyses were stratified by baseline low or high UPF consumption (i.e. below or above our population sex-specific median of UPF consumption, respectively).

Results:
Over a median follow-up of 12.2 y, 2,230 all-cause deaths occurred. In multivariable-adjusted models also including the FSAm-NPS dietary index and UPF, BMI had a J-shaped association with mortality (p-value<0.001; p for non-linearity<0.001); amongst lower UPF consumers, BMI values ≥33.6 kg/m
2
were associated with increased death risk, while BMI values ≤25 kg/m
2
were not (
Figure
). Higher UPF consumers experienced greater mortality risk both at higher and lower BMI values (
Figure
; p for interaction across UPF intake groups=0.016).

Conclusions:
In this cohort of adult Italians, UPF consumption acts as an effect modifier of the association between BMI and mortality, regardless of the overall diet quality. These findings suggest that a body weight considered to be healthy, when associated with a large dietary share of highly processed foods, is unlikely to provide substantial long-term health advantages.
Abstract P220: Dietary Patterns and Lower Risk of Early Stage of Renal Dysfunction in 9-Year Follow-Up in a Japanese General Population: Tanushimaru Cohort Study
Authors: Morikawa Nagisa , Enomoto Mika , Fukami Ako , Sato Hiromi , Adachi Hisashi , Fukumoto Yoshihiro
Published: March 2023

Introduction:
Chronic kidney disease (CKD) is a growing public health problem with aging society and a progression to end-stage renal disease is associated with a higher risk of death. Previous studies have suggested that healthy dietary patterns like vegetable-based diet may reduce risk of incident CKD in general populations. However, there is less evidence on whether dietary patterns have impact on early stage of renal dysfunction (RD). Therefore, we investigated the longitudinal association between dietary patterns and early stage of RD in a general population.

Methods:
We recruited 1943 men and women aged 40 to 95 years in the prospective Tanushimaru cohort study in Japan in 2009. Their dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ). Principal component analysis (PCA) identified the main dietary patterns. In 984 participants re-examined in 2018, estimated glomerular filtration rate (eGFR) was calculated by CKD-EPI method in 2009 and 2018. RD and early RD were defined as eGFR < 60 and < 90 mL/min/1.73m
2
, respectively . Multivariable linear and logistic regression analyses were performed to examine the association of the main dietary patterns in 2009 with RD and early RD in 2018. Covariates included cardiovascular risk factors and eGFR at baseline.

Results:
Mean levels of eGFR in 2009 and 2018 were 94.0 and 84.3 mL/min/1.73m
2
. The prevalence of RD and early RD in 2018 were 8.8% (n=87) and 58.5% (n=576), respectively. The PCA revealed three major dietary patterns: vegetable pattern (vegetables, mushrooms and seaweeds); rice pattern (rice, bread and miso soup); and alcohol pattern (alcoholic beverages, cakes and snacks). The higher vegetable pattern score was significantly associated with higher eGFR in 2018 (p=0.006) and modestly associated with lower risk of early RD (p=0.06), but not RD (p=0.1) in the fully-adjusted models.

Conclusions:
The vegetable pattern was significantly associated with higher eGFR and may prevent an early stage of RD in a 9-year follow-up.
Abstract P223: Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Industrial Trans-Fatty Acids in Nigeria
Authors: Marklund Matti , Aminde Leopold N , Wanjau Mary N , Ale Boni M , Ojo Adedayo E , Okoro Clementina E , Adegboye Abimbola O , Veerman J. Lennert , Wu Jason HY , Huffman Mark D , Ojji Dike B
Published: March 2023

Objectives:
To estimate the potential health gains, costs, and cost-effectiveness of a mandatory limit on industrial trans fatty acids (iTFA) in the Nigerian food supply.

Methods:
We used Markov cohort models to estimate the effect on ischemic heart disease (IHD) burden, costs, and cost-effectiveness of a mandatory iTFA-limit (≤2% of all fats) for foods in Nigeria. Data on demographics, IHD epidemiology, and trans-fatty acid intake were derived from the 2019 Global Burden of Disease Study. We calculated the IHD burden attributable to iTFA by comparing the current trans-fatty acid intake to counterfactual settings with complete elimination of iTFA intake. Policy implementation costs (including government costs for legislation and monitoring, and industry costs for product reformulation), avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and healthcare costs saved were estimated over 10 years and lifetime of the Nigerian population. Incremental cost-effectiveness ratios using net costs (i.e., implementation costs minus healthcare cost savings) and HALYs gained (both discounted at 3%) were used to assess cost-effectiveness.

Results:
Over the first 10 years, elimination of iTFA intake was estimated to prevent 9,996 (95% uncertainty interval: 8,870; 11,118): IHD deaths and 66,569 (58,862; 74,083) IHD events, and to save 90 million USD (78; 102) in total healthcare costs. The corresponding estimates over the lifetime were 259,934 (228,736; 290,191), 479,308 (95% UI: 420,472; 538,177), and ~518 (450; 587). Policy implementation costs (government plus industry) were estimated as 18 million USD (12; 25) over the first 10 years, and 27 million USD (20; 35) over the population lifetime. The intervention was estimated to be cost-saving. Findings were robust across several deterministic sensitivity analyses (Figure).

Conclusions:
Our findings support legislating a mandatory limit of iTFAs as a cost-saving strategy to avert substantial numbers of IHD events and deaths in Nigeria.
Abstract P224: The Collaborative, Iterative Process of Changing Diet Toward Plant Proteins: A Qualitative Study Exploring the Drivers and Process of Dietary Change
Authors: Parameswaran Vijaya , Coen Corinne , Cola Phillip , Dash Rajesh , Stange Kurt , Lyytinen Kalle
Published: March 2023

Background:
Psychological models describe dietary change as linear, self-regulatory, and outcome driven. Yet, the average adult tries at least two diets a year and abandons them after a few days. The cardiometabolic benefits of plant proteins (PP) are undisputed, but changing protein choices can be challenging.

Methods:
We recruited 30 adults who changed their protein choice using snowball sampling and conducted inductive semi-structured interviews to understand why and how protein choices shift, who influences them, and whether they stick. Participants shared influencer names, the extent of influence (high-3, medium-2, low-1), and their rationale regarding food decisions. We transcribed and analyzed the interviews to identify common themes and mapped their social network.

Results:
(90%) 27/30 identified at least two PP sources, (33%) 10/30 entirely replaced animal protein (AP) with PP, (57%) 17/30 decreased AP intake significantly but did not replace it with PP, (10%) 3/30 increased AP sources. All reported continuing change for at least six months. Our analysis, Figure 1, uncovers a mindful process of change that is collaborative, continuous, iterative, and adaptive, anchored in three dimensions: 1) Crafting the milieu - personal and social environment: 2) Discovering social self - cultivating psychosocial awareness thru practice and reflection: and 3) Sociotechnical art - acquiring culinary knowledge from others. Social network analysis (SNA) revealed three boundary spanners connecting more than one group, betweenness (>0.4), three popular participants, eigencentrality (>0.5) and many community formations, modularity (0.82), Figure 2.

Conclusion:
Based on our results, people who desire change gravitate toward those who have successfully navigated it. The process of dietary change reveals opportunities to tailor diets supporting close family and connections. Identifying and targeting diet recommendations towards influencers in local communities may help achieve widespread and long-lasting change.
Abstract P225: Physical Activity and Heart Failure Prognosis in Older Postmenopausal Women
Authors: LaMonte Michael J , Miremad Moafi-Madani , Nguyen Steven , Lacroix Andrea Z , Hovey Kathleen M , Roberts Mary B , Soliman Ahmed , Eaton Charles B
Published: March 2023

Background:
Accumulating evidence suggests that participating in physical activity (PA) following heart failure (HF) diagnosis is associated with better prognosis, including lower mortality risk. Few studies have focused on this relationship in postmenopausal women, in whom HF burden is high.

Methods:
The present study, conducted in the Women’s Health Initiative, included 2,181 postmenopausal women (mean age 68 years; 85% white, 10% black, 3% Hispanic at enrollment in 1993-1998) who were diagnosed postbaseline with incident hospitalized acute HF and had at least one self-reported PA assessment before and after (mean age 73 at latter assessment) HF diagnosis. Total recreational PA was summarized in metabolic equivalent (MET) hours per week. Women were followed for all-cause mortality from their post-HF PA assessment through March 2014. Cox regression with age as the time scale was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality associated with PA categories (before/after HF): Inactive (<7.5 MET-hr/wk)/Inactive, n=1,048; Active (≥7.5 MET-hr/wk)/Inactive, n=407; Inactive/Active, n=212; Active/Active, n=514.

Results:
There were 1,047 (48%) deaths during a mean follow-up of 12 years. Crude mortality rates per 1,000 person-years [number of deaths] across the above PA groups were 42.4 [533], 42.1 [206], 36.9 [94], and 34.7 [214]. After adjusting for age (timescale), race and ethnicity, and WHI study component, HRs (95% CI) for mortality across the PA groups were 1.00 (referent), 0.94 (0.79, 1.10), 0.80 (0.64, 1.01), and 0.60 (0.51, 0.71). Further adjustment for baseline education, BMI, physical function, smoking, menopausal hormone use, history of diabetes, hypertension, myocardial infarction, stroke, coronary revascularization, atrial fibrillation, and incident myocardial infarction during follow-up prior to HF diagnosis attenuated these associations but did not eliminate statistical significance for the Active/Active group: 1.00 (referent), 1.04 (0.87, 1.24), 0.87 (0.69, 1.10), 0.74 (0.62, 0.89). A similar pattern of results was evident when cardiovascular mortality was the study outcome.

Conclusions:
Maintaining PA levels following hospitalization for acute HF was associated with lower all-cause mortality in older postmenopausal women, an understudied population in this regard. Among women whose PA following HF diagnosis was higher than their pre-HF PA level, there was a trend for lower mortality although this did not achieve statistical significance. Studies are needed to determine whether PA is associated with prognosis in HF subtypes, such as HF with preserved ejection which is a prevalent HF subtype in older women.
Abstract P228: Accelerometer-Derived Daily Steps, Cognition, and Cognitive Impairment in U.S. Community-Dwelling Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Martinez-Amezcua Pablo , Dooley Erin , Pompeii Lisa , Evenson Kelly R , Rippon Brady , Windham B Gwen , Mosley Thomas , Schrack Jennifer , Gabriel Kelley P , Palta Priya
Published: March 2023

Introduction:
Higher physical activity levels have been shown to preserve cognitive function and prevent cognitive impairment (CI). Whether daily steps, an easily interpretable physical activity metric, is associated with measures of brain health has not been widely studied.

Hypothesis:
Higher daily step count is associated with better cognitive function and lower odds of CI.

Methods:
Cross-sectional analysis of ARIC participants (mean age: 78 years, 41% male, 19% Black) who wore an accelerometer (ActiGraph GT3X) on the waist for ≥10 hours on ≥3 days between 2016-17. Daily steps were derived and examined continuously and by quartiles. Global and domain-specific (memory, language, executive function) factor scores were estimated from a battery of cognitive tests. Participants were classified as having CI if they had an adjudicated diagnosis of mild CI or dementia. Hypotheses were tested using linear and logistic regression models, adjusted for age, sex, race, education, and accelerometer wear time.

Results:
Among 454 participants, 88 (19.4%) had CI. The mean number of daily steps was 3,501 (SD=1,974). In adjusted models, a higher daily step count was associated with better global cognition and executive function factor scores (e.g., those in the 4
th
daily-step quartile [≥4,499 steps] vs. 1
st
[<2074 steps] had a 0.43 [95% confidence interval: 0.24 to 0.61] higher executive function score). Associations of step count with memory or language scores were not supported. The odds of CI were lower for participants who had a higher daily steps count (e.g., those in the 4
th
daily-step quartile vs. 1
st
had 62% [odds ratio (OR)=0.38, 95% confidence interval: 0.16 to 0.90] lower odds of CI. The OR of CI for continuous daily steps shown in the Figure.

Conclusions:
Higher daily steps were associated with better cognitive function and may be a helpful marker in identifying participants with CI. Prospective studies of accelerometer-measured physical activity and cognitive outcomes are needed to understand the direction of these associations.
Abstract P229: The Associations Between Muscular Strengthening Activity, Physical Function, and All-Cause Mortality Among Older Adults With Cardiovascular Disease
Authors: Boyer William , Laddu Deepika , Gorzelitz Jessica , Booker Robert
Published: March 2023

Background:
CVD is the leading cause of mortality in the US. Strong evidence suggests that aerobic physical activity (PA) is associated with reducing the risk of mortality among those with CVD. However, the extent to which muscular strengthening activity (MSA), as well as measures of physical functioning (PF), is related to mortality risk reduction is unknown in those with CVD.

Purpose:
To examine the associations between MSA and PF with all-cause mortality among a representative sample of the US with CVD.

Methods:
Participants aged ≥50 years (n=5,531; mean age 64.3 years, 52% female) from the 1999-2006 NHANES with complete covariates and outcomes were included. A subset (n=2,094) had MEC-measured PF data (time to peak force in seconds [TPF]; peak force in newtons [PF-N]; time to complete a 20-foot walk in seconds [TCW]) available at baseline through 2002. MSA volume was dichotomized as meeting (≥2 days/week) vs not meeting current MSA guidelines (<2 days/week). Multivariable Cox proportional hazards regression models estimated associations (HR) between (1) MSA categories, and (2) quartiles of PF [TPF, TCW, PN-F], with all-cause mortality in the overall sample, and then stratified by enrollment age (<50-64 years and ≥65 years).

Results:
A total of 2,046 deaths from any cause were identified over the 69,386 person-years of follow-up. Null associations were observed between MSA categories with mortality in multivariable models. Age stratified models revealed lower risk of all-cause mortality in adults ≥65 years meeting MSA guidelines versus insufficient MSA (HR 0.85, 0.73-0.99); however this association was not observed in adults aged 50-64 (HR 1.17, 0.82-1.65). Dose-response reductions in all-cause mortality risk were found across all quartiles for TCW and PF-N but not for TPF. These findings were consistent in adults aged 50-64 years and ≥65 years.

Conclusions:
Results suggest that meeting MSA recommendations is particularly beneficial for lowering all-cause mortality risk among those ≥65 years. Further, higher levels of PF appear to be associated with lower all-cause mortality risk among adults, supporting the role of assessing PF a potential indicator of future mortality risk. These findings collectively underscore the importance of including MSA in exercise prescriptions for older adults with CVD.
Abstract P236: Neighborhood Socioeconomic Status and Functional Status Impairment in Late-Life: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Patterson Sierra , Palta Priya , Martinez-Amezcua Pablo , Lee Mark , Kucharska-Newton Anna
Published: March 2023

Introduction:
Neighborhood characteristics and physical activity levels may impact physical function. The present study examined the relationship between neighborhood socioeconomic status (NSES) and functional status impairment among older men and women and examined whether this relationship differed by physical activity.

Hypothesis:
Compared to those with high levels of NSES, participants with low NSES will have higher odds of functional impairment in late life. This association will be modified by physical activity.

Methods:
We constructed an aggregate measure of NSES using census-based indicators of wealth, education, and occupation and quantified distribution-based tertiles of low, middle, and high NSES among ARIC cohort participants in Visit 5 (2011-2013). We used the Rosow-Breslau scale to ascertain functional status (range 0-4; functional impairment defined as a score<4) during the 2016 annual telephone interview. Multivariable logistic regression was used to examine the association between NSES tertiles and functional status impairment adjusting for age, race, ARIC center, and sex. We tested for effect modification by AHA-defined physical activity (categorized as poor, intermediate, ideal based on weekly minutes of moderate-to-vigorous physical activity). We also tested for effect modification by sex, race, and age.

Results:
Among 4,439 participants (mean age: 75 (SD 5) years, 22% Black, 55% female), 1,788 (40%) had functional status impairment. In analyses adjusted for sex, race, and age, the odds of functional impairment among participants with low NSES were 1.86 (95% CI: 1.60, 2.16) times the odds of functional impairment among those with high NSES. There was evidence of effect measure modification by race (p=0.06) and age (p=0.07). In White participants, the odds of functional status impairment among participants with low NSES was 1.99 (95% CI: 1.69, 2.35) times the odds of functional impairment among those with high NSES. This association was attenuated in Black participants (OR: 1.38, 95% CI: 0.96, 2.00). In participants less than 74 years, the odds of functional status impairment among participants with low NSES was 2.17 (95% CI: 1.73, 2.72) times the odds of functional impairment among those with high NSES. This association was attenuated in participants 74 years and older (OR: 1.64, 95% CI: 1.34, 1.99). There was no evidence of effect modification by physical activity (p=0.20) nor sex (p=0.65).

Conclusions:
Low NSES is modestly associated with functional status impairment in older adulthood. This association appeared stronger in Whites compared to Blacks, and in those younger than 74 years.
Abstract P238: Gait Characteristics in Older Adults Using the Protokinetics Zeno Walkway: The Atherosclerosis Risk in Communities Study
Authors: Skow Laura , Windham B Gwen , Sharrett A R , Griswold Michael , Schrack Jennifer
Published: March 2023

Introduction:
Slowed gait speed in older adults is associated higher vascular disease burden, greater risk of dementia, and falls. Gait mat measurement technology captures speed as well as additional gait parameters, with potential importance for better risk prediction and identification in older adults, but normative data are needed. We assessed correlations between mat-measured gait speed and gait parameters to identify potential targets for future gait research. We hypothesized that gait parameters would not correlate with overall mat-measured gait speed as strongly as overall gait speed correlates within repeat trials of mat or stopwatch-measured trials.

Methods:
Participants (n = 402, mean age: 81 years, 54% women, 19% Black race) from the Atherosclerosis Risk in Communities Study completed two consecutive usual pace walks on Zeno Walkway™ gait mats at visit 8. Two-hundred thirty-six participants additionally completed two 4-meter usual pace walks timed by stopwatch. We assessed validity using the difference between the faster of two trials each for mat- and stopwatch-measured gait speed using Bland-Altman plots, and Pearson’s correlations, and examined reliability with consecutive trials within measurement type. We reported mean, standard deviation, range, and correlation of 37 gait parameters with gait speed, as well as intra-person variability (coefficient of variation) and parameter asymmetry between footfalls.

Results:
Participants had an average gait speed of 0.92 m/sec (SD 0.19 m/sec) measured by mat and 0.99 m/sec (SD 0.21 m/sec) by stopwatch. Mat-measured gait speed was strongly correlated with stopwatch measured speed (Pearson’s Correlation 0.85). Mat-measured walks were on average 0.08 m/sec faster than paired stopwatch-measured walks (standard deviation of difference 0.11 m/sec, p<0.001), regardless of gait speed. Consecutive mat walks had higher Pearson’s and R-squared correlations (0.95 and 0.90) than consecutive stopwatch walks (0.89 and 0.83). Of 37 gait parameters tested, 9 were positively correlated (Pearson’s correlations 0.64 to 0.76) and 7 were negatively correlated (Pearson’s correlations -0.64 to -0.42) with gait speed. Parameter variability in single stance center of pressure distance and gait speed was moderately negatively correlated (Pearson’s correlation -0.50). Correlations between gait speed and gait parameter asymmetry were low (<|0.33|).

Conclusions:
Gait mat technology shows high reliability and high correlation with stop-watch measurement in older adults in the ARIC population. Additional gait parameters were largely not strongly correlated with gait speed, including step-to-step measures of variability and asymmetry, suggesting avenues for future research to evaluate gait differences more granularly as more sensitive indicators of health risk in older adults.
Abstract P241: Later Menarche Onset Portends Lower Risk of Preterm Birth: Results From the Boston Birth Cohort
Authors: Chen Yingan , Wang Guoying , Hong Xiumei , Zhang Mingyu , Wang Xiaobin , Mueller Noel T
Published: March 2023

Introduction:
Age at menarche onset reflects many health aspects in women. Later age at menarche has been associated with lower risk of several cardiometabolic disease outcomes, including diabetes and various cardiovascular diseases. However, no studies have reported the association of maternal menarche age with risk of preterm birth (PTB)—a pregnancy outcome with significant racial disparities and cardiometabolic etiology.

Hypothesis:
Later age at menarche onset is associated with lower risk of PTB.

Methods:
We conducted a case-control study in the Boston Birth Cohort, including 2242 mothers with PTB [gestational age (GA) <37 wks], and 6022 mothers with term birth (GA ≥37 wks). We used a maternal postpartum questionnaire (administered 24-72 hrs after delivery) to collect data on age at menarche, sociodemographic and lifestyle factors. We used medical records to ascertain GA. We used multivariable-adjusted logistic regression models and restricted cubic splines to examine the association between age at menarche and odds of PTB.

Results:
Of the 8264 mothers in our study, 46.9% identified as Black and 28.8% as Hispanic. Maternal age at delivery was 28.1y ±6.5y and age at menarche was 12.85y ±1.86y. Our multivariable-adjusted cubic spline suggested a linear dose-response association of age at menarche with odds of PTB and GA (Figure). Per 1-year later menarche onset of menarche was associated with 5% (95% CI: 2%-8%) lower odds of PTB, after adjustment for maternal place of birth, education, smoking status, Mediterranean diet score, and pre-pregnancy BMI. We found a similar pattern (5% lower odds per 1-year later, 95% CI: 1%-8%) in Black mothers.

Conclusion:
In a large cohort of racially and ethnically diverse women, later age at menarche is associated with lower risk for PTB. Our findings suggests that the origins of higher risk for PTB start early in life, before puberty, and appear to be independent of adiposity. Future studies are needed to identify mechanisms and points of intervention.