bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 038: Improvements in Meeting the
2008 Physical Activity Guidelines for Americans
by Cardiovascular Disease Status — United States, 2012 and 2017
Authors: Omura John D , Hyde Eric T , Loustalot Fleetwood , Fulton Janet E , Carlson Susan A
Published: March 2019

Introduction:
Physical activity can help prevent and manage cardiovascular disease (CVD), and is one of the AHA Life’s Simple 7 metrics. Recent behavioral recommendations have specifically targeted physical activity for adults at high risk for CVD. For example, in 2014 the US Preventive Services Task Force recommended intensive behavioral counseling interventions for adults with cardiovascular risk factors. Our purpose was to examine the magnitude of differences in prevalence of meeting the aerobic component of the
2008 Physical Activity Guidelines for Americans
by CVD status over five years.

Methods:
Nationally representative self-reported data from the 2012 and 2017 National Health Interview Survey (N=32,568 and N=25,258 respectively) were analyzed. Prevalence of meeting the aerobic guideline was estimated overall and by CVD status (no CVD/not at risk; at risk for CVD: overweight or has obesity and ≥1 of diabetes, high cholesterol, or hypertension; or having CVD). T-tests were used to identify significant differences.

Results:
Similar differences in age-adjusted prevalence of meeting the aerobic guideline were observed across CVD statuses in both 2012 and 2017, with adults with no CVD and not at risk having the highest prevalence (57.7% in 2017) and those with CVD having the lowest prevalence (38.5% in 2017) (p<0.05). From 2012 to 2017, prevalence increased significantly overall (7.8%), among those with no CVD and not at risk (7.8%), and among those at risk (13.0%) (p<0.001). Among those with CVD, the increase (8.5%) was not significant.

Conclusions:
Prevalence of meeting the aerobic guideline showed significant improvement among adults with better CVD statuses; however, only about half of those at risk and 39% of those with CVD currently meet the aerobic guideline. The anticipated release of the 2
nd
edition of the Physical Activity Guidelines presents an important opportunity for promoting physical activity. Efforts to identify and address the barriers those with higher CVD risk face could help prevent or manage CVD.
Abstract 045: The Dose-Response Effect of a Mediterranean Style Diet With Lean Beef on Lipids and Lipoproteins
Authors: Fleming Jennifer , Kris-Etherton Penny , Petersen Kristina , Baer David
Published: March 2019

A Mediterranean dietary pattern is widely recommended because of an extensive evidence base showing beneficial effects on cardiovascular disease (CVD) risk and mortality. The reduction in cardiovascular mortality is due, in part, to the improvements in lipids and lipoproteins versus a Western dietary pattern. Plant-based diets such as a Mediterranean diet are recommended for CVD risk reduction. However, adherence to plant-based diets is often hampered by the limited or restricted intake of red meat, a staple of the American diet. We conducted a multicenter, 4-period controlled feeding, randomized crossover study at Penn State University and USDA-Beltsville to evaluate the effects of a Mediterranean diet (CHO 42%, PRO 17%, FAT 41%, SFA 8%, MUFA 26%, PUFA 8%) with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an Average American diet (AAD; CHO 52%, PRO 15%, FAT 33%, SFA 12%, MUFA 13%, PUFA 8%) on CVD risk factors. We tested the hypothesis that including 0.5, 2.5 or 5.5 oz/d (based on 2100 kcals) of lean beef in a healthy Mediterranean style diet will confer similar cardioprotective benefits, and be superior to an AAD. Each Mediterranean diet included 7oz. equivalents of protein, of which 0.5, 2.5 or 5.5 oz. came from beef and the remainder from fish, poultry, pork, nuts, eggs, and legumes. The quantities of beef reflect amounts consumed in a traditional Mediterranean diet (0.5 oz.), current consumption in the U.S. (2.5 oz.), and an amount that represents all animal protein equivalents (5.5 oz.). Participants (n=60; 30 per site) included generally healthy normal to overweight/obese males and females (BMI= 20-38 kg/m
2
) 30 to 60 years. Participants were randomized to each of the 4 diets for 4 weeks with an approximate 2-week break between treatments. Fasting blood samples were collected on two consecutive days at baseline (start of study) and at the end of each 4-week period. All three Mediterranean diets elicited similar lowering of total cholesterol (TC; p<0.0001), LDL-C (p<0.001), non-HDL-C (p<0.0001) and apolipoprotein B (apoB) (p<0.0001) that was greater than the AAD. All diets (AAD, MED0.5, MED2.5 and MED5.5) decreased HDL-C (-3.46 ± 1.11, -4.93 ± 1.14, -4.44 ± 0.93, and -3.31 ± 1.20 mg/dl, respectively; p<0.01) and apolipoprotein A1 (apoA1) (-8.63 ± 1.77, -11.45 ± 1.72, -11.21 ± 1.71, and -7.97 ± 1.90 mg/dl, respectively; p<0.0001). The MED5.5 attenuated the reduction in apoA1 versus the other two MED diets (p<0.05). In conclusion, a healthy Mediterranean Style diet containing 0.5 to 5.5 oz/day of lean beef improves multiple CVD risk factors compared to a current American dietary pattern.
Abstract MP02: Urinary Level of Trimethylamine-N-Oxide Predicts an Increased Risk of Coronary Heart Disease Among Urban Chinese Adults
Authors: Yu Danxia , Shu Xiao-Ou , Rivera Emilio , Zhang Xianglan , Cai Qiuyin , Calcutt Marion , Xiang Yong-Bing , Li Honglan , Gao Yu-Tang , Wang Thomas , Zheng Wei
Published: March 2019

Introduction:
Trimethylamine-N-oxide (TMAO), a diet-derived, gut microbial-host co-metabolite, has been associated with adverse cardiovascular outcomes in patient populations. However, the evidence is lacking from prospective studies conducted in general populations and in non-Western populations.

Hypothesis:
TMAO level is associated with risk of coronary heart disease (CHD) in general populations.

Methods:
We examined associations of urinary TMAO and its precursors (i.e., choline, betaine, and carnitine) with risk of CHD in a case-control study nested within two prospective cohorts of Chinese adults, including 275 incident CHD cases and 275 individually matched controls.

Results:
Urinary TMAO, but not its precursors, was associated with risk of CHD. Odds ratio (OR, 95% CI) for the highest vs. lowest quartiles of TMAO was 1.91 (1.08-3.35; p-trend=0.008) after adjusting for CHD risk factors including obesity, diet, lifestyles, and metabolic diseases and 1.75 (0.96-3.18; p-trend=0.03) after further adjusting for potential confounders/mediators including central obesity, dyslipidemia, low-grade inflammation, and intakes of seafood and deep-fried meat/fish, which were associated with TMAO level in our study. OR was 1.30 (1.03-1.63) per standard deviation increase in log-TMAO in the fully-adjusted model. History of diabetes modified the TMAO-CHD association. A high TMAO level (≥ vs. <median) showed ORs of 6.21 (1.64-23.6) and 1.56 (1.00-2.43) among diabetic and non-diabetic participants, respectively (p-interaction=0.02). History of diabetes also modified the associations of choline, betaine, and carnitine with risk of CHD with significant positive associations being found among diabetics but null associations among total and non-diabetic participants.

Conclusions:
Our study suggests that TMAO may play a role in the development of CHD, highlighting the importance of diet-gut microbiota-host interplay in cardiometabolic health.
Abstract MP06: Vitamin K Status and Cardiovascular Disease: A Participant-Level Meta-Analysis
Authors: Shea M. Kyla , Weiner Daniel E , Matuszek Gregory , Booth Sarah L , Benjamin Emelia J , Cushman Mary , Kritchevsky Stephen B , Burke Gregory L , Barger Kathryn
Published: March 2019

Introduction:
A role for vitamin K in CVD has been proposed because vitamin K-dependent proteins are present in vascular tissue. In individual cohorts, low vitamin K status has been associated with increased CVD. We conducted a participant-level meta-analysis to summarize the association between circulating vitamin K and CVD in the Framingham Offspring Study, the Health, Aging, and Body Composition Study (Health ABC), and the Multi-ethnic Study of Atherosclerosis (MESA), three cohorts in which circulating vitamin K measures and confirmed cardiovascular events are available.

Aim:
To determine the association between vitamin K status and CVD in community-dwelling adults, overall and according to CVD risk and known risk factors.

Methods:
Circulating phylloquinone (vitamin K1) was measured from baseline fasting blood samples in 3626 participants and categorized as ≤0.5 nM, >0.5 - ≤1.0 nM and >1.0 nM. Multivariable Cox proportional hazards models assessed the association between circulating phylloquinone and risk of a composite of CVD and mortality.

Results:
Among the 3626 participants, mean baseline age was 65±11 yrs; 45% were men and 65% white. There were 1436 composite events over a median of 15.4 years. Participants with circulating phylloquinone < 0.5 nM had a 21% higher risk for CVD and mortality compared to those with >1.0nM [HR(95%CI)=1.21(1.06, 1.38)]. When stratified according to baseline CVD risk and risk factors, those with circulating phylloquinone < 0.5 nM had a 27%-82% higher risk for CVD and mortality outcomes compared to those with >1.0 nM (
Table
).

Conclusion:
Lower circulating phylloquinone was independently associated with a higher risk for CVD and mortality in community-dwelling adults, and more so among those at risk for CVD. Additional studies are needed to confirm our findings and clarify if segments of the population can derive cardiovascular benefit from improving vitamin K status.
Abstract MP07: The Association of Optimism, Chronic Kidney Disease and Rapid Kidney Function Decline Among African Americans in the Jackson Heart Study
Authors: Glover La’Shaunta’ , Cain Loretta , Butler Crystal , Forde Allana , Purnell Tanjala , Young Bessie , Sims Mario
Published: March 2019

Background:
The burden of chronic kidney disease (CKD) and incidence of end-stage renal disease are greater among African Americans than other racial and ethnic groups. A number of studies have attributed the higher prevalence of CKD to traditional risk factors and lower socioeconomic status. However, few studies have examined the association of kidney disease with dispositional optimism, the expectation that positive things will happen.

Hypothesis:
We hypothesize that there would be an inverse association between optimism and CKD and RKFD.

Objective:
To examine the association of optimism with CKD at baseline (2000-2004) and rapid kidney function decline (RKFD) between exams 1 and 3 (2000-2013) among African Americans.

Methods:
We examined 5292 African American participants from the Jackson Heart Study. Optimism was measured using the 6-item Life Orientation Test-Revised (LOT-R) scale and was categorized into tertiles. CKD at baseline was defined as the presence of albuminuria or reduced glomerular filtration rate (eGFR) <60 ml/min/1.73m
2
, or report of dialysis at baseline examination. RKFD was defined as a decline > 4 ml/min/1.73m
2
/ year between exams 1 and 3. The associations between optimism and kidney outcomes were tested using multivariable logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex, education, income, waist circumference, alcohol intake, physical activity, smoking, diabetes, and hypertension.

Results:
After exclusion of missing CKD status, there were 682/3422 (19.9%) cases of CKD at exam 1 and 303/3706 (8.2%) who had RKFD at exam 3. Participants with CKD and RKFD were less optimistic (
p
<0.05) and were more likely to be older, less educated, have a higher waist circumference, a higher diabetes prevalence. After full adjustment, high (vs. low) optimism was associated with a 32% lower odds of CKD (OR 0.68, 95% CI 0.53-0.85). After 7.21 median years of follow up, high (vs. low) baseline optimism was associated with a 33% lower odds of RKFD after full adjustment (OR 0.67 95% CI 0.48-0.95).

Conclusions:
Higher optimism was associated with a lower odds of CKD and a lower odds of RKFD over a period of 7 years in this sample of African Americans.
Abstract MP08: Higher Fitness Level and Favorable Hemodynamic Responses to Submaximal Exercise Test in Young Adults are Associated With Lower Risk of Chronic Kidney Disease in Later Life: The Framingham Heart Study
Authors: Lee Joowon , Xanthikis Vanessa , Song Rebecca , Vasan Ramachandran S
Published: March 2019

Introduction:
Studies have demonstrated that higher cardiorespiratory fitness (CRF) and a favorable heart rate (HR) and blood pressure (BP) response to submaximal exercise, including during the recovery period, are associated with lower cardiovascular disease (CVD) risk. However, there are limited studies examining the association of CRF and hemodynamic response to exercise test with incidence of chronic kidney disease (CKD).

Hypothesis:
We hypothesized that high CRF and a favorable HR and BP response to submaximal exercise test and during recovery will be associated with lower risk of CKD prospectively.

Methods:
We evaluated 3,535 Framingham Offspring Study participants (mean age 43.5 yrs, 52.1% women) without CKD, who completed a submaximal exercise test between 1979-1983. CKD incidence was defined as eGFR <60ml/min/1.73m
2
on follow-up. Multivariable-adjusted Cox regression models with discrete time intervals were used to relate CRF and hemodynamic responses to exercise test at baseline with the incidence of CKD on follow-up.

Results:
At baseline, 23% of participants had chronotropic incompetence and 19.6% had impaired HR recovery after exercise (Δ HR
1
< 12 bpm). On follow-up (median 25.7 years), 801 individuals (22.8%; 434 women) developed CKD. Participants in the second and third tertile of CRF (defined based on age and sex-specific treadmill exercise duration) had lower risk of CKD compared to those in the first tertile of CRF (
Table
). Participants with chronotropic incompetence, higher peak SBP during exercise and impaired HR recovery had higher risk of CKD, compared to those with chronotropic competence, lower peak SBP during exercise, and normal HR recovery post-exercise (
Table
).

Conclusions:
Higher CRF and favorable HR and BP responses to exercise test in young adulthood may be a marker of lower risk of CKD in later life. The biological mechanisms underlying the observed association warrant further investigation.
Abstract MP14: Trends in Stroke Incidence Among Older Adults- ARIC 1990-2016
Authors: Koton Silvia , Sang Yingying , Schneider Andrea L , Rosamond Wayne D , Gottesman Rebecca F , Coresh Josef
Published: March 2019

Introduction:
Stroke incidence has generally declined in the last decades in the US. Using validated stroke data in the Atherosclerosis Risk in Communities (ARIC) study, we have previously shown decreasing stroke incidence rates from 1987 to 2011 among ≥65 years old (JAMA 2014). We evaluated whether stroke incidence declines among older adults continued during 2011 to 2016.

Methods:
Among 15,792 individuals recruited in ARIC in 1987-1989, 14,357 were free of stroke at baseline and eligible for the present study. Definite or probable stroke events were identified with a computer algorithm and physician reviews. Cases before 1990 were not included. We studied crude incidence rates (per 1,000 person-years) stratified by 5-year periods for age group and 3-year calendar period of follow-up. Temporal trends in rates were estimated using Poisson regression incidence rate ratios adjusted for age, gender, race-center, and time-varying hypertension, diabetes, coronary heart disease, cholesterol lowering medication use and smoking.

Results:
In ARIC, 1,279 incident strokes occurred over 320,089 person-years among 14,357 participants. Five age-groups were studied: 65-69, 70-74, 75-79, 80-84 and ≥85. Length of follow-up periods differed by age-group as ARIC is a closed cohort. In the 75-79 years old, representative for groups with long follow-up, crude incidence rates (95% CI) per 1,000 person-years decreased from 10.37 (7.11-15.13) in 1999-2001 to 6.58 (4.93-8.79) in 2011-2013 and 5.67 (4.16-7.73) in 2014-2016. Decreasing incidence rates were observed in the analysis by gender and race as well. Linear trends in incidence rate ratios for 3-year periods showed a decrease in adjusted stroke incidence rates from 1990 to 2016 in ARIC participants ≥65 years old (Figure).

Conclusions:
Validated total stroke incidence rates among ≥65 years old decreased over calendar time in the ARIC cohort. The decrease in rates reported to 2011 extends for the subsequent 5 years (to 2016) in men and women, whites and African-Americans.
Abstract MP21: Heart Failure Risk Associated With Optimal Levels of Modifiable HF Risk Factors: The Atherosclerosis Risk in Communities Study (ARIC)
Authors: Hamo Carine E , Kwak Lucia , Florido Roberta , Echouffo-Tcheugui Justin , Blumenthal Roger , Loehr Laura , Matsushita Kunihiro , Nambi Vijay , Ballantyne Christie M , Selvin Elizabeth , Folsom Aaron , Heiss Gerardo , Coresh Joseph , Ndumele Chiadi E
Published: March 2019

Background:
Several heart failure (HF) risk factors, including hypertension, diabetes mellitus, obesity, and physical activity, are well described. However, the degree to which optimization of these modifiable risk factors might impact the incidence of HF is not yet fully defined.

Hypothesis:
We hypothesized more optimal control of major modifiable HF risk factors is associated with progressively lower HF risk.

Methods:
We performed a prospective analysis of 13,534 ARIC participants (mean age 57, 55% female), examining HF risk associations of different cutpoints of glycemia (HbA1c), systolic blood pressure (SBP), body mass index (BMI) and physical activity (assessed at Visit 2 [1990-92], except for physical activity assessed at Visit 1 (1987-89]). Optimal risk factor control was defined as HbA1c < 7%, SBP < 120 mmHg, BMI 18.5-25 kg/m
2
, and AHA-recommended activity levels. Severely uncontrolled risk factors were defined as HbA1c > 8%, SBP > 160 mmHg, BMI > 35 kg/m
2
and no exercise physical activity. Intermediate values were considered mild to moderately uncontrolled. Cox models simultaneously including all risk factors were constructed to assess associations of risk factor levels with incident HF (by discharge codes) after Visit 2 through 2016.

Results:
There were 2,827 HF events over a median 24 years of follow-up. Risk gradations were seen across categorizations of each risk factor (Table). In the full model, relative to optimal control, HRs were 2.06 for BMI ≥ 35 kg/m
2
, 1.16 for poor physical activity, 2.31 for HbA1c > 8% and 1.80 for SBP ≥ 160 mmHg. No risk gradient was seen from SBP < 120 to 140 mmHg among hypertensives. Incidence rates (per 1000 PYs) were 7.9 for all optimally controlled risk factors, 14.5 for 3-4 mild to moderately uncontrolled risk factors and 39.5 for 3-4 severely uncontrolled risk factors.

Conclusion:
Optimal control of modifiable risk factors is strongly linked to lower HF risk. Our findings suggest prioritizing optimization of existing risk factors may be central to successful strategies to prevent HF onset.
Abstract MP25: Longitudinal Assessment of Sleep Patterns During Early Childhood and Their Association With Obesity
Authors: Kaar Jill L , Schmiege Sarah , Kalwarf Heidi , Woo Jessica G , Daniels Stephen , Simon Stacey L
Published: March 2019

Objective:
To identify sleep patterns in early childhood and examine the influence of these patterns on health behaviors and obesity.

Methods:
Prospective cohort study of healthy 3-year old children (n=301) measured annually through age 6. Parent-reported
total sleep duration (TSD) was calculated as night-time sleep plus daytime naps . Insufficient sleep was defined as TSD <10 hours/day.
A latent growth curve model was estimated to establish the trajectory of TSD over four years. At each time period, univariate regression models were estimated to: (a) identify modifiable and demographic (i.e., race/ethnicity, gender) predictors of insufficient sleep and (b) test the association of insufficient sleep with health behaviors (i.e., diet, screen time) and obesity status (adjusting for time-specific daily energy intake, screen time, and moderate-vigorous physical activity (MVPA)).

Results:
The analytical cohort was 49% female, predominately white (82%) with 36% reporting household incomes below $50,000. At age 3, 21% were defined as overweight or obese and at age 6, 32% of the cohort were defined as overweight or obese. Children had a similar bed and wake time across the four-year study with an average bedtime at 9:27PM and waketime at 8:01AM. Growth curve modeling showed decreases of 39.6 minutes in TSD from age 3 to age 6; though statistically significant (p<0.001), this may be due to the developmental expected decrease in daytime naps over this age range. The most consistent modifiable predictors of insufficient sleep from ages 4-6 years were bedtimes after 9PM (age 4 OR: 27.3 (95%CI: 3.7, 201); age 5 OR: 37.3 (95% CI: 5.1, 274); age 6 OR: 13.2 (95% CI: 3.1, 55)) and insufficient sleep the prior year (age 4 OR: 11.4 (95%CI: 3.8, 34); age 5 OR: 5.9 (95% CI: 3.0, 11.6); age 6 OR: 6.5 (95% CI: 3.4, 12.4)). Children reported as “non-white” were more likely to be classified with insufficient sleep at ages 4-6 years (age 4 OR: 2.6 (95%CI: 1.3, 5.2); age 5 OR: 2.39 (95% CI: 1.2, 4.7); age 6 OR: 2.2 (95% CI: 1.1, 4.3)). Children at ages 5-6 years with insufficient sleep reported 29 and 36 minutes more screen time per day compared to those with sufficient sleep (p < 0.05). Insufficient sleep did not predict diet and MVPA behaviors. Insufficient sleep status was also significantly associated with obesity status as children with insufficient sleep at age 5 were 2.22 times (95% CI: 1.20,4.1) more likely to be overweight and obese compared than children with adequate sleep (p = 0.01).

Conclusions:
Sleep patterns appear to be established by age 3 years with little change throughout young childhood, and with implications for early obesity development. Early intervention to improve sleep may be necessary during this time, especially for children from racial/ethnic minority backgrounds, prior to the establishment of sleep patterns, to prevent negative consequences of insufficient sleep.
Abstract MP26: Visceral Obesity and Systemic Inflammation Predict Sleep Disordered Breathing in Normal Weight, Never Obese Adolescents: A Longitudinal, Population-Based Study
Authors: Danisi Jacqueline M , Fernandez-Mendoza Julio , He Fan , Sawyer Marjorie D , Calhoun Susan L , Liao Jason , Liao Duanping , Vgontzas Alexandros N , Bixler Edward O
Published: March 2019

Introduction:
Although obesity is a known risk factor for sleep disordered breathing (SDB), a significant proportion of children with SDB are not obese or overweight as per body mass index percentile (BMI%) for age-and-sex. It is unknown whether premorbid or concurrent adiposity phenotypes are associated with SDB in normal weight youth.

Hypothesis:
We hypothesize that central obesity is a predictor of apnea/hypopnea index (AHI) in adolescents who have been otherwise normal weight since childhood.

Methods:
We analyzed data from the Penn State Child Cohort (N=421), a random population-based sample of 8.7 (1.7) year old children followed-up as 17.0 (2.3) year old adolescents. Of these, 242 subjects (49.2% female, 18.2% minority) were classified as persistently normal weight based on BMI%<85 at both baseline and follow-up. Neck, hip and waist circumference (WC) were measured and “central obesity” was defined as a WC%≥85 for age-and-sex at baseline. During the follow-up exam, android and gynoid distribution and subcutaneous (SAT) and visceral (VAT) adipose tissue composition were assessed via DEXA scan, while inflammatory biomarkers were assayed from a fasting blood sample. The AHI was obtained from 9-hour, in-lab polysomnography at baseline and follow-up. Multivariable linear regression models examined the association between adiposity and inflammation with AHI at follow-up while adjusting for sex, race, adenotonsillectomy, age and AHI at baseline.

Results:
The average AHI at baseline was 0.7 (0.9) events/hour and 2.3 (6.3) events/hour at follow-up. Unadjusted analyses showed that WC (β=0.159) and central obesity (β=0.227) at baseline, but not BMI%, neck or hip circumference, and VAT (β=0.307), IL-6 (β=0.245), SAT (β=0.235), CRP (β=0.222), and android distribution (β=0.195) at follow-up were significantly (P<0.05) associated with a higher follow-up AHI. Multivariable-adjusted analyses showed that VAT (β=0.299), IL-6 (β=0.191), central obesity (β=0.185) and CRP (β=0.163) were independently associated with a higher follow-up AHI.

Conclusions:
This is the first study to demonstrate that central obesity in childhood is a strong predictor of SDB in adolescence, even in individuals who have been persistently normal weight since childhood as per BMI% standards. These data support the clinical utility of simple measures of central obesity in childhood (i.e., WC) as early surrogate markers of increased risk of future development of SDB in the transition to adolescence. Furthermore, our study demonstrates that increased visceral adiposity and systemic inflammation are strong correlates of adolescent SDB, which supports the clinical utility of these biomarkers in predicting the cardiometabolic risk associated with adolescent SDB.
Abstract MP30: Gaps in Provider Lifestyle Counseling and Its Adherence Among Obese Adults With Diabetes in the United States
Authors: Aneni Ehimen , Valero-Elizondo Javier , Osondu Chukwuemeka U , Brandt Eric J , Nasir Khurram
Published: March 2019

Introduction:
The 2013 ACC/AHA guidelines on the management of obesity in adults strongly recommend lifestyle counseling on calorie restriction, improved physical activity and referral to a weight loss program for obese adults who are likely to benefit from them. This study assessed clinician adherence to these guidelines and the compliance with this advice among obese adults with diabetes in the United States.

Methods:
We utilized the National Health Interview Survey (2016 -2017) for this study. Individuals were asked if in the last 12 months, they had been told to reduce caloric intake, increase physical activity, or if they had been referred to a weight loss program by their health provider. For those who said yes, they were asked if they had taken the advice of the provider. We analyzed the frequencies of these questions and the compliance with this advice among obese individuals with diabetes.

Results:
Among those who were mildly obese (BMI 30 - 34.9kg/m
2
, N=1,502), approximately 37% and 40% were not counseled on caloric restriction and increasing physical activity respectively. Among the morbid obese with diabetes (BMI ≥35 kg/m
2
, N=1,670), this number was approximately 28% for both caloric restriction and increasing physical activity. Referral for a weight loss program was very low: 21% and 32% in mild and morbidly obese with diabetes. Among those referred, only approximately 30% enrolled in a weight loss program. In subgroup analyses, females, persons with public insurance or who lacked insurance, low-income earners and those with 10+ years from their diabetes diagnosis were less likely to be counseled about any 2 of these lifestyle changes.

Conclusions:
Lifestyle counseling and its compliance among obese adults with diabetes in the United States is still suboptimal and shows disparities by gender and socioeconomic status. This study highlights the gaps in the implementation of the AHA/ACC 2013 guidelines on management of obesity among adults particularly among those with diabetes who will derive the greatest benefit.
Abstract MP35: Physical Activity and Risk of Cardiovascular Events and All-Cause Mortality Among Kidney Transplant Recipients
Authors: Kang Augustine , Kim Hongseok , Garber Carol E , Eaton Charles , Risica Patricia M , Bostom Andrew G
Published: March 2019

Introduction:
Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events and all-cause mortality among a cohort of KTRs.

Methods:
N = 4377 participants were examined from a large, multiethnic, multicenter trial (37% female; mean age 51.9 ± 9.4 years; 75% White; 20% with prevalent CVD). PA was measured at baseline and was derived from a modified PA summary score from the Yale Physical Activity Survey (YPAS) and divided into tertiles (T1, T2, T3), from lowest to highest PA. Kaplan-Meier survival curves were used to graph the risk of CVD events and all-cause mortality between PA tertiles. Cox proportional hazards regression models were constructed to examine the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction, CVD death) and all-cause mortality over time. There was no violation of the proportional hazards assumption. Covariates include age, sex, race, smoking status, diastolic blood pressure, blood lipids, BMI, transplant vintage, and donor type.

Results:
Participants were followed up to 2,500 days. The cohort reported 486 CVD events and 419 deaths. Fully adjusted models revealed that compared to the lowest tertile, the highest tertile had significantly lower risk of: CVD events (HR, 0.628, 95% CI, 0.499-0.790) and all-cause mortality (HR, 0.533, 95% CI, 0.414-0.688). Compared to middle T2 scores, T3 of PA scores had significantly lower: risk of CVD events (HR, 0.709, 95% CI, 0.563-0.895) and all-cause mortality (HR, 0.635, 95% CI, 0.491-0.822). Results were similar in unadjusted models.

Conclusion:
Physical activity was associated in a dose-response manner with a reduced risk of CVD events and all-cause mortality in kidney transplant recipients. These observed associations in a large, international sample of KTRs, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs. Future work to confirm these associations and to determine whether increasing PA will reduce risk in KTRs is needed, which may help inform if PA should be integrated into lifestyle management strategies among KTRs.
Abstract MP37: Estimating Sodium Intake Using Timed Urine Collections From a Controlled Feeding Study
Authors: Lobene Andrea J , Macdonald-Clarke Claire J , Martin Berdine R , McCabe Linda D , McCabe George P , Weaver Connie M
Published: March 2019

Introduction:
Hypertension is a major risk factor for CVD affecting 34% of American adults. High sodium (Na) intake is identified as a modifiable risk factor for high blood pressure, but our ability to assess Na intake is poor. The gold standard is to measure Na excretion in a 24h urine collection, but this is burdensome. An alternative method is to predict 24h Na excretion from a spot urine sample. However, we do not know how well predicted 24h Na excretion reflects intake, the true outcome of interest, or the ideal time to collect a spot urine sample. These gaps can only be filled using a controlled feeding study in which intake is known and timing of urine collections is controlled.

Hypothesis:
We hypothesized that, with currently available equations, 24h Na excretion predicted from spot urine samples will not accurately reflect intake.

Methods:
This is a secondary analysis of a randomized, multi-phase, crossover, full-feeding trial in healthy adults (
n
= 39, aged 29.7 ± 11.2 y). Data from the two control phases were used in which dietary intake and testing conditions were identical. Participants ate three meals in a clinic setting and spot urine samples were collected every 2 hours as part of a 24h collection. Urine samples were analyzed for sodium, potassium, and creatinine. The INTERSALT equations were used to predict 24h Na excretion from each of the 9 spot urine samples collected. Predicted 24h Na excretion values were compared with observed 24h excretion and known dietary intake using repeated measures ANOVA. Intra-class correlations for each timed spot urine sample were calculated to determine the variability in average spot urine Na excretion between the two control phases.

Results:
Predicted 24h Na excretion using the spot urines at hour 10, 12, overnight, and early morning collection were not significantly different from observed 24h Na excretion (all
p
≥ 0.21). However, predicted 24h Na excretion underestimates observed 24h Na excretion by about >600 mg. Importantly, all predicted 24h excretions as well as observed 24h excretion were significantly lower than intake by >1000 mg (all
p
< 0.001). Intraclass correlations were significant at hour 0, 2, 8, 12, and evening/overnight (all
p
< 0.05), suggesting low day-to-day variability in Na excretion at these times.

Conclusions:
Regardless of time of spot urine collection, predicted 24h Na excretion is lower than Na intake, suggesting currently-available equations do not provide adequate estimates of Na intake. The next step is to develop equations to accurately predict Na intake from a controlled feeding study model using spot urine samples collected at a time when Na excretion is consistent from day to day. These improved equations could be used to implement effective dietary interventions to reduce blood pressure and CVD risk.
Abstract MP41: A Diet High in Carbohydrate and Low in Fat Alters the HDL Proteome and Metabolism of 9 HDL Proteins in Humans
Authors: Andraski Allison B , Singh Sasha A , Lee Lang , Higashi Hideyuki , Smith Nathaniel , Aikawa Masanori , Sacks Frank M
Published: March 2019

Introduction:
When dietary carbohydrate replaces fat, HDL cholesterol (HDL-C) and the primary HDL protein apolipoprotein A1 (apoA1) decrease. The proportion in plasma of large HDL2 decreases while small HDL3 increases. These findings suggest that diet affects metabolically important attributes of HDL that produce the size changes. We studied in humans the effect of dietary carbohydrate and unsaturated fat on the HDL proteome and metabolism of 9 HDL proteins across 5 HDL sizes.

Methods and Results:
Twelve participants were placed on a healthy, controlled diet high in unsaturated fat (HF) or high in carbohydrate (HC) in a randomized crossover design. At the end of each 4-week diet period, subjects were infused with a stable isotope tracer (D3-Leu) in order to label all newly synthesized HDL proteins. Blood samples were collected and tracer was followed for 70 hrs post-infusion. ApoA1-HDL was isolated by immunoaffinity purification, separated into 5 HDL particle sizes, and prepared for analysis by mass spectrometry. We used label free quantification to characterize the HDL proteome. The proteome composition and distribution across the 5 HDL sizes were remarkably conserved in all subjects on both diets. Diet altered the abundance of several proteins on the major HDL sizes alpha2 and alpha3. The HC diet increased proteins involved in lipid metabolism (apoC3, apoA2) and decreased antioxidant (PON1, PON3) and protease inhibitor (SERPINA3, SERPING1) proteins. We also monitored the metabolism of 9 proteins that likely affect HDL metabolism - apoA1, apoA2, apoA4, apoC3, apoE, apoJ, apoL1, apoM and LCAT. We used parallel reaction monitoring and XPI software to measure the amount of D3-Leu tracer over time in these 9 proteins across the 5 HDL sizes. We found that the HC diet increased apoA2 and apoJ and decreased apoA1 pool sizes on large HDL. The HC diet also increased apoM turnover in large HDL, and apoA1, apoA2, and apoE turnover across the HDL size range.

Conclusions:
Dietary carbohydrate when it replaces unsaturated fat alters the HDL proteome and metabolism of several HDL proteins on specific HDL sizes. Carbohydrate increases the abundance of proteins involved in lipid metabolism, decreases antioxidant and protease inhibitor proteins, and accelerates turnover of apoA1, apoA2, apoE, and apoM. This study suggests that diet modulates HDL function by affecting HDL composition and the metabolism of major HDL proteins.
Abstract MP49: Lower Levels of County Housing Affordability Are Linked to Worse Cardiometabolic Risk Profiles in Middle-Aged and Older Adults
Authors: Rodgers Justin , Wallace Robert B , Briesacher Becky A , Baum Christopher F , Kim Daniel
Published: March 2019

Introduction:
Housing is a fundamental social determinant of health. Past studies have shown that high levels of unaffordable housing raise residents’ chances of moving, often redistributing individuals into socioeconomically disadvantaged neighborhoods and dwellings. This may simultaneously expose individuals to health-detrimental factors while limiting their exposure to health-promoting factors. Residents within unaffordable housing areas may also experience adverse physical and mental health outcomes through various psychosocial, behavioral and material pathways. Yet few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans.

Hypothesis:
We investigated the hypothesis that lower levels of county housing affordability are linked to higher odds of incident hypertension, diabetes, obesity, and depression.

Methods:
Using a nationally-representative sample of 3,722 middle-aged to older adults from the National Longitudinal Survey of Youths 1979 and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent, mortgage) between 2000 and 2008 and individual-level odds of incident hypertension, obesity, diabetes, and depression during the follow-up period 2008-2014. Incidence of hypertension and diabetes was assessed through survey-reported physician diagnosis. Obesity was defined as a BMI
≥
30 kg/m
2
, and depression was measured using the 7-item Center for Epidemiologic Studies Depression Scale and designated based on a cut-off score of 7. We employed fixed effects logistic regression models to reduce bias due to time-invariant confounding.

Results:
Each percentage point increase in the median county-level percentage of household income spent on rent or mortgage was associated with a 17% increase in the odds (OR = 1.17, 95% CI = 1.00 to 1.39; p = 0.047) of incident hypertension, a 37% increase in the odds (OR = 1.37, 95% CI = 1.00 to 1.87; p = 0.049) of obesity, and a 15% increased odds (OR = 1.15, 95% CI = 1.01 to 1.31; p = 0.030) of depression, controlling for individual- and area-level demographic and socioeconomic factors. No association was observed for diabetes. These associations were stronger among renters than among homeowners, and in men compared to women. In sensitivity analyses, these findings were robust when we limited the sample to non-movers and when we used alternative depression score cut-points.

Conclusions:
Our findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help to reduce the population burden of cardiovascular disease.
Abstract MP58: Intermuscular Fat Density: Novel Risk Factor for Cardiometabolic Risk Factors in African-Ancestry Men
Authors: Tilves Curtis , Kuipers Allison L , Zmuda Joseph M , Carr J J , Terry James G , Nair Sangeeta , Sekikawa Akira , Bunker Clareann H , Wheeler Victor , Miljkovic Iva
Published: March 2019

Background:
While overall obesity remains a major risk factor for cardiometabolic diseases, the location of stored fat is also thought to play a role. In addition to fat storage in ectopic sites, the density of fat, a marker of fat quality, is emerging as a novel risk factor for cardiometabolic diseases. Previous studies have focused primarily on visceral (VAT) and abdominal subcutaneous (SAT) adipose tissue density and in predominantly white cohorts; however, studies in populations of African ancestry who are at higher risk of cardiometabolic diseases are lacking. Additionally, information is lacking on associations of density of other relevant ectopic fat depots, such as intermuscular adipose tissue (IMAT), with cardiometabolic risk factors.

Methods:
We investigated whether VAT, SAT, or thigh IMAT densities were associated with cardiometabolic measures in 648 black men aged 50-91 years (mean age 63.6 years, mean BMI 27.7 kg/m
2
). Adipose tissue volume (cm
3
) and density (Hounsfield units, HU) was measured in the abdomen (between L4 and L5) and mid-thigh from computed tomography scans. Cardiometabolic measures, including blood pressure, fasting serum glucose and insulin homeostasis, and serum lipids (N=476), were transformed as needed and used as outcomes in multiple linear regression models adjusting for age, lifestyle factors, medication use (antihypertensive, antidiabetic, or lipid-lowering), and corresponding fat depot volume.

Results:
After adjustment (Table), VAT, SAT, and IMAT densities were significantly associated with fasting insulin, insulin resistance, and lipids. Results remain similar after adjustment for BMI instead of fat volume and in a sensitivity analysis excluding those taking relevant medications.

Conclusion:
As reported in other studies, in our study among African ancestry individuals VAT and SAT were associated with several cardio-metabolic risk factors. Importantly, our findings suggest that thigh IMAT density may be a novel predictor of cardiometabolic risk in African ancestry men.
Abstract MP60: Changes in Gut Microbiota Metabolite TMAO Are Related to Changes in Hepatic and Visceral Fat in Weight-loss Diet Interventions: the POUNDS Lost Trial
Authors: Li Xiang , Sun Dianjianyi , Zhou Tao , Heianza Yoriko , Bray George , Sacks Frank , Qi Lu
Published: March 2019

Objective:
Gut microbiota metabolite Trimethylamine-N-oxide (TMAO) has been related to obesity and various cardiometabolic disorders. TMAO is involved in lipid metabolism in the liver; however, little is known about whether changes in TMAO affect hepatic fat and abdominal fat distribution, and whether genetic variations modify such effects.

Research Design and Methods:
The present study included 92 overweight and obese participants from the POUNDS Lost trial having complete data on computed tomography (CT) scans and a genetic risk score (GRS) for nonalcoholic fatty liver disease (NAFLD). We analyzed the associations of changes in plasma TMAO with changes in hepatic fat and fat distribution from baseline to 6 months; we also assessed the interactions between the GRS and changes in TMAO.

Results:
Larger decreases in TMAO from baseline were significanly associated with a reduction in subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and total adipose tissue (TAT) at 6 months, p=0.01, 0.02, and 0.003, respectively. In addition, we found that larger decreases in TMAO were associated with increases in HDL-cholesterol and decreases in triglycerides, p=0.02 and 0.03, respectively. Moreover, we observed significant interactions between 6-month changes in TMAO and the NAFLD GRS on the concurrent changes in liver fat (P
interaction
=0.007) and VAT (p
interaction
=0.018). Among individuals whose TMAO decreased, a lower NAFLD GRS tends to predict a greater improvement in hepatic fat and a reduction in VAT; while in those whose TMAO increased, no differences in hepatic fat or VAT were observed across the tertiles of NAFLD GRS.

Conclusions:
Our data indicate that changes in TMAO are related to changes in hepatic and visceral fat in weight loss diet interventions; and such relations are modified by genetic variation.

Trial Registration:
ClinicalTrials.gov NCT00072995.
Abstract MP63: How Much Does Exclusive Breastfeeding to the Recommended Six Months Increase Maternal Postpartum Weight Loss in Healthy Women?
Authors: Tahir Muna J , Haapala Jacob L , Whitaker Kara M , Foster Laurie P , Duncan Katy M , Teague April M , Kharbanda Elyse O , McGovern Patricia M , Schoenfuss Tonya C , Harnack Lisa , Fields David A , Jacobs David R , Demerath Ellen W
Published: March 2019

Objective:
Postpartum weight retention increases the risk of future obesity and cardiovascular disease. Although exclusive breastfeeding (EBF) has been promoted as an effective means to lose gestational weight gain, previous studies report mixed findings for the relationship between duration of EBF and maternal postpartum weight loss (PPWL). This study evaluates whether meeting the recommended 6-months of EBF is associated with greater PPWL by 6-months than a shorter duration of EBF.

Methods:
The Mothers and Infants LinKed for Health (MILK) study is an ongoing prospective cohort of non-diabetic, non-smoking mother-infant dyads, all of whom were exclusively breastfeeding at 1-month postpartum. Breastfeeding exclusivity was subsequently self-reported by mothers at 3 and 6-months postpartum. Maternal pre-pregnancy weight and weight at delivery were abstracted from medical records. PPWL was calculated as maternal weight measured at 1, 3 and 6-months minus maternal weight at delivery. Mixed effects linear regression models were used to test the association of duration of EBF with repeated measures of PPWL after adjustment for covariates including maternal pre-pregnancy weight, gestational weight gain, parity, physical activity and infant sex.

Results:
Among 315 mothers who were exclusively breastfeeding at 1-month, 93% and 75% continued EBF to 3 and 6-months, respectively. By 6-months postpartum, weight loss (least square means ± standard error) was -8.55 ± 1.31 kg among EBF to 1-month, -10.60 ± 0.82 kg among EBF to 3-months and -11.73 ± 0.37 kg among EBF to 6-months (Figure). EBF to 6-months was associated with greater PPWL by 6-months postpartum than EBF to 1 or 3-months (p<0.05) after covariate adjustment.

Conclusion:
EBF to 6-months postpartum was associated with greater maternal PPWL than shorter EBF durations. Interventions may promote prolonged EBF as a means of increasing maternal weight loss by 6-months postpartum, but additional research is needed to explore whether these differences persist after weaning.
Abstract MP66: Body Mass Index Trajectories From Childhood to Adulthood: Evidence From the International Childhood Cardiovascular Cohort (i3C) Consortium
Authors: Cleland Verity , Tian Jing , Buscot Marie-Jeanne , Magnussen Costan , Bazzano Lydia A , Burns Trudy L , Daniels Stephen R , Dwyer Terence , Jacobs David R , Juonala Markus , Prineas Ronald J , Raitakari Olli , Sinaiko Alan R , Steinberger Julia , Urbina Elaine M , Woo Jessica G , Venn Alison J
Published: March 2019

Background:
Understanding body mass index (BMI) trajectories across the lifecourse may help identify risk of overweight or obesity and strategic points for preventive interventions. We describe BMI trajectories from childhood to adulthood in four population-based cohorts established in the 1970s-80s and their sociodemographic correlates.

Methods:
Data were from 12,086 participants (45% male) from four cohorts established in Australia, Finland and the US. Participants had ≥3 measures of height and weight, including ≥1 in childhood (6-18 years, mean 9.7 to 11.1 years at first visit) and ≥1 in adulthood (mean 40.0 to 50.9 years at last visit). Latent Class Growth Mixture Modelling estimated BMI trajectory groups. Correlates (age, gender, race, parental education) of BMI trajectories were identified with log multinomial regression.

Results:
Mean BMI ranged from 17.8-18.3 kg/m
2
at first visit and 26.4-30.2 kg/m
2
at last visit. Six BMI trajectories (Figure) were identified in three cohorts: persistently normal (48-57% of participants), improving from high (1-2%), progressing to overweight (30-39%), progressing to obese (1-8%), late onset obese (2-6%), and progressing to severe obesity (1-3%). One cohort had a seventh group: greatly improving (<1%). Women were less likely to progress to overweight and more likely to progress to obese than men. Black participants were at greater risk of progressing to obesity, severe obesity and late onset obesity than white participants. Improving from high BMI was associated with being younger at first visit and lower parental education.

Conclusion:
Similar BMI trajectories were identified across cohorts, countries and time, despite different BMI distributions. Females and black Americans were most likely to be of high BMI at the end of follow-up. Few participants (≤2%) improved from high BMI. A better understanding of the factors that influence the highest and improving BMI trajectories may help identify risk reduction strategies.