bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P125: Patterns in Timing of Energy Intake and the Impact on Fat Mass in Adolescents
Authors: Decker Jessica , Zemel Babette , Mitchell Jonathan
Published: March 2023

Introduction:
Pediatric obesity is excessively high, tracks into adulthood, and increases the risk of multiple chronic diseases (e.g., heart disease). There are dietary guidelines to help prevent childhood obesity, but they do not account for the timing of energy intake, which may be associated with obesity, independent of diet content. We aimed to determine: 1) energy intake timing patterns in adolescents, 2) if energy intake timing patterns differed by sociodemographic factors, and 3) if energy intake timing patterns associated with obesity-related outcomes.

Methods:
The Sleep and Growth Study (S-Grow) assessed diet in adolescents using three 24hr diet recalls in 8
th
and 9
th
grade. Time-stamped meals were analyzed using Nutrient Data System for Research software. We calculated the average energy (kcal) consumed for two-hour intervals during the 24-hour day (e.g., 00:00-01:59, 02:00-03:59, etc.) and input the 12 energy intake timing variables into a principal component model to identify energy intake timing patterns. Principal components (PC) with an eigen value 1.0 were retained. Linear mixed effect models were used to determine if sociodemographic factors associated with standardized PC loading scores and if the standardized PC loading scores associated with body mass index (BMI) and fat mass index (FMI, measured by dual energy X-ray absorptiometry), adjusting for sociodemographic factors.

Results:
Five PCs were identified explaining 58.6% of variance in timing of energy intake. Compared to females, male adolescents were more likely to have a higher PC1 score, corresponding to a “low overnight, moderate morning, high daytime and early evening” intake pattern (beta=0.57, 95% CI=0.20, 0.94). Adolescents living in households with $40-69K (compared to >$99K) annual income were more likely to have a higher PC4 score, corresponding to a “high later evening and overnight, moderate morning, low afternoon and early evening” intake pattern (beta=0.44, 95% CI=0.05, 0.83). Adolescents living in households with <$40K (compared to >$99K) annual income were more likely to have a higher PC5 score, corresponding to a “low overnight, high morning, moderate prolonged daytime and late evening” intake pattern (beta=-0.93, 95% CI=-1.66, -0.19). In addition, the PC5 loading score was associated with lower BMI (beta=-1.38, 95% CI=-2.18,-0.58) and lower FMI (beta=-0.94, 95% CI=-1.45,-0.43).

Conclusion:
We detected distinct energy intake timing patterns in adolescents. Demographic factors were associated with some of the energy intake patterns, and the energy intake pattern corresponding to “low overnight, high morning, moderate prolonged daytime and late evening” (PC5) was associated with obesity-related outcomes. These findings need to be replicated but point to future pediatric dietary guidelines considering the timing of energy intake for obesity prevention.
Abstract P127: Early Life Adversity and Obesity Risk in Adolescence: A 9-year Population-Based Prospective Cohort Study
Authors: Steinman De Visser Hannah , Brunton Nicole , Dufault Brenden , McGavock Jonathan M
Published: March 2023

Objective:
We previously found that exposure to adverse childhood experiences (ACEs) is associated adolescent obesity. This study was designed to identify mediators of this association. We hypothesized that exposure to adverse experiences before 9 yrs would be associated with an increased risk of obesity at 18 yrs, and that behavioural and emotional factors would mediate this association.

Methods:
In 2007/2008, 8568 nine-year-olds were randomly sampled, enrolled in the Growing up in Ireland cohort study and followed in 18 yrs. The main exposures were 14 adverse experiences including four of the traditional ACEs before 9 years of age, self-reported by the primary care giver. The main outcome, body mass index (BMI) was measured objectively at 18 yrs. Mediators were self-reported daily activity, soda intake, self-image (Piers Harris) and behavioural difficulties (Strengths and Difficulties Questionnaire) at 9 and 13 yrs. Co-variates were household income and primary caregiver BMI. Structural equation models (SEMs) tested for mediators of the association between exposure to adverse experiences and ACEs before 9 yrs and BMI at 18 yrs.

Results:
Among the 6039 adolescents with complete data, 76% experienced any adversity, 14% experienced an ACE, 49% were female and 27% were overweight/obese at 18 yrs. BMI Z score was higher at ages 9 (0.47 vs 0.36, p < 0.05) and 13 yrs ( 0.39 vs 0.29, p < 0.05) in those exposed to an adverse experience or an ACE, compared to those unexposed. Behavioural difficulties were higher and self image was lower at all three time points for those exposed to any adversity or an ACE, compared to those unexposed. SEMs revealed that behavioural difficulties and self concept, but not exercise or soda intake, modestly mediate the association between exposure to adverse experiences and BMI at 18 years (Figure 1).

Conclusion:
Exposure to any adversity or ACEs are not directly associated BMI at 18 yrs. Behavioural difficulties and self-concept weakly mediate the association between adverse childhood experiences and BMI at 18yrs.
Abstract P129: Age at Menarche Associated With Cardiovascular Disease Risk Factors and History Among African American Women: The Jackson Heart Study
Authors: Jackson Katelyn , Walker Benjamin , Heitman Elizabeth , Atehortua De la Peña Nelson , Reneker Jennifer
Published: March 2023

Menarche is the onset of menstruation and is a definitive indication of female puberty. The average age at menarche has steadily declined worldwide over the past century. While many cardiovascular conditions have their start during youth, age at menarche may also play a role in predicting the risk for cardiovascular disease (CVD). Of particular importance is the disproportionately high number of CVDs that affect African Americans, which contributes greatly to the disparities in life expectancy between African Americans and Whites. This study aims to address a gap in knowledge about African American women’s health by examining the association between age at menarche and CVD. We assessed the hypothesis that an earlier age at menarche is associated with increased odds of CVD risk factors and history for women in the Jackson Heart Study. This study was a secondary analysis of baseline data from 2,458 females in the Jackson Heart Study, a longitudinal cohort study of African Americans in the Jackson, MS metropolitan area. Early menarche was defined as menarche occurring at less than 12 years of age. Cardiovascular disease risk factors included hypertension, diabetes, obesity, and abdominal obesity (waist circumference >88cm). Cardiovascular disease history included coronary heart disease, heart attack, and stroke. The association between early menarche and CVD risk factors and history was examined using multivariable logistic regression models, controlling for physical activity, nutrition, smoking, alcohol use, education, income, and oral contraceptive use. The prevalence of CVD risk factors and CVD history was higher for women with an early age at menarche (<12 years) than for other women. After adjusting for covariates, early age at menarche was associated with greater odds of hypertension (OR, 1.47 [95% CI, 1.17-1.84]), obesity (OR, 1.77 [95% CI, 1.43, 2.19]), abdominal obesity (OR, 1.87 [95% CI, 1.44, 2.41)], history of coronary heart disease (OR, 1.98 [95% CI, 1.33, 2.94]), and history of heart attack (OR, 1.76 [95% CI, 1.09, 2.84]). Early age at menarche was not significantly associated with diabetes or stroke history. In conclusion, in this large sample of African American women in the Jackson Heart Study, we observed that menarche before 12 years of age was associated with increased odds of CVD risk factors and CVD history compared to those with menarche after 12 years of age. These findings highlight the importance of exposures during youth and childhood which may contribute to poor health outcomes in later life.
Abstract P140: Potential Mediators for Cardiovascular Benefits of Novel Diabetes Medications: A Meta-Regression Analysis
Authors: Rodriguez Valadez Jose M , Tahsin Malak , Masharani Umesh , Park Meyeon , Hunink M.G. Myriam , Yeboah Joseph , Li Lihua , Weber Ellerie , Li Yan , Berkalieva Asem , Avezaat Luuk , Max Wendy , Fleischmann Kirsten E , Ferket Bart S
Published: March 2023

Background:
Prior research suggests cardiovascular (CV) benefits of glucose-lowering interventions may be mediated by changes in hemoglobin A1c (HbA1c), bodyweight, systolic blood pressure (SBP), hematocrit, and urine albumin-creatinine ratio (uACR). We evaluated the heterogeneity of CV benefits by these potential mediators for sodium-glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) using a meta-analytic approach.

Methods:
We performed a systematic review and meta-regression analyses of 12 SGLT2i and 9 GLP-1RA CV outcome trials using linear mixed models of treatment efficacy measured as log hazard ratios (HRs) vs changes in potential mediators. We extracted follow-up mediator data for treatment and control, preferably at 12 months post randomization. Outcomes included MI, stroke, and MACE (a composite of MI, stroke, or CV death). We investigated slope differences between drug classes using interaction terms and likelihood-ratio tests.

Results:
Treatment efficacy for MACE improved with more HbA1c reduction among GLP-1RA (slope .26; P
slope
.02) but not among SGLT2i trials (slope -.22; P
slope
.39; P
interaction
.06), see
Figure
. Treatment efficacy for MACE, MI, and stroke decreased with more weight loss for SGLT2i (slope –.17, –.29, –.39; P
slope
<.05) but not for GLP-1RA trials (slope .05, .03, .07; P
slope
.30, .62, .32). Slopes differed significantly between drug classes: P
interaction
<.05. For stroke, we observed a trend of less treatment efficacy with increases in hematocrit among five SGLT2i trials with available data (slope .96; P
slope
.07). We did not find any indication of mediation effects by SBP and uACR for SGLT2i or GLP-1RAs (slopes -.11 -.07; P
slopes
≥ .05).

Conclusion:
We confirm previous findings of increased CV benefits with reductions in HbA1c for GLP1-RAs. Further research is needed to investigate the potential loss of SGLT2i efficacy with greater weight loss and increase in hematocrit.
Abstract P142: Mediation of Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c Through Weight: A Randomized Clinical Trial
Authors: Dorans Kirsten S , Bazzano Lydia A , Qi Lu , He Hua , Chen Chung-shiuan , Mills Katherine T , Nguyen Bernadette , OBrien Matthew , Uwaifo Gabriel I , He Jiang
Published: March 2023

Introduction:
Low-carbohydrate diets lead to weight loss and improvement in hemoglobin A1c and other cardiometabolic outcomes. However, there is limited research on how much of the glycemic effects of low-carbohydrate diets are mediated by weight loss.

Hypothesis:
The effect of a low-carbohydrate dietary intervention on hemoglobin A1c would be mediated by weight loss.

Methods:
We conducted a 6-month randomized clinical trial on the effects of a low-carbohydrate diet intervention (target <40 net grams of carbohydrates during first 3 months; <60 net grams for months 3-6) compared with usual diet on hemoglobin A1c. Participants were 40-70 years with untreated HbA1c of 6.0-6.9%. In post hoc mediation analyses, we examined whether the effect of the intervention on 6-month change in hemoglobin A1c was mediated by 3-month weight, after adjustment for age, sex, race, education, and baseline levels of behavioral and cardiometabolic risk factors. We used the causal framework approach described by and the SAS macro developed by Valeri and VanderWeele.

Results:
150 participants (mean [SD] age 59 [8] years; 108 [72%] female; 88 [59%] Black) were randomized to either the low-carbohydrate diet intervention (75 participants) or usual diet (75 participants) arm. Mean (SD) HbA1c was 6.16% (0.30%) at baseline. Six-month data was collected on 142 participants (95%). Compared with the usual diet arm, the low-carbohydrate diet intervention arm had significantly greater 6-month reduction in HbA1c (net difference, -0.23% [95% CI, -0.32 to -0.14%]) and body weight (-5.9 kg [95% CI, -7.4 to -4.4 kg]). In mediation analyses, 59% of the total effect of intervention on 6-month change in hemoglobin A1c was mediated by weight measured at 3 months (Table).

Conclusions:
In mediation analyses, a substantial proportion (59%) of the total effect of intervention on 6-month change in hemoglobin A1c was mediated through weight measured at 3 months. Future research should further explore contributions of weight loss to reductions in glycemia in other populations.
Abstract P145: The Effect of Exercise Level on Weight Maintenance and Cardiometabolic Risk Factors After Clinically Significant Weight Loss: Results From the Prevail-p Study
Authors: Swift Damon L , McGee Joshua , Grammer Emily , Huff Anna , Gniewek Nicole , Clunan Covey , Osborne Briceida , Martin Corby , Beyl Robbie , Carels Robert , Pories Walter , Houmard Joseph A , Matarese Laura
Published: March 2023

Introduction:
Clinically significant weight loss is associated with health benefits for overweight and obese adults. Participation in adequate amounts of physical activity is critical for weight maintenance. However, few studies in the literature have evaluated the amount of physical activity needed to promote weight maintenance in a supervised exercise training study with corresponding data on cardiovascular risk factors.

Methods:
Overweight and obese adults (N=39) completed a 10-week OPTIFAST
®
weight loss program with supervised aerobic exercise training with the goal of achieving clinically significant weight loss (≥7%). Participants who met the weight loss goal were randomized to levels of aerobic training consistent with physical activity recommendations (PA-REC) (~550 MET minutes per week) or weight maintenance recommendations (WM-REC) (~970 MET minutes per week) for 18 additional weeks. Weight, body composition, and blood measures (e.g., fasting glucose, insulin, and lipids) were measured at baseline, after weight loss (10 weeks), and at follow-up (28 weeks).

Results:
Thirty-three of the 39 participants achieved clinically significant weight loss (~85%). There were reductions in weight (-8.8 kg), body fat (-2.1%), visceral fat (-120.4 g), along with other health indicators (systolic blood pressure [-6.8 mmHg], diastolic blood pressure [-5.9 mmHg], HOMA-IR [-2.4] and lipids) after the weight loss phase (all p’s< 0.05). Full data for the weight maintenance phase were available in 21 participants due to the COVID pandemic (PA-REC: 12, WM-REC:9). Larger improvements in cardiorespiratory fitness (as assessed by estimated METs [1.7 vs. 0 METs, p=0.01] and relative VO
2
peak [2.3 vs.0.5 ml/kg/min, p=0.04]) were observed in the WM-REC group compared to the PA-REC group, while changes in waist circumference (-2.4 vs. 0.5 cm, p=0.06), visceral fat (-45.7 vs. 8.2 g, p=0.06), and absolute VO
2
(0.1 vs. 0.2 L/min, p=0.09) approached significance. No significant changes were observed between groups for changes in weight, blood pressure, glucose metabolism, or lipid parameters during the maintenance phase (all ps>0.05).

Discussion:
Clinically significant weight loss combined with aerobic exercise resulted in improvements in cardiometabolic parameters. Exercise at levels associated with the weight maintenance guidelines resulted in greater improvements in cardiorespiratory fitness and may have the potential to improve measures of central adiposity to a greater extent than the minimum physical activity recommendations following weight loss. Future studies should evaluate the impact of different levels of aerobic exercise after clinically significant weight loss in long term interventions.
Abstract P148: Perceived Religious Influence on Health is Associated With Beneficial Cardiovascular Health Behaviors Within Predominantly Black Churches in New Orleans, Louisiana
Authors: Allouch Farah , Mills Katherine T , Laurent Jodie , Alvarado Flor , Gustat Jeanette , He Hua , He Jiang
Published: March 2023

Introduction:
CVD is the leading cause of death in the US. Black populations are disproportionately affected by CVD. Further, Black populations have substantially high rates of religiosity. Previous research has demonstrated a positive correlation between religiosity and health, but the mechanisms are unclear. In this study, we describe the relationship between perceived religious influence on CVD health behaviors, risk factors and confidence in participating in medical care within predominantly Black churches in New Orleans, Louisiana.

Hypothesis:
Perceived religious influence on health is positively associated with CVD health behaviors, risk factors and confidence in participating in medical care.

Methods:
A survey in 302 members of 13 churches with predominantly Black congregations was conducted during the needs assessment of the Church-based Health Intervention to Eliminate Racial Inequalities in Cardiovascular Health (CHERISH) trial. Religious influence on health was assessed with two statements, (1) “Religious beliefs have great influence on my health” and (2) “I tend to avoid things harmful to my body because of religious beliefs” and measured with a five-point Likert scale ranging from “strongly disagree” to “strongly agree”. Outcomes included fruit and vegetable intake, physical activity, smoking status, self-reported hypertension, hypercholesterolemia, diabetes, and confidence in asking questions to provider and understanding treatment plans. Logistic regression and cumulative odds logistic regression models were used to examine the association with individual and composite outcomes, respectively, adjusting for age, sex, and education.

Results:
Survey respondents were 77% (233/302) female with a mean age of 65.5 years, and 72% (218/302), 56% (168/302), and 37% (111/302) reported hypertension, hypercholesterolemia, and diabetes, respectively. Perceived religious influence on health was associated with daily fruit and vegetable consumption (OR = 1.64; 95% CI: 1.01, 2.67), physical activity (OR = 1.76; 95% CI: 1.05, 2.96), composite health behaviors (OR = 1.59; 95% CI: 1.03, 2.48), confidence in asking questions to provider (OR = 3.46; 95% CI: 1.41, 9.12), and the composite confidence outcome (OR = 2.11; 95% CI: 1.06, 4.26). Avoiding harmful things because of religion was associated with physical activity (OR = 1.97; 95% CI: 1.17, 3.38) and composite health behaviors (OR = 1.56; 95% CI: 1.01, 2.42). There was no association between the exposures and self-reported hypertension, hypercholesterolemia, or diabetes.

Conclusion:
Perceived religious influence on health was associated with beneficial CVD health behaviors and confidence in participating in medical care. These findings may inform cultural tailoring of interventions to reduce CVD among the US Black population.
Abstract P149: Police Contact in Adolescence and Healthy Lifestyle Patterns During the Transition to Adulthood: A Longitudinal Study
Authors: Qureshi Farah , Jackson Dylan B
Published: March 2023

Background:
Considerable work finds that adverse childhood experiences may predispose cardiovascular disease (CVD) in adulthood. While youth contact with police is an increasingly common early life adversity with known health impacts, it remains understudied in cardiovascular research. This prospective study investigated whether encounters with police in adolescence were associated with CVD-related lifestyle factors during the transition to adulthood.

Methods:
Data came from the Panel Study of Income Dynamics Child Development and Transition to Adulthood Supplements (N=2,361). In 2002 and 2007, participants aged 10-19y reported how often they were stopped and questioned by the police in the past 6 months (never, once, 2+ times). In 2005-2019, biennial surveys were completed from age 18-28y assessing 5 healthy lifestyle factors: body mass index 18.5-25 kg/m
2
, 8-11h of sleep per night for those ≤19y or 6-9h of sleep per night for those ≥20y, non-smoking, no binge drinking, and engaging in regular physical activity. Participants who reported having these factors at each available follow-up assessment were defined as sustaining healthy patterns over time. Poisson regression models evaluated associations between police contact and sustained healthy patterns of both individual lifestyle factors and multiple factors (range=0-5). Sensitivity analyses excluded youth who reported being arrested by police. Differences by race and gender were evaluated via interaction terms.

Results:
In the overall sample, 9% of youth were stopped by police once and 9% twice or more. Separately, 5% reported a history of arrest. Both police stops and arrests were more common among Black youth (1 stop: 11%, 2+ stops: 11%, arrest: 8%) than White youth (1 stop: 7%, 2+ stops: 7%, arrest: 2%). After adjusting for study covariates, frequent police stops were associated with a lower likelihood of maintaining healthy sleep patterns (IRR
1 stop
=0.79, 95% CI=0.52, 1.20; IRR
2+ stops
= 0.42, 95% CI=0.23, 0.77), abstaining from binge drinking in young adulthood (IRR
1 stop
=0.86, 95% CI=0.70, 1.04; IRR
2+ stops
=0.74, 95% CI=0.59, 0.92), and sustaining healthy patterns of multiple lifestyle factors (IRR
1 stop
=0.91, 95% CI=0.75, 1.09; IRR
2+ stops
=0.71, 95% CI=0.58, 0.88). Associations with other lifestyle factors were comparable in magnitude but characterized by wide confidence intervals. Nearly identical associations were observed when excluding youth with a history of arrest. Tests for interaction found no evidence of moderation by race or gender.

Conclusions:
Youth contact with police is related to unhealthy lifestyle patterns during the transition to adulthood, which may have important consequences for cardiovascular health across the lifespan. Given the disproportionate burden of police contact experienced by Black youth, future research should consider its potential role as an early driver of CVD disparities.
Abstract P150: Residential Segregation and Hypertension Risk in Black and White Americans
Authors: Kamin Mukaz Debora , Sparks Andrew , Plante Timothy B , Judd Suzanne E , Howard George , Howard Virginia J , Carson April P , Dean Lorraine , Dougherty Geoff , Cushman Mary
Published: March 2023

Introduction:
Black adults experience the highest hypertension burden of any American group. Evidence indicates social factors adversely affecting Black people explain some of the excess hypertension burden. It’s unclear whether residential segregation, a key cause of health inequities, has a differential impact on Black and White people.

Hypothesis:
The magnitude of the association of residential segregation and risk of incident hypertension will be greater in Black than White people.

Methods:
Our sample included 6,143 Black and White REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants without prevalent hypertension (2003-7), and with a follow-up visit 9.3 years later. Baseline county-level segregation was measured with the (1) dissimilarity index (DI, the difference in race distribution of census tracts relative to their county), (2) isolation index (ISI, the degree to which Black people are exposed only to one another in a county), and (3) interaction index (ITI, the degree to which Black people are exposed to White people in a county). Modified Poisson regression estimated the risk ratios (RR) of incident hypertension per SD increment of baseline residential segregation.

Results:
The mean (SD) age was 61(8) years for Black people and 62(8) years for White people. Hypertension incidence was 46% for Black people and 33% for White people. There was no

association of any of the three measures of residential segregation (DI, ISI and ITI) with incident hypertension, with RRs all around 1.0 (
Figure
).

Conclusions:
Three measures of residential segregation were not associated with incident hypertension risk in Black and White participants of the REGARDS cohort. Findings differ from a previous study that reported that a measure of racial clustering was associated with higher risk of hypertension in Black people. Taken together, findings suggest that, in Black people, different domains of residential segregation capture factors related differently to hypertension development.
Abstract P157: Genetically Determine Gut Microbiome Abundance, Obese, and Incident Type 2 Diabetes
Authors: Tang Rui , Kou Minghao , Li Xiang , Wang Xuan , Ma Hao , Liang Zhaoxia , Heianza Yoriko , Qi Lu
Published: March 2023

Introduction:
Gut microbiota has been linked to the body’s adiposity and the development of type 2 diabetes (T2D). A recent genome-wide association study identified that genetic variants at the
ABO
locus (SNPs rs8176645 and rs550057) were associated with the abundance of gut microbiome (i.e.,
Bifidobacterium bifidum
and
Collinsella aerofaciens,
respectively).

Hypothesis:
We assessed the hypothesis that the genetically determined gut microbiome abundance was associated with incident T2D, and such association could be modified by obese status.

Methods:
A total of 339,465 European ancestry participants who are initially free of T2D at baseline and have available information on genetic variants from the UK Biobank population were included in this study. The genetic risk score (GRS) was constructed by the risk alleles of the two genetic variants at the
ABO
locus. Cox proportional hazard models were used to estimate the associations between the genetic variants/GRS and incident T2D.

Results:
During a median of 11.8 years of follow-up, 11,566 incident T2D were documented. We observed that the gut microbiome-related variants rs8176645 and rs550057 were both significantly associated with incident T2D after adjustment for sex, age, body mass index (BMI), Townsend deprivation index, smoking, drinking, regular physical activity, and diet score at baseline (hazard ratio [HR] per copy of risk allele A of rs8176645 1.05, 95% CI [1.02-1.09],
P
-value=0.001; HR per copy of risk allele T of rs550057 1.06, 95% CI [1.03-1.09],
P
-value<0.001; respectively). The GRS also showed a significant association with T2D incidence in the fully adjusted model (HR=1.03, 95% CI [1.01-1.05],
P
-value<0.001). In addition, we found that BMI significantly modified the associations between GRS and T2D, which were more pronounced in non-obese participants (
P
-interaction=0.008).

Conclusion:
Our findings indicate that the genetically determined gut microbiome abundance significantly predicts T2D risk, independent of traditional risk factors.
Abstract P164: Using Mixed Methods to Assess Community Based Participatory Research Implementation: Assessment of a Walking-Based Health Intervention Program
Authors: Spitz Lindsay , Salinas Jennifer J , Valuenzuela Roy
Published: March 2023

Introduction:
The Border Coalition for Fitness (BCF) is a community-based organization sponsored by Texas Tech University Health Sciences Center El Paso(TTUHSC El Paso) that facilitates walking-based programs. These interventions aim to increase physical activity among a majority Hispanic population in El Paso, TX. To provide programming that effectively meets the community's needs, the BCF aims to operate within a community-based participatory research (CBPR) framework that centers on community engagement and the translation of research into tangible benefits to the community. This mixed methods assessment examines perceptions of the BCF and its impact on the community.

Methods:
For the quantitative study, depending on the self-selected group (BCF, community leader, or community participant), respondents completed either a leadership (BCF, community leaders) or non-leadership (community participants) questionnaire. Both assess perceptions on a scale from 0 to 10, 10 being the best, across three constructs: leadership(L), resources(R), and ability and commitment to organize(C). For the qualitative study, members of the BCF and former walking intervention participants completed one-on-one interviews consisting of 13 open-ended questions. Qualitative interviews are ongoing.

Results:
Preliminary results from the quantitative survey (n=103) show high ratings across stakeholder groups and constructs. BCF members consistently represent the highest ratings (L:9.6; R:9.6; C:9.3) across all constructs, followed by the community leaders (L:8.3; R:8.1; C:8.5), and finally, community participants (L:8.0; R:7.7; C:7.6). There is good agreement among BCF members (n=5) and community members (n=2) that the BCF has a strong collaborative relationship with its academic sponsor and the community and provides impactful programming. Areas cited for improvement included a need for more autonomy on the part of the BCF and improved understanding of and interaction with the BCF on the part of community members.

Conclusion:
In conclusion, early findings from this mixed-methods assessment indicate strong support for the BCF and its programming among leadership and the community. However, insight gained from the qualitative interviews highlights several areas of improvement in terms of community-based participatory research practices, particularly encouraging community engagement with the BCF beyond participation in the walking-based programs.
Abstract P166: First Trimester Plasma Per- and Polyfluoroalkyl Substance (PFAS) Concentrations and Blood Pressure Trajectories Throughout the Second and Third Trimesters of Pregnancy
Authors: Arvayo Jordan , Stephenson Briana J , Aris Izzuddin , Preston Emma V , Hivert Marie-France , Oken Emily , Rifas-Shiman Sheryl L , Zota Ami , James-Todd Tamarra
Published: March 2023

Introduction:
Evidence suggests that PFAS exposures increase risk of hypertensive disorders of pregnancy. Prior studies did not examine blood pressure (BP) trajectories during pregnancy – an important outcome to consider since adverse health outcomes can occur without diagnosis of a hypertensive disorder.

Hypothesis:
We hypothesized that higher PFAS exposures in the 1
st
trimester would be associated with higher BP trajectory and faster BP velocity in later stages of pregnancy.

Methods:
We collected plasma from 1,308 individuals to measure six circulating PFAS in early pregnancy (median: 9.4 weeks gestation). Systolic BP (SBP) and diastolic BP (DBP) measurements, recorded from 12 weeks gestation until delivery, were abstracted from outpatient medical records. We estimated the mean BP trajectory via growth curve analysis, then employed BKMR to examine PFAS exposures with parameters of the trajectory – adjusting for age, race/ethnicity, pre-pregnancy BMI, income, parity, alcohol intake, and physical activity. We evaluated effect modification by age and BMI.

Results:
We collected a median of 13 BP measurements (IQR: 11 – 14) per participant. BKMR single PFAS analyses showed higher concentrations of PFOS were associated with higher SBP and DBP trajectory from 12 weeks gestation to delivery (Figure 1A) as well as faster SBP velocity. Stratified analyses showed evidence of effect modification. PFOS was associated with higher SBP trajectory in those with a BMI < 25 kg/m
2
and higher DBP trajectory in those with a BMI ≥ 25 kg/m
2
(Figure 1B). In contrast, PFNA and PFHxS were associated with lower DBP trajectory for those with low BMI (Figure 1C). Lastly, exposure to lower quantiles of the PFAS mixture was associated with slower SBP velocity for those with low BMI. No associations were observed between PFAS and DBP velocity.

Conclusions:
Our findings suggest that select prenatal PFAS exposures may impact BP trajectories during pregnancy. Higher concentrations of PFOS are associated with higher BP trajectory and faster BP velocity.

1
Abstract P168: Early Life Metal Profiles and Kidney Function in Mid-Adolescence: A Preliminary Study in Project Viva
Authors: Lin Pi-i D , Cardenas Andres , Rifas-Shiman Sheryl L , Zota Ami R , Hivert Marie-France , Oken Emily , Aris Izzuddin M , Sanders Alison P
Published: March 2023

Introduction:
The developing kidney is vulnerable to pre- and postnatal environmental stressors. Suboptimal environmental conditions during early life, such as exposure to toxic metals and deficiency in essential metals, can alter the risk of kidney dysfunction later in life. In this pilot study, we aimed to examine the relationship between prenatal exposure to metals and adolescent kidney function using data from Project Viva, a Boston-area prospective pre-birth cohort.

Hypothesis:
Prenatal exposure to higher metal concentrations, both individually and as mixtures, will be associated with altered kidney function in mid-adolescence.

Methods:
We assessed the following metals in erythrocyte samples collected during pregnancy: 1
st
-trimester [arsenic (As), barium (Ba), cadmium (Cd), cesium (Cs), mercury (Hg), lead (Pb), copper (Cu), magnesium (Mg), manganese (Mn), selenium (Se), and Zinc (Zn)]; 2
nd
-trimester (Pb, Mn, Hg, and Se). We measured plasma cystatin C and creatinine from blood samples collected in mid-adolescence (mean age 18 years) in a sub-sample of Project Viva participants. We calculated the estimated glomerular filtrate rate (eGFR) using a cystatin C-based equation for children. We examined associations of prenatal metal exposure and mid-adolescent eGFR using linear regression for single metal analyses, and Bayesian kernel machine regression and quantile-based g-computation for mixture analyses. In all models, we adjusted for maternal education level, annual household income, race/ethnicity, child sex, and age at eGFR assessment.

Results:
A total of 146 participants had complete data for 1
st
-trimester erythrocyte metals and mid-adolescent eGFR, and 105 participants had complete data for 2
nd
-trimester blood metals and mid-adolescent eGFR. All children had eGFR values in the normal range (i.e., >60 mL/min/1.73m
2
); the mean (SD) eGFR was 92.0 (13.7) mL/min/1.73m
2
. Most pairwise metal-eGFR relationships were statistically null; however, a 2-fold increase in 1
st
-trimester Zn was associated with higher eGFR (β 7.25 mL/min/1.73m
2
; 95% CI 0.33, 14.16), while a 2-fold increase in 2
nd
-trimester Pb was associated with lower eGFR (β -4.90 mL/min/1.73m
2
; 95% CI -8.32, -1.48). Mixture analyses did not identify statistically significant findings but suggested some non-linear associations and interactions between metals.

Conclusions:
Preliminary evidence suggests that prenatal Zn exposure is associated with higher kidney function while prenatal Pb exposure is associated with lower kidney function in mid-adolescence. We plan to assess eGFR in additional participants to increase the power of the analyses.
Abstract P169: Prenatal Per- and Polyfluoroalkyl Substance (PFAS) Exposures and Offspring Blood Pressure From Birth to Late Adolescence: A Prospective Study in Project Viva
Authors: Zhang Mingyu , Rifas-Shiman Sheryl L , Aris Izzuddin , James-Todd Tamarra , Oken Emily , Hivert Marie-France
Published: March 2023

Introduction:
Mice studies showed that prenatal PFAS exposures increase offspring blood pressure (BP), but findings in human studies are inconsistent. Prior studies did not have repeated BP measurements from birth to late adolescence or use a mixture approach to investigate the interactions or overall effects of prenatal PFAS exposures.

Methods:
Participants are from the prospective pre-birth cohort Project Viva. We measured PFAS in maternal plasma samples collected in the 1
st
-trimester (median: 9.6w) and child systolic (SBP) and diastolic BP (DBP) at six follow-up visits: 1) birth; 2) infancy (median: 6m); 3) early childhood (median: 3.2y); 4) mid-childhood (median: 7.7y); 5) early adolescent (median: 13.0y), 6) mid-adolescent (median: 17.5y). At each study visit, BP was measured 4-5 times, and the average value was taken. We used linear regression to examine associations of each individual PFAS, and Bayesian kernel machine regression (BKMR) to examine PFAS mixtures, with BP at each visit, adjusting for maternal age, race/ethnicity, education, pre-pregnancy body mass index, parity, smoking status, and chronic hypertension before pregnancy.

Results:
Sample sizes at each visit ranged from 549-919 (
Legend
). Prenatal PFAS was not consistently associated with offspring SBP or DBP across all visits. PFOS was associated with higher SBP in mid-childhood (
Panel A1
), EtFOSAA was associated with higher SBP in infancy and in mid-childhood (
Panel A5
), and MeFOSAA was associated with higher SBP in infancy (
Panel A6
). PFOS, PFNA, EtFOSAA, and MeFOSAA were associated with lower DBP only in early childhood but not at other visits (
Panels B1, B4, B5, B6
). BKMR did not suggest prenatal PFAS interactions or the overall effects of exposure to multiple PFAS on offspring SBP or DBP.

Conclusions:
There are no consistent associations between prenatal PFAS exposures and BP from birth to late adolescence. Future studies should examine whether there are other critical windows (e.g., mid- or late pregnancy) of susceptibility for PFAS on offspring BP.
Abstract P171: Associations Between Metals and Allostatic Load Among Non-Hispanic Asians and Non-Hispanic Whites From the National Health and Nutrition Examination Survey: 2015-2020
Authors: Le Austin , Morello-Frosch Rachel , de la Rosa Rosemarie
Published: March 2023

Introduction:
Environmental metal exposure has been linked with multi-system toxicity and elevated stress hormones, and high metal concentrations have been observed among Asian Americans. Metal exposure may also increase Allostatic Load (AL), or physiologic “wear-and-tear” on the body.

Hypothesis:
Metal biomarker concentration is associated with high AL among non-Hispanic Asian (NHA) and non-Hispanic White (NHW) adults.

Methods:
AL scores were calculated based on 9 biomarkers representing cardiovascular, metabolic, and immune system function using data from the National Health and Nutrition Examination Survey (2015-2020). High AL was defined as having ≥3 high-risk biomarkers based on empirically defined thresholds. Lead, cadmium, and mercury were quantified in blood while arsenic, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were measured in urine. Metal concentrations were categorized into empirically-defined sample tertiles. Survey-weighted logistic regression analyses controlled for demographic, socioeconomic, and health behavior variables. Analyses were also stratified by NHA and NHW.

Results:
The study sample consisted of 5,012 adults [mean age: 50.4, SE: 0.5] (21.6% foreign-born NHA, 2.7% US-born NHA, and 75.7% NHW). Prevalence of high AL was 38.2% among NHW, 32.4% among foreign-born NHA, and 19.3% among US-born NHA. Metal exposure demonstrated heterogenous relationships with AL (
Table
). Individuals in the highest tertile of cadmium exposure had 38% greater odds of having high AL than those in the lowest tertile, however this association was attenuated after controlling for socioeconomic status and health behaviors. Lead, mercury, arsenic, DMA, and MMA were associated with lower odds of high AL. Relationships were similar when stratified by NHW and NHA.

Conclusion:
The association between metals and AL differs by metal type in our study population. Future studies should explore the mechanistic pathways between high metal exposure and AL.
Abstract P175: Shared Medical Appointments in Heart Failure for Post-Hospitalization Follow-Up
Authors: Taveira Tracey H , Cohen Lisa , Ball Sherry , Laforest Sherry K , Gee Julie A , Schaub Kimberley , Dev Sandesh , Parent Melanie , Hearns Rene , Wu Wen-Chih H
Published: March 2023

Introduction:
Shared medical appointments (SMAs) are medical visits where several patients with a common disease have clinic at the same time with medical provider(s). SMAs in heart failure (HF) is a unique opportunity where providers of different disciplines, one of which is a prescriber with HF expertise, can improve the health of patients recently discharged with HF.

Hypothesis:
Compared with usual care, patients discharged with HF randomized to a HF-SMA will experience better cardiac health status as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) and overall health status as measured by the EQ-5D Visual Analog Scale (EQ5D-VAS)

Methods:
We conducted a 3-site open label randomized-controlled trial of parallel design. Participants within 12 weeks of a HF hospitalization were randomized to receive either HF-SMA versus usual care. The HF-SMA team consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist and included four 2 hour sessions that met every other week for 8 weeks. Primary outcomes are overall health status measured by EQ5D-VAS (range 0-100 with 0 = worst health and 100 = Best health) and cardiac health status by KCCQ (range 0-100, higher score is better cardiac health), after 180 days post randomization.

Results:
Of the 242 patients enrolled (mean age 69.3±9.4 years, 71.5% white, 94.6% male), 83.8% HF-SMA and 84.8% usual care participants completed the study. Although both groups had significant improvements from baseline in their overall health status, patients in the HF-SMA intervention experienced a greater improvement in EQ5D-VAS scores than usual care (change = 7.2 ± 15.8 versus -0.4 ± 19.0 points, p<0.001, respectively). There were no significant differences between the groups in the cardiac health status KCCQ Summary or Clinical Scores.

Conclusion:
HF-SMA achieved higher Improvements in overall health status than usual care but not in cardiac health status. Future studies should power to compare data on event outcomes to better understand impact.
Abstract P176: The Association of Blood Urea Nitrogen With Incident Heart Failure in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Liu Hairong , Ishigami Junichi , Mathews Lena M , Konety Suma H , Hall Michael E , Chang Patricia , Ndumele Chiadi E , Rosamond Wayne D , Matsushita Kunihiro
Published: March 2023

Background:
Blood urea nitrogen (BUN) has been shown as a potent predictor of morbidity and mortality in patients with heart failure (HF). Whether BUN levels are associated with incident HF in the general population is unknown.

Methods:
Among 14,263 ARIC participants without a history of HF at baseline (1987-1989) (mean age 54 [SD 5.7] years, Female 54.4%, Black 25.4%), we assessed the association of BUN with incident HF. BUN levels (mg/dL) were divided by quartiles in the primary analysis, and the highest quartile was further divided into tertiles in the secondary analysis (Q1<13, Q2 13-15, Q3 15-17, Q4a 17-19, Q4b 19-21, Q4c >21). We defined HF as hospitalization or death with HF diagnosis and estimated hazard ratios (HRs) using multivariable Cox regression models.

Results:
During a median follow-up of 26.2 years, 3,506 participants developed incident HF (incidence rate 10.7 per 1,000 person-year). When we adjusted for demographic variables, using the lowest quartile (Q1) as the reference, the top quartile (Q4) showed an HR of 1.18 (95% CI 1.08, 1.10) (Model 1 in
Table
). When we subdivided Q4, Q4c showed the highest HR (1.40 [95% CI 1.21, 1.61]). The association was similar after further adjusting for lifestyle and other clinical factors (Model 2 in
Table
). Further adjustment for estimated glomerular filtration rate modestly attenuated the association (Model 3 in
Table
), but HRs remained significant for Q4 as a whole (1.11 [1.01, 1.22]) and Q4c (1.27 [1.09, 1.47]). In subgroup analysis, the association was stronger in Black participants than in White participants (p-for-interaction <0.05).

Conclusion:
In this community-based cohort, higher BUN levels were significantly associated with incident HF. BUN levels are often measured as part of routine clinical care and thus may inform clinicians to identify individuals at risk of HF, particularly in resource-constrained settings with limited availability of measuring HF-specific markers such as natriuretic peptides.
Abstract P181: Impact of Blood Pressure on Longitudinal Patterns of Pre-Heart Failure in a Hispanic/Latino Population-Based Cohort: Results From the Echocardiographic Study of Latinos (ECHO SOL)
Authors: Duran Luciano Priscilla , April-Sanders Ayana K , Lee Un Jung , McLeod Jennifer , Kaplan Robert , Hurwitz Barry E , Swett Katrina , Daviglus Martha L , Bilsker Martin , Sotres-Alvarez Daniela , Ponce Sonia , Kansal Mayank M , Cai Jianwen , Talavera Gregory A , Rodriguez Carlos J
Published: March 2023

Introduction:
Hypertension (HTN) is a modifiable risk factor for heart failure (HF) and a common antecedent for pre-HF, but its effect on pre-HF is not well known.

Hypothesis:
Variations in blood pressure (BP) will be related to distinct patterns of pre-HF (prevalent and incident).

Methods:
Two echocardiograms were performed ∼4.3 years apart on 1643 adults in the Hispanic/Latino cohort ECHO SOL. Pre-HF was defined as systolic dysfunction (LVEF <50%/ global longitudinal strain >15%) or diastolic dysfunction (≥ Grade 1) or left ventricular remodeling (left ventricular mass index >115 for men, >95 for women/ relative wall thickness >0.42). At visit 1 (V1), 953 were normotensives, and 690 hypertensives [controlled and uncontrolled]. Groups were subdivided at visit 2 (V2) based on maintenance or changes from V1 BP status. Logistic regression models were used to determine the association of BP with pre-HF. All analyses were weighted due to complex survey design.

Results:
Higher BP at baseline (linear and by tertiles) was significantly associated with prevalent pre HF (table 1). Higher pulse pressure was significantly associated with incident pre-HF (table 1). Normotensives at V1 who later developed HTN (≥ 130/80 mmHg) at V2 had higher odds of having prevalent (2.05 [95% CI, 1.24 - 3.39]) and incident (2.42 [95% CI, 1.07 - 5.51]) pre-HF than those who remained with BP <130/80 mmHg at V2. When defining uncontrolled HTN as BP ≥ 130/80 mmHg, we found that uncontrolled hypertensives at V1 who remained uncontrolled at V2 had higher odds (2.75 [95% CI, 1.18 - 6.41]) of having prevalent pre-HF compared to uncontrolled hypertensives who progressed to controlled HTN at V2 (<130/80 mmHg).

Conclusion
A significant association exists between BP and prevalent/incident pre-HF in the Hispanic/Latino population. Additionally, those who progress from normal BP to hypertension face an increased risk of developing prevalent/incident pre-HF compared to those who remain normotensives. Blood pressure control of <130/80 mmHg could result in less prevalent pre-HF.