tbuckley/cabot-search huggingface dataset:
Abstract P360: Association of Neighborhood-Level Socioeconomic Disadvantage and Maternal Cardiovascular Health in Early Pregnancy: The nuMoM2b-HHS Study
Authors: Kartik K Venkatesh, William Grobman, Xiaoning Huang, Lynn Yee, Janet M Catov, Hy Simhan, Erin Cleary, Brian Mercer, Uma Reddy, Robert Silver, Lisa Levine, Judith Chung, George Saade, Rebecca McNeil, Victoria L Pemberton, Jasmina Varagic, C Noel N Bairey, Philip Greenland, Courtney Lynch, Sadiya S Khan
Journal: Circulation (2024)

Introduction: To determine whether residing in a more socioeconomically deprived area during early pregnancy is associated with worse maternal cardiovascular health (CVH), as quantified by the American Heart Association Life’s Essential 8 (LE8). Methods: Secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study cohort. Participant home addresses in the first trimester were geocoded at the census-tract level. The exposure was neighborhood-level area deprivation index (ADI), categorized by tertile (least deprived [T1], reference; most deprived [T3]). The outcome was CVH defined by the LE8 assessed in the first trimester, which includes physical activity, diet quality, tobacco use, sleep quantity, body mass index (BMI), blood pressure, and serum fasting glucose and lipid levels to create a score ranging from 0 to 100 (higher being better). Multivariable linear regression models were used to examine associations between ADI tertile and CVH scores for each component and a summary CVH score. Results: In this cohort of nulliparous individuals in the first trimester, the mean ADI was 45.2 (SD: 30.7), and the mean overall LE8 was 82.2 (SD: 12.0). Compared with those with the least neighborhood disadvantage (i.e., T1), individuals living in neighborhoods with greater neighborhood disadvantage had lower mean LE8 scores, indicating worse CVH (T1 vs. T2 adjusted mean: 84.68 vs. 81.75; adj. ß: -2.92; 95% CI: -4.19, -1.66; and T1 vs. T3: 84.68 vs. 79.15; adj. ß: -5.52; 95% CI: -7.92, -3.12) (p&lt;0.01 for trend). The greatest neighborhood disadvantage (i.e., T3) was also associated with individual elements of the LE8, including poorer diet quality, higher BMI, and higher systolic and diastolic blood pressure. Conclusions: Neighborhood-level socioeconomic disadvantage was associated with worse CVH in early pregnancy. Multi-level interventions should consider structural approaches that address the social determinants of place-based disparities in maternal CVH.
Abstract P222: Prolonged Sitting Time Was Associated With Central Obesity-Related Parameters Among Hong Kong Chinese Women: A Cross-Sectional Study
Authors: Yan Zhang, Yao Jie Xie, Yunyang Deng
Journal: Circulation (2024)

Introduction: The evidence concerning the association between sitting time and central obesity in Hong Kong Chinese women was still scarce. Hypothesis: Prolonged sitting time was positively associated with increased waist circumference (WC), hip circumference, and trunk body fat percentage; and also larger waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) among Hong Kong Chinese women. Methods: Data were extracted from a cohort study named “Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women”. The baseline data (2019-2021) were used for analysis. Sitting time and physical activity level were measured by the International Physical Activity Questionnaire short form. Body weight, height, WC, hip circumference, and trunk body fat percentage were measured according to standard protocol. The WHR and WHtR were then calculated. Central obesity was defined as WC ≥80.0 cm. Subgroup analysis were conducted based on age (≥60 and &lt;60 years) and whether participants met the recommended physical activity guidelines (≥75 minutes/week of vigorous physical activity or ≥150 minutes/week of moderate-intensity physical activity). Results: A total of 3,280 Hong Kong Chinese women aged 56.46±8.30 years were included. The overall prevalence of central obesity was 32.26% (1,058 of 3,280). Participants with central obesity had a longer sitting time compared to those without (8.01±3.27 vs. 7.60±3.25 hours/day, P =0.001). After adjusting for age, education, living alone or with family members, drink, smoking, and physical activity, each additional hour of daily sitting time was significantly correlated with 0.678 unit increase in hip circumference ( P &lt;0.001), 0.003 unit increase in WHR ( P =0.004), 0.004 unit increase in WHtR ( P =0.002), and 5.485 unit increase in trunk body fat percentage ( P &lt;0.001). With a one-unit augment in sitting time, the odds of being central obesity was 1.187-fold higher ( 95% CI= 1.108-1.587, P &lt;0.001). In subgroup analysis, the sitting time-central obesity association was significant in women aged ≥60 years ( OR =1.192, 95% CI= 1.085-1.309, P &lt;0.001). Whereas, such positive association existed both in women who did not meet the physical activity guidelines ( OR =1.413, 95% CI =1.011-1.977, P =0.043, 8+ vs. &lt;8 hours/day) and those who adhered to the guidelines ( OR =1.326, 95% CI =1.108-1.587, P =0.002, 8+ vs. &lt;8 hours/day). Conclusions: Longer sitting time exhibited a positive relationship with central obesity-related indices in terms of WC, hip circumference, trunk body fat percentage, WHR and WHtR. The significant association between sitting time and central obesity was only observed in older women, but it remained consistent and robust regardless of whether the subjects followed the recommended physical activity guidelines.
Abstract P428: Risk-Based Approach to Defining Prediabetes Among Middle-Aged Adults in the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mary R Rooney, Amelia S Wallace, Justin B Echouffo, Joe Coresh, Elizabeth Selvin
Journal: Circulation (2024)

Introduction: Current prediabetes definitions, based on fasting blood glucose (FG) or HbA1c, are broad and capture many individuals who will never develop diabetes. Other risk factors including age, sex, body mass index (BMI), systolic blood pressure (SBP), and family history of diabetes, are not part of current definitions but are highly predictive of progression from prediabetes to diabetes. We evaluated whether approaches to defining prediabetes that incorporate standard clinical measures can improve 10-year diabetes risk prediction. Methods: We conducted a prospective analysis of 11,322 participants in the Atherosclerosis Risk in Communities (ARIC) Study aged 46-70 years (55% women, ~20% Black adults) without diabetes at baseline (1990-1992). We used logistic regression to develop risk equations for incident diabetes over ~10-year based on combinations of HbA1c, FG, and/or clinical measures (age, sex, BMI, SBP, family history of diabetes). We calculated area under the curve (AUC) for 10-year diabetes risk, comparing American Diabetes Association (ADA) prediabetes definitions (HbA1c 5.7-6.4%, FG 100-125 mg/dL, either, or both) with our new risk equations. Results: Over ~10 years of follow-up, there were 1230 incident cases of diabetes. The ~10-year absolute diabetes risk for persons with HbA1c 5.7-6.4% was 27% (AUC=0.66) and for persons with an FG of 100-125 mg/dL was 16% (AUC=0.64). Risk equations combining FG and HbA1c yielded an AUC of 0.76. The additional inclusion of all 5 clinical measures increasing the AUC to 0.78 (ΔAUC=0.02; p&lt;0.001). Simple clinical measures, primarily BMI, led to modest improvements in risk discrimination when added to HbA1c alone (ΔAUC=0.03; p&lt;0.001) or FG alone (ΔAUC=0.03; p&lt;0.001). Conclusions: Defining prediabetes based on both an elevated FG and elevated HbA1c (confirmatory definition) or using clinical variables (age, sex, BMI, SBP, family history) added to either FG or HbA1c can substantially improve our ability to identify middle-aged adults who will progress to diabetes.
Abstract P242: The Effects of Wellness Coaching on Lowering Stroke Risk Factors in a Wisconsin Native American Population
Authors: Louden Akin, Stephanie M Wilbrand, Timothy Hess, Amanda Riesenberg, Jenna Maybock, Connie Vandenberg, Carrie Blohowiak, Jay Kennard, Debra Danforth, Robert J Dempsey, Carol Mitchell
Journal: Circulation (2024)

Objective: Native Americans are disproportionally affected by obesity, diabetes and stroke. This study tests the hypothesis that weight loss and change in BMI are related to coaching participation in the first 52 weeks of a two-year study. Methods: Participants of the “Stroke Prevention in the Wisconsin Native American Population” study age ≥55 years with three or more stroke risk factors were assigned to a High Risk-Intensive Coaching arm (n=49); informed consent was obtained for all participants. These participants engaged in routine wellness coaching visits centered around lifestyle modification in an effort to reduce risk factors for stroke. Data analysis was performed with SPSS (SPSS, IBM Corporation, Armonk, NY, US) and R (RStudio, PBC, Boston, MA, US). Continuous variables are reported with median and interquartile range (IQR). A participation score (total coaching sessions attended ÷ 52 weeks) was calculated for each participant and total weight loss for the first 52 weeks was also calculated (baseline weight in pounds - the weight in pounds at the last coaching session closest to week 52), (n=49). The Wilcoxon Signed Rank test was used to test the hypothesis that weight loss or change in BMI was significantly different than baseline. A smoothing spline was used to assess a potential dose-response relationship between participation score and weight loss and change in BMI. Results: Of the 49 participants examined, 36 were female and 13 were male, with a median age of 66 (IQR =10.0) years. Risk factors observed at baseline included smoking (n=11, 22.4%), median BMI of 31.6 lb/in 2 (IQR=7.7), and median physical activity of 90 minutes per week (IQR=210.0). Biometric measures were also recorded at baseline, with a median systolic blood pressure of 149 mmHg (IQR=26.0) and median diastolic of 80 mmHg (IQR=14.0), median total cholesterol of 156 mg/dL (IQR=57.0), median LDL of 87 mg/dL (IQR=57.0), median HDL of 46 mg/dL (IQR=16.0), median non-HDL of 110 mg/dL (IQR=61.0), and median hemoglobin A1C of 6.5 mg/dL (IQR=1.2). Participation score median of 0.33 (IQR=0.375) range 0.06-0.87. Weight loss median 3.6 (IQR=9.45) range -41 to 35 pounds. A spline analysis found a significant dose-response relationship between participation score in the first 52 weeks of the study and weight loss (r 2 =0.199 deviance 23%, p=0.006) and BMI (r 2 =0.145, deviance 16.7%, p=0.010). Conclusion: Preliminary results suggest that participation in a wellness coaching program may be associated with weight loss and change in BMI in this study population. Future work will continue to examine how coaching is related to weight loss and change in BMI in a larger cohort and with a wider age range.
Abstract MP30: Sugar-Sweetened Beverages, Fruit Juices, and Whole Fruits Throughout Childhood and Adolescence and Glycemic Outcomes in Late Adolescence in Project Viva
Authors: Soren Harnois-Leblanc, Jessica G Young, Sheryl L Rifas-Shiman, Karen M Switkowski, Wei Perng, Izzuddin M Aris, Emily Oken, Marie-France Hivert
Journal: Circulation (2024)

Objective: To investigate sex-specific associations of sugar-sweetened beverages (SSBs), 100% fruit juices, and whole fruit intake throughout childhood and adolescence with insulin resistance and glycemic outcomes in late adolescence. Methods: We used data from Project Viva, an ongoing pre-birth cohort from eastern Massachusetts. We evaluated intake of SSBs, 100% fruit juices, and whole fruit at early childhood (median age: 3.1 yrs), mid-childhood (7.6 yrs) and early teen research visits (12.9 yrs) using food frequency questionnaires. We measured fasting blood glucose, insulin and glycated hemoglobin (HbA1c) levels in late adolescence (17.4 yrs). We estimated insulin resistance with the homeostasis model assessment for insulin resistance (HOMA-IR). We computed sex-specific linear regression models to estimate associations of average consumption of SSBs, fruit juice and whole fruit across the 3 childhood-early teen visits with late adolescence HOMA-IR, fasting glucose and HbA1c adjusting for demographics, socioeconomic status, mother BMI, child BMI z-score, and parental history of type 2 diabetes in early childhood (model 1), and additionally for lifestyle habits and diet quality in early childhood (model 2). Results: A total of 240 girls and 215 boys met eligibility criteria and had an outcome measure in late adolescence. Greater SSB intake throughout childhood and adolescence was associated with higher HOMA-IR, fasting glucose, and HbA1c in boys only (Figure). Also in boys, greater fruit juice intake was associated with higher HbA1c in late adolescence. Effect estimates in girls were of small magnitude and centered to the null, except for fruit juice and HbA1c with associations in the same direction as boys (Figure). We did not observe any association with respect to whole fruits for either sex. Conclusion: Findings suggest that SSBs and fruit juice consumption throughout childhood and adolescence are associated with less favorable glycemic traits in boys, suggesting greater risk of developing diabetes.
Abstract P212: Adherence Trends to a Remotely Supervised Weight Loss and Exercise Training Intervention to Improve Rheumatoid Arthritis Cardiovascular Risk
Authors: Katherine A Collins, Leanna M Ross, Alyssa M Sudnick, Brian J Andonian, Kim M Huffman
Journal: Circulation (2024)

Introduction: Individuals with rheumatoid arthritis (RA) have an increased risk for cardiometabolic disease. By improving traditional markers of cardiometabolic health, interventions that induce weight loss and increase physical activity may also reduce RA-related cardiometabolic disease risk. However, to achieve these health benefits, an individual must adhere to such interventions. To understand whether sustained behavioral modification is feasible for individuals with RA, assessing adherence to prescribed intervention components is needed. Hypothesis: We hypothesized that adherence to a daily step goal would be greater than adherence to more intensive intervention components. Methods: Older adults with RA and overweight/obesity (n = 20) were randomized and completed 16 weeks of “usual care” Counseling Health as Treatment (CHAT) or remotely Supervised Weight loss and Exercise Training (SWET). The SWET program consisted of caloric restriction (7% weight loss goal), aerobic training (AT; 150 minutes/week), and resistance training (RT; twice weekly). Both groups were given a daily goal of 6,000 steps. Pearson correlation analyses assessed for a relationship between baseline measures and average daily step count. Results: Participants were on average 66.7 ± 5.4 years old, Caucasian (65.0%), men (80.0%), with obesity (body mass index: 32.4 ± 2.9 kg/m 2 ). For SWET and CHAT, respectively, average daily step adherence was 117.8% (7065.6 ± 2117.0 steps/day) and 118.2% (7093.4 ± 2965.4 steps/day) (Figure 1A). Average adherence to SWET-only components was 84.0 ± 0.5% for AT, 83.0 ± 0.2% for RT, and 93.9 ± 0.1% for weigh-ins (Figure 1B). Step count adherence was unrelated to baseline measures. Conclusions: Step count adherence 1) was similar in both groups despite the intervention delivery strategy, and 2) exceeded other more intensive SWET intervention components (i.e., AT and RT). Findings highlight step counts as an achievable and sustainable RA exercise goal.
Abstract P278: 1-year Outcomes of A1c Reduction, Weight Loss, and Lowered QRISK3 Scores in Type 2 Diabetes Remission: Insights From an RCCT Leveraging Whole-Body Digital Twin Technology
Authors: Shashank Joshi, Mala Dharmalingam, Arun Vadavi, Mohamed Thajudeen, Ashok Keshavamurthy, Suchitra Bhonsley, Paramesh Shamanna
Journal: Circulation (2024)

Background and Aims: The effects of digital twin (DT) technology for remission of T2D on cardiovascular risk reduction is unknown. We evaluated the effectiveness of the DT to improve A1c and body weight and QRISK3 (QResearch Cardiovascular Disease Risk Algorithm 3), which is a prediction algorithm to estimate the 10-year risk for developing cardiovascular disease (CVD), in patients enrolled to achieve remission of T2DM. DT platform uses AI and Internet of Things, to integrate multi-dimensional data to give precision nutrition and health recommendations via the mobile app and by coaches. Materials and Methods: We evaluated the data from prospective cohort of 204 participants who had been on DT for 1 year. Remission was defined as A1C levels less than 6.5% without medication for over 3 months. Outcomes included the change in HbA1c, body weight and change in QRISK3 scores. The DT uses a machine learning algorithm to integrate clinical and sensor data to predict personal glucose response. Patients were connected to continuous glucose monitoring (CGM) throughout the study and self-recorded dietary intake using the mobile app. Results: The study participants had a mean diabetes duration of 3.7±2.6 years and a mean age of 44±8.2 years. Based on the ADA criteria, at 1 year, 73% (n=149/204) continued to be under remission. The mean QRISK3 at baseline was 12.6 (±10.7, 95% CI 11.2 to 14) which significantly reduced to 9.5 (±7.9, 95% CI 8.5 to 10.6) at 360 days, p=0.0009. A1c (%) at baseline was 8.9 (±1.8, 95% CI 8.6 to 9.1, minimum 5.5, maximum 16.2) which reduced to 6 (±0.6, 95% CI 5.9 to 6, minimum 4.7, maximum 9.2), p&lt;0.0001. Body weight (kg) at baseline was 78.3 (±14.2, 95% CI 76.4 to 80.2) which reduced to 70.7 (±12.8, 95% CI 69 to 72.4), &lt;0.0001. There was a significant correlation between the reduction in body weight and QRISK3 (Pearson r 0.24 95% CI 0.1 to 0.3, p=0.0004). However, the correlation between the reduction in A1c and QRISK3 (Pearson r 0.04, 95% CI -0.09 to 0.18, p=0.53 ns) was comparable. At baseline, there were 53% of participants who had low risk score (&lt;10), 28% as intermediate risk (10-20), 19% as high risk (&gt;20%) that at 1 year shifted to 67% as low risk, 23% as intermediate risk and 10% as high-risk scores. Conclusion: Incorporating the Digital Twin (DT) technology, which blends AI and IoT for tailored health guidance, our RCCT indicated significant 1-year advancements in A1c, weight, and QRISK3 scores among T2DM patients aiming for remission. The transformative potential of DT is evident, particularly in shifting a majority of participants towards lower cardiovascular risk categories.
Abstract P263: Cardiometabolic Multimorbidity Among Rural Low-Wage Workers Participating in a Worksite-Based Health Assessment
Authors: Ashley Burch, Elisabeth Lee, Paul Shackelford, Paul Bolin
Journal: Circulation (2024)

Introduction: Multimorbidity or the co-occurrence of two or more chronic conditions, is common among adults in the US and cardiometabolic multimorbidity is becoming progressively more common. Non-medical factors, such as lower educational attainment and poverty can increase a person’s risk of having cardiometabolic multimorbidity. The burden of cardiometabolic multimorbidity and its association with self-perceived health among a sample of rural, low-wage workers has not been established. Methods: Between December 2020 and August 2023, we partnered with 34 business to conduct worksite-based health screening clinics. Participants completed questionnaires, including the EQ-5D, and a physical assessment. Disease screenings included diabetes, obesity, and hypertension. Results: A total of 1128 individuals (45.1% Black, 56.7% male) were screened and included in this report. On a scale from 0 (poor health) to 100 (best health) the mean self-reported health was 78.4. On-site lab results identified 104 (9.2%) participants with an indicator of diabetes (HbA1c≥6.5), 575 participants were obese (51.0%), and 450 had a systolic blood pressure ≥ 140 (39.9%). Cardiometabolic multimorbidity was found in over a quarter of participants (28.3%, see figure). Self-perceived health differed among multimorbidity clusters. Participants with the lowest self-perceived health included those who screened positive for all three conditions (diabetes, obesity, and hypertension) (68.9), followed by those who screened positive for both diabetes and obesity (72.4), and those with only obesity (76.3). Participants without any positive screens had the highest health score (81.5). Conclusion: Of the 1128 individuals screened, over a quarter of participants screened positive for cardiometabolic multimorbidity. An additional 40.3% of the sample screened positive for one of the chronic conditions. Self-perceived health was associated with cardiometabolic multimorbidity; obesity appears to be an important factor in this relationship.
Abstract MP57: Universal and Targeted Lipid Screening in Youth Living With Overweight or Obesity
Authors: Corinna Koebnick, Xia Li, Margo A Sidell, Poornima S Kunani
Journal: Circulation (2024)

Background: Current NHLBI Expert Panel guidelines recommend universal screening once between 9-11 years and, again, between 17-21 years. Targeted screening is recommended for 2 years and older with a) obesity, or b) overweight AND personal or family history of obesity-related co-morbidities. The present study compares compliance with current lipid screening guidelines by race/ethnicity and socioeconomic status (SES). Methods: Using electronic health record data for n=300,776 youth between 2 and 17 years of age from Kaiser Permanente Southern California and a BMI-for-age &gt;=85 th percentile, HR for the ordering of a lipid screening according to the current guidelines were calculated for both, universal screening and targeted screening at any age for children living with obesity with and without comorbid conditions such as diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD) and adjusted for age, sex, BMI-for-age class (overweight, moderate obesity between 95 th and 1.2 x 95 th percentile, obesity &gt;= 1.2 x 95 th percentile of BMI-for-age), and comorbid conditions (diabetes, hypertension, and NAFLD). Results: The average age of the cohort was 8.6 (SD 5.7) years with 49.4% Hispanic, 25.0% White, 7.3% Black, and 9.3% Asian/Pacific Islander youth, 19.8% with state-subsidized insurance. Of these, 13.2 of youth lived with obesity between 95 th and 1.2 x 95 th percentile, and 5.2% &gt;= 1.2 x 95 th percentile of BMI-for-age. For 43.1% of youth, a universal lipid screening was ordered as recommended. The aHR for universal screening was 1.23 (1.21-1.26) for Hispanic, 1.15 (1.11-1.19) for Black, 1.27 (1.23, 1.31) for Asian/PI youth compared to white youth, 1.05 (1.03-1.07) for youth with state-subsidized insurance compared to those without. Among youth living with obesity, targeted screening was ordered as recommended for 38.1% of youth with 23.8%, 68.1%, and 61.6% for 2-8, 9-17, and 15-17 year olds respectively. The aHR for targeted screening was 1.58 (1.58-1.61) for youth living with obesity &gt;= 1.2 x 95 th percentile of BMI-for-age compared to those between 95 th and 1.2 x 95 th percentile, 1.08 (1.06-1.10) for youth with state-subsidized insurance compared to those without, 1.57 (1.49-1.65) for youth with diabetes, and 1.11 (1.04-1.20) for youth with NAFLD compared to those without. The aHR for targeted screening did not vary by race/ethnicity. Conclusions: In this integrated health care system, universal and targeted screening missed about 50% of youth living with overweight or obesity. While universal screening rates were higher for minority youth and lower SES, targeted screening rates were driven by obesity severity and comorbid conditions than race or SES.