Ethnic and sex variations in overweight self-perception: relationship to sedentariness

Objective: With increasing frequency, health promotion messages advocating physical activity are claiming weight loss as a benefit. However, messages promoting physical activity as a weight loss strategy may have limited effectiveness and cross‐cultural relevance. We recently found self‐perceived overweight to be a more robust correlate of sedentary behavior than BMI in Los Angeles County adults. In this study, we examined ethnic and sex differences in overweight self‐perception and their association with sedentariness in this sample. Research Methods and Procedures: We conducted bivariate and multivariate analyses of cross‐sectional survey data from a representative sample of Los Angeles County adults. Results: Women were more likely to perceive themselves to be overweight than men overall (73.2% of overweight/non‐obese and 24.1% of average weight women vs. 44.5% of overweight/non‐obese and 5.6% of average weight men) and within each ethnic group. African‐Americans were least likely (41.3% of overweight/non‐obese African‐Americans self‐identified as overweight) and whites were most likely to consider themselves overweight (60.6% of overweight/non‐obese whites self‐identified as overweight). Overweight (vs. average weight) self‐perception was correlated with sedentariness among average weight adults (45.3% vs. 33.0%, p < 0.001), overweight adults (43.4% vs. 33.6%, p < 0.001), men (average and overweight: 38.4% vs. 27.8%, p < 0.001), overweight whites (41.9% vs. 29.7%, p = 0.0012), and African‐Americans and Latinos (41.6% vs. 33.9%, p = 0.005). Discussion: These data suggest that our society's emphasis on weight loss rather than lifestyle change may inadvertently discourage physical activity adoption/maintenance among non‐obese individuals. However, further research is needed, particularly from prospective cohort and intervention studies, to elucidate the relationship between overweight self‐perception and healthy lifestyle change.     

Adiposity in Childhood Is Related to C‐Reactive Protein and Adiponectin in Young Adulthood: From the Bogalusa Heart Study

To determine the association between cardiovascular (CV) risk factors in childhood and high‐sensitivity C‐reactive protein (hsCRP) and adiponectin in adulthood, 835 eligible white and African‐American young adult subjects (age range 24–42 years, average 34 years, 43% men, 31% African Americans) who had CV risk‐factor variable data from their childhood (20 years earlier, age range 5–18 years, average 14 years) were selected. Stepwise linear regression models revealed that mean logarithmic hsCRP level in adulthood was 0.02 greater with every increase of 1 mm in skinfold thickness in childhood, 0.25 greater for African Americans than whites, 0.36 greater for girls than boys, and 0.15 greater for every unit increase in BMI z score. Mean logarithmic adiponectin level in adulthood was 0.36 greater for girls than boys, 0.22 greater for whites than African Americans, and 0.01 less with every increase of 1 mm of childhood skinfold thickness. Seventy participants (8%) were overweight or obese in their childhood, and 64 of these (91%) remained obese in their young adulthood. In conclusion, childhood adiposity and African‐American race were associated with higher hsCRP and lower adiponectin levels in their adulthood. Skinfold thickness and BMI z score in childhood were the main obesity determinants for higher hsCRP and lower adiponectin levels in young adulthood.     

Additive Interactions of Maternal Prepregnancy BMI and Breast‐feeding on Childhood Overweight

Objective: To examine the interactions of maternal prepregnancy BMI and breast‐feeding on the risk of overweight among children 2 to 14 years of age. Research Methods and Procedures: The 1996 National Longitudinal Survey of Youth, Child and Young Adult data in the United States were analyzed (n = 2636). The weighted sample represented 51.3% boys, 78.0% whites, 15.0% blacks, and 7.0% Hispanics. Childhood overweight was defined as BMI ≥95th percentile for age and sex. Maternal prepregnancy obesity was determined as BMI ≥30 kg/m². The duration of breast‐feeding was measured as the weeks of age from birth when breast‐feeding ended. Results: After adjusting for potential confounders, children whose mothers were obese before pregnancy were at a greater risk of becoming overweight [adjusted odds ratio (OR), 4.1; 95% confidence interval (CI), 2.6, 6.4] than children whose mothers had normal BMI (<25 kg/m²; p < 0.001 for linear trend). Breast‐feeding for ≥4 months was associated with a lower risk of childhood overweight (OR, 0.6; 95% CI, 0.4, 1.0; p = 0.06 for linear trend). The additive interaction between maternal prepregnancy obesity and lack of breast‐feeding was detected (p < 0.05), such that children whose mothers were obese and who were never breast‐fed had the greatest risk of becoming overweight (OR, 6.1; 95% CI, 2.9, 13.1). Discussion: The combination of maternal prepregnancy obesity and lack of breast‐feeding may be associated with a greater risk of childhood overweight. Special attention may be needed for children with obese mothers and lack of breast‐feeding in developing childhood obesity intervention programs.     

Lifestyle factors and incident mobility limitation in obese and non-obese older adults

Objective: This study examines the association between incident mobility limitation and 4 lifestyle factors: smoking, alcohol intake, physical activity, and diet in well‐functioning obese (n = 667) and non‐obese (n = 2027) older adults. Research Methods and Procedures: Data were from men and women, 70 to 79 years of age from Pittsburgh, PA and Memphis, TN, participating in the Health, Aging and Body Composition (Health ABC) study. In addition to individual lifestyle practices, a high‐risk lifestyle score (0 to 4) was calculated indicating the total number of unhealthy lifestyle practices per person. Mobility limitation was defined as reported difficulty walking 1/4 mile or climbing 10 steps during two consecutive semiannual assessments over 6.5 years. Results: In non‐obese older persons, significant risk factors for incident mobility limitation after adjustment for socio‐demographics and health‐related variables were current and former smoking [hazard ratio (HR) = 1.51; 95% confidence interval (CI), 1.20 to 1.89; HR = 1.40; 95% CI, 1.12 to 1.74), former alcohol intake (HR = 1.30; 95% CI, 1.05 to 1.60), low and medium physical activity (HR = 1.78; 95% CI, 1.45 to 2.18; HR = 1.29, 95% CI, 1.07 to 1.54), and eating an unhealthy diet (HR = 1.57; 95% CI, 1.17 to 2.10). In the obese, only low physical activity was associated with a significantly increased risk of mobility limitation (HR = 1.44; 95% CI, 1.08 to 1.92). Having two or more unhealthy lifestyle factors was a strong predictor of mobility limitation in the non‐obese only (HR = 1.98; 95% CI, 1.61 to 2.43). Overall, obese persons had a significantly higher risk of mobility limitation compared with non‐obese persons, independent of lifestyle factors (HR = 1.73; 95% CI, 1.52 to 1.96). Conclusions: These results underscore the importance of a healthy lifestyle for maintaining function among non‐obese older adults. However, a healthy lifestyle cannot overcome the effect of obesity in obese older adults; this stresses the importance of preventing obesity to protect against mobility loss in older persons.     

Total and Central Obesity among Elderly Hispanics and the Association with Type 2 Diabetes

Objective: To report the prevalence of total and central obesity in a representative sample of Puerto Rican and Dominican elders in Massachusetts, to compare them with a neighborhood‐based group of non‐Hispanic white elders, and to examine associations of obesity indices with the presence of type 2 diabetes. Research Methods and Procedures: We examined the prevalence of overweight, obesity, and central obesity in 596 Hispanics of Caribbean origin, ages 60 to 92 years, and 239 non‐Hispanic whites, and tested linear and logistic regression models to determine associations among body mass index (BMI), waist circumference (WC), and diabetes. Results: Obesity (BMI ≥ 30 kg/m²) was prevalent among all ethnic groups, ranging from 17% to 29% for Dominican and Puerto Rican men, respectively, and from 29% to 40% for non‐Hispanic white and Dominican women, respectively. These differences were not statistically significant. Among Hispanic men and women, diabetes was prevalent across all BMI and WC categories but tended to be greatest among those with BMI of 25 to 29 kg/m² (41% to 43%). In contrast, diabetes was most prevalent in the obese group (36% to 45%) of non‐Hispanic whites. Both BMI and WC were associated with the presence of diabetes, but the coefficients were greater for non‐Hispanic whites than for Hispanics. Discussion: Caribbean Hispanics and non‐Hispanic whites living in the same Massachusetts localities had high prevalences of overweight and obesity. Total and central obesity exerted a differential effect on the presence of diabetes among ethnic groups; for Hispanics, diabetes was prevalent even among non‐obese individuals, whereas for non‐Hispanic white women, the prevalence of diabetes was strongly associated with total and central obesity. Additional research is needed to investigate the factors associated with the differential effect of obesity on the prevalence of type 2 diabetes among Hispanic and non‐Hispanic white elders.     

Management of Obesity: A Challenge for Medical Training and Practice

Health‐care providers are in a unique position to encourage people to make healthy lifestyle choices. However, lifestyle modification counseling is a complex task, made even more so by the cultural and socioeconomic diversity of patient populations. The objective of this study is to evaluate the prevalence and predictors of attending and physician‐in‐training weight control counseling in an urban academic internal medicine clinic serving a unique low‐income multiethnic high‐risk population. In 2006, patients (n = 256) from the Associates in Internal Medicine clinic (Division of General Medicine at the New York Presbyterian Hospital, Columbia University Medical Center, New York, NY) were recruited and completed a questionnaire, which assessed demographic variables, health conditions, access to health‐care services, physician weight control counseling, and weight loss attempts. Seventy‐nine percent of subjects were either overweight or obese. Only 65% of obese subjects were advised to lose weight. Attending physicians were more likely than physicians‐in‐training to counsel subjects on weight control (P < 0.01). Factors that were significantly (P < 0.05) associated with different types of weight control counseling included obesity, cardiovascular disease (CVD) risk factors, female gender, nonblack race, college education, married status, and attending physician. Subjects advised to lose weight were more likely to report an attempt to lose weight (P < 0.01). Rates of weight control counseling among physicians are suboptimal, particularly among physicians‐in‐training. Training programs need to promote effective clinical obesity prevention and treatment strategies that address socioeconomic, linguistic, and cultural factors.     

Workplace Health Promotion: Assessing the Cardiopulmonary Risks of the Construction Workforce in Hong Kong

Objective

Health needs of different employee subgroups within an industry can differ. We report the results of a workplace cardiopulmonary risk assessment targeting workers and support staff in the construction industry.

Methods

A free worksite-based cardiopulmonary risk assessment for 1,903 workers on infrastructural contracts across Hong Kong was initiated in May 2014. Cardiopulmonary risk screening was performed in 60-minute blocks for approximately 30 workers/block with individualized feedback and lifestyle counseling. Risk profiles stratified by occupational roles are differentiated using the χ²-test for categorical and Student’s t-test for continuous variables.

Results

Most construction workers and clerks/professionals were male (83.2% and 71.2%, respectively) and Chinese (78.7% and 90.9%, respectively). Construction workers were older (mean: 44.9 years, SD 11.5) and less well-educated (6.1% received tertiary education) than clerks/professionals (35.0 years, 10.7; 72.6% received tertiary education), but more likely to be hypertensive (22.6% vs. 15.4%, p<0.001), overweight/obese (71.7% vs. 56.6%, p<0.001), centrally obese (53.1% vs. 35.5%, p<0.001), and have undesirable levels of high-density lipoprotein (41.6% vs. 35.8%, p<0.05) and diabetic levels of non-fasting blood glucose (4.3% vs. 1.6%, p<0.05). Up to 12.6% of construction workers and 9.7% of office clerks/professions had three or more metabolic syndrome risk factors. While construction workers were more likely than clerks/professionals to be daily smokers, they reported better work-related physical activity and diet.

Conclusions

Simple worksite health risk screening can identify potentially high-cardiopulmonary-risk construction industry employee subgroups for onward confirmatory referral. Separate cardiopulmonary health promotion strategies that account for the varying lifestyle profiles of the two employee subgroups in the industry appear justified.     

The impact of a delayed sleep–wake schedule on depression is greater in women – A web-based cross-sectional study in Japanese young adults

Sleep-related problems, such as symptoms of insomnia, daytime sleepiness, shorter sleep duration, or a delayed sleep–wake schedule, are known to be risk factors for depression. In general, depression is more prevalent in women than in men, but sleep-related problems do not necessarily show similar gender predominance. Hence, it can be speculated that the impact of sleep-related problems on the development process of depression differs between genders; however, so far, few studies have focused on this issue. The aim of this study was to clarify gender differences in the rates of depression of people with the above sleep-related problems, and to examine gender differences in factors associated with depression in Japanese young adults. A web-based questionnaire survey comprising assessments of demographic variables, sleep-related variables (bed time, wake time, sleep onset latency, frequency of difficulty in initiating sleep and that in maintaining sleep, i.e. symptom components of insomnia, and daytime sleepiness), and the 12-item version of the Center for Epidemiologic Studies Depression Scale was administered to 2502 participants (males:females?=?1144:1358, age range?=?19–25 years). Female predominance in the rate of depression was observed only in subjects with a delayed sleep–wake schedule (χ²₍₁₎?=?15.44, p?<?0.001). In men, daytime sleepiness and difficulty in initiating sleep were significantly associated with depression (odds ratio [OR]?=?2.39, 95% confidence interval [CI]?=?[1.69, 3.39], p?<?0.001; OR?=?3.50, 95% CI?=?[2.29, 5.35], p?<?0.001, respectively), whereas in women, significant associations were found between depression and a delayed sleep–wake schedule (OR?=?1.75, 95% CI?=?[1.28, 2.39], p?<?0.001), daytime sleepiness (OR?=?2.13, 95% CI?=?[1.60, 2.85], p?<?0.001), and difficulty in initiating sleep (OR?=?4.37, 95% CI?=?[3.17, 6.03], p?<?0.001). These results indicate that in younger generations, the impact of a delayed sleep–wake schedule on the development of depression is greater in women; specifically, women are vulnerable to depression when they have an eveningness-type lifestyle, which is possibly attributable to the female-specific intrinsic earlier and shorter circadian rhythm. These results suggest the necessity of gender-based approaches to treating sleep-related problems for alleviating or preventing depressive symptoms in young adults.     

Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: A randomized controlled trial

Objective:

Optimizing gestational weight gain (GWG) in early pregnancy is of clinical and public health importance, especially in higher risk pregnancies.

Design and Methods:

In a robustly designed, randomized controlled trial, 228 pregnant women at risk of developing gestational diabetes mellitus (GDM) were allocated to either control (written health information only) or intervention (four‐session lifestyle program). All women received standard maternal care. Measures were completed at 12‐15 and 26‐28 weeks gestation. Measures included anthropometrics (weight and height), physical activity (pedometer and International Physical Activity Questionnaire), questionnaires (risk perception), and GDM screening.

Results:

The mean (SD) age [31.7 (4.5) and 32.4 (4.7) years] and body mass index [BMI; 30.3 (5.9) and 30.4 (5.6) kg/m²] were similar between control and intervention groups, respectively. By 28 weeks, GWG was significantly different between control and intervention groups [6.9 (3.3) vs. 6.0 (2.8) kg, P < 0.05]. When stratified according to baseline BMI, overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [7.8 (3.4) vs. 6.0 (2.2) kg, P < 0.05], yet in obese women, GWG was similar in both groups. Physical activity levels declined by 28 weeks gestation overall (P < 0.01); however, the intervention group retained a 20% higher step count compared to controls [5,203 (3,368) vs. 4,140 (2,420) steps/day, P < 0.05]. Overall, GDM prevalence was 22%, with a trend toward less cases in the intervention group (P = 0.1).

Conclusions:

Results indicate that a low‐intensity lifestyle intervention, integrated with antenatal care, optimizes healthy GWG and attenuates physical activity decline in early pregnancy. Efficacy in limiting weight gain was greatest in overweight women and in high‐risk ethnically diverse women.     

Age-Dependent Influence of Gender on the Association Between Obesity and a Cluster of Cardiometabolic Risk Factors

BackgroundObesity is a main risk factor in metabolic syndrome. Gender is known to influence the risk of obesity and other cardiovascular risk factors. However, it remains to be determined whether there is a gender-specific difference in the relationship between obesity and accumulation of other cardiometabolic risk factors such as hypertension, dyslipidemia, and diabetes.ObjectiveThe aim of this study was to determine whether the association between obesity and a cluster of other cardiometabolic risk factors is modified by gender.MethodsThe subjects were 17,791 Japanese men and women who were divided into younger (35–40 years) and older (60–70 years) age groups. The relationships between obesity (body mass index [BMI] ≥25 kg/m² or waist-to-height ratio [WHtR] ≥0.5) and multiple cardiometabolic risk factors (≥2 of the risk factors of high blood pressure, dyslipidema, and hyperglycemia) were compared between men and women in each age group.ResultsIn the younger group, the crude odds ratios (ORs) for multiple cardiometabolic risk factors in obese versus nonobese subjects were significantly higher in women than in men (BMI: 6.23 [range, 5.53–7.02] in men vs 16.63 [range, 12.37–22.37] in women, P < 0.01; WHtR: 6.04 [range, 5.36–6.81] in men vs 9.77 [range, 7.14–13.37] in women, P < 0.01), whereas this difference was not found in the older group (BMI: 3.03 [range, 2.69–3.42] in men vs 2.92 [range, 2.33–3.67] in women P = 0.076; WHtR: 3.11 [range, 2.78–3.47] in men vs 2.50 [range, 2.02–3.09] in women, P < 0.05). On multivariate logistic regression analysis, the ORs for multiple cardiometabolic risk factors after adjusting for age, smoking, alcohol consumption, and regular exercise in subjects with versus subjects without a large waist circumference tended to be higher in women than in men in the younger group but not in the older group. The ORs of the interaction term consisting of gender and each adiposity index for multiple cardiometabolic risk factors were significantly higher than a reference level of 1.00 in the younger group (BMI: 2.68 [range, 1.95–3.69], P < 0.01; WHtR: 1.62 [range, 1.16–2.27], P < 0.01) but not in the older group (BMI: 0.95 [range, 0.74–1.23], P = 0.712; WHtR: 0.80 [range, 0.63–1.02], P = 0.066).ConclusionThe results suggest that the association between obesity and a cluster of cardiometabolic risk factors is stronger in women than in men, and this gender-specific difference exists in younger (35–40 years) but not in older (60–70 years) individuals.     

CMV seropositivity and T‐cell senescence predict increased cardiovascular mortality in octogenarians: results from the Newcastle 85+ study

Although chronic infection with cytomegalovirus (CMV) is known to drive T lymphocytes toward a senescent phenotype, it remains controversial whether and how CMV can cause coronary heart disease (CHD). To explore whether CMV seropositivity or T‐cell populations associated with immunosenescence were informative for adverse cardiovascular outcome in the very old, we prospectively analyzed peripheral blood samples from 751 octogenarians (38% males) from the Newcastle 85+ study for their power to predict survival during a 65‐month follow‐up (47.3% survival rate). CMV‐seropositive participants showed a higher prevalence of CHD (37.7% vs. 26.7%, P = 0.030) compared to CMV‐seronegative participants together with lower CD4/CD8 ratio (1.7 vs. 4.1, P < 0.0001) and higher frequencies of senescence‐like CD4 memory cells (41.1% vs. 4.5%, P < 0.001) and senescence‐like CD8 memory cells (TEMRA, 28.1% vs. 6.7%, P < 0.001). CMV seropositivity was also associated with increased six‐year cardiovascular mortality (HR 1.75 [1.09–2.82], P = 0.021) or death from myocardial infarction and stroke (HR 1.89 [107–3.36], P = 0.029). Gender‐adjusted multivariate Cox regression analysis revealed that low percentages of senescence‐like CD4 T cells (HR 0.48 [0.32–0.72], P < 0.001) and near‐senescent (CD27 negative) CD8 T cells (HR 0.60 [0.41–0.88], P = 0.029) reduced the risk of cardiovascular death. For senescence‐like CD4, but not near‐senescent CD8 T cells, these associations remained robust after additional adjustment for CMV status, comorbidities, and inflammation markers. We conclude that CMV seropositivity is linked to a higher incidence of CHD in octogenarians and that senescence in both the CD4 and CD8 T‐cell compartments is a predictor of overall cardiovascular mortality as well as death from myocardial infarction and stroke.     

Clinical Profile and Management of Patients With Hypertension and Chronic Ischemic Heart Disease According to BMI

Obesity is associated with numerous risk factors and comorbidities such as hypertension, metabolic syndrome, type 2 diabetes, and cardiovascular diseases. However, numerous studies have reported an obesity paradox; the overweight and obese patients with established cardiovascular disease have better prognosis than those with a BMI <25 kg/m². This study was designed to assess potential differences in the clinical profile and management of hypertensive outpatients with chronic ischemic heart disease in obese and lean patients that could explain these two apparently contradictory points. Overweight and obesity were defined as a BMI 25–29.9 kg/m² and ≥30 kg/m², respectively. Cardiovascular risk factors goals were considered according to European Society of Hypertension‐European Society of Cardiology 2003, National Cholesterol Education Program Adult Treatment Panel III and American Diabetes Association 2005 guidelines. A sample of 2,024 patients (66.8 ± 10.1 years; 31.7% women) was included. Of these, 0.1% had a BMI <20 kg/m²; 17.1% BMI 20–24.9 kg/m²; 53.7% BMI 25–29.9 kg/m²; 23.7% BMI 30–34.9 kg/m²; 4.3% BMI 35–39.9 kg/m²; and 1.1% BMI ≥40 kg/m². The subgroup of patients with BMI ≥30 kg/m² had a higher proportion of women, diastolic dysfunction, diabetes, dyslipidemia, left ventricular hypertrophy, and heart failure. There was an inverse relationship between risk factors control rates and BMI (all comparisons BMI 20–24.9 kg/m² vs. 25–29.9 kg/m² vs. ≥30 kg/m²): blood pressure (BP) control (51.7% vs. 42.4% vs. 29.2%, P < 0.001); low‐density lipoprotein cholesterol (LDL‐C) control (35.2% vs. 30.5% vs. 27.9%, P = 0.03) and diabetes control (38.6% vs. 27.6% vs. 22.2%, P = 0.023). In conclusion, in patients with hypertension and chronic ischemic heart disease, as BMI increases, the clinical profile worsens as well as risk factors control rates.     

Development and validation of robust metabolism-related gene signature in the prognostic prediction of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours worldwide. Given metabolic reprogramming in tumours was a crucial hallmark, several studies have demonstrated its value in the diagnostics and surveillance of malignant tumours. The present study aimed to identify a cluster of metabolism-related genes to construct a prediction model for the prognosis of HCC. Multiple cohorts of HCC cases (466 cases) from public datasets were included in the present analysis. (GEO cohort) After identifying a list of metabolism-related genes associated with prognosis, a risk score based on metabolism-related genes was formulated via the LASSO-Cox and LASSO-pcvl algorithms. According to the risk score, patients were stratified into low- and high-risk groups, and further analysis and validation were accordingly conducted. The results revealed that high-risk patients had a significantly worse 5-year overall survival (OS) than low-risk patients in the GEO cohort. (30.0% vs. 57.8%; hazard ratio [HR], 0.411; 95% confidence interval [95% CI], 0.302–0.651; p < 0.001) This observation was confirmed in the external TCGA-LIHC cohort. (34.5% vs. 54.4%; HR 0.452; 95% CI, 0.299–0.681; p < 0.001) To promote the predictive ability of the model, risk score, age, gender and tumour stage were integrated into a nomogram. According to the results of receiver operating characteristic curves and decision curves analysis, the nomogram score possessed a superior predictive ability than conventional factors, which indicate that the risk score combined with clinicopathological features was able to achieve a robust prediction for OS and improve the individualized clinical decision making of HCC patients. In conclusion, the metabolic genes related to OS were identified and developed a metabolism-based predictive model for HCC. Through a series of bioinformatics and statistical analyses, the predictive ability of the model was approved.     

Comparison of Cardiovascular Risk Factors in Obese Blacks and Whites

Blacks are known to have higher blood pressure levels, a higher prevalence of hypertension, and higher body weights than whites. However, the interrelationships of these and other cardiac risk factors have not been analyzed in an obese population. We compared blood pressure (BP) and lipid levels in 174 obese blacks and 939 obese white patients who were entering a weight loss program; we also assessed the effects of weight loss on these factors. Prevalence of treated hypertension was similar in blacks and whites (28% vs. 25%, respectively). In patients not taking BP medication, black women weighed more (108 kg) than white women (102 kg) and black and white males' weights were similar (135 kg vs. 131 kg). Systolic and diastolic BP were similar in black and white women; black males had similar SBP but a significantly lower DBP than white males (83 mmHg vs. 89 mmHg, respectively). Lipid levels were similar in black and white women except black women had lower triglycerides (1.30 mmol/L) than white women (1.58 mmol/L, p<0.05); and black males compared to white males had significantly lower total cholesterol (4.76 mmol/L vs. 5.56 mmol/L), LDL-cholesterol (3.15 mmol/L vs. 3.52 mmol/L) and triglycerides (1.31 mmol/L vs. 2.17 mmol/L, p<0.05). Adult-onset obesity adversely affected a number of cardiovascular risk factors in whites, but not in blacks. Blacks lost significantly less weight (?13 kg) than whites (?19 kg). However, controlling for the difference in weight loss, blacks sustained comparable improvement in lipids and blood pressure, except for TC/HDL-C (whites improved significantly more, ?0.36 kg/m2, than blacks, 0.03 kg/m2). Thus, the impact of obesity on cardiovascular risk factors seems ameliorated in blacks com-pared to whites.     

Relationships of BMI to Cardiovascular Risk Factors Differ by Ethnicity

The burden of cardiovascular risk associated with obesity disproportionately affects African Americans and little is known about ethnic/racial differences in the relationship of obesity to cardiometabolic risk. This report assesses whether obesity is similarly associated with cardiometabolic risk factors in African Americans and whites of European ancestry. Cross‐sectional observational data from the Jackson Heart Study (JHS) and the Framingham Heart Study (FHS) were compared. This analysis uses participants aged 35–74 years with BMI >18.5 kg/m², and free of prevalent cardiovascular disease (CVD), from the initial JHS clinical examination (2000–2004) and the FHS Offspring (1998–2001) and Third Generation (2002–2005) cohorts. Participants were evaluated for the presence of lipid abnormalities, hypertension, and diabetes. Overall, 4,030 JHS (mean age 54 years, 64% women) and 5,245 FHS (mean age 51 years, 54% women) participants were available for analysis. The prevalence of all risk factors except high triglycerides and low high‐density lipoprotein (HDL) was substantially higher in JHS (all P < 0.001) and BMI was associated with increasing prevalence of most CVD risk factors within each race. For diabetes mellitus, hypertension, and low HDL, steeper relationships to BMI were observed in FHS than in JHS (P values <0.001–0.016). There were larger proportional increases in risk factor prevalence with increasing BMI in whites than in African Americans. The higher prevalence rates of cardiometabolic risk factors at nearly all levels of BMI in African Americans, however, suggest that additional factors contribute to the burden of CVD risk in African Americans.     

Prepregnancy Obesity and Risk of Stillbirth in Viable Twin Gestations

We sought to estimate the impact of prepregnancy obesity on demise of one or both fetuses in twin gestations. We performed a retrospective cohort study using the Missouri maternally linked cohort files (years 1989–2005). Prepregnancy obesity was defined as a BMI ≥30. Outcomes of interest were stillbirth (intrauterine fetal death at ≥20 weeks' gestation) and demise of one (partial loss) or both (complete loss) fetuses, regardless of the cause. We used Cox Proportional Hazards with correction for intracluster correlation to obtain risk estimates. The overall stillbirth rate for twin gestations was 15.5/1,000 (18.4/1,000 vs. 14.5/1,000 in obese and normal weight mothers, respectively; P = 0.02). The rate for complete fetal loss was higher in obese mothers (8.3/1,000 vs. 5.6/1,000; P = 0.01) but was comparable for partial fetal loss (19.1/1,000 for obese vs. 16.3/1,000 for normal weight mothers; P = 0.1). Adjusted estimates confirmed these findings (adjusted hazards ratio (AHR) and 95% confidence interval (CI) = 1.31 (1.02–1.68) for stillbirth; AHR = 1.59; CI = 1.01–2.51) for complete loss; and AHR = 1.21; CI = 0.91–1.62) for partial loss. Subanalysis conducted on stillbirth showed that the risk associated with obesity was only elevated for same‐sex (AHR = 1.54; CI = 1.15–2.04) but not opposite‐sex twins (0.99; CI = 0.56–1.75). Our findings may find utility in counseling of obese women with twin gestations.     

Disparities among 2009 Pandemic Influenza A (H1N1) Hospital Admissions: A Mixed Methods Analysis – Illinois,April–December 2009

During late April 2009, the first cases of 2009 pandemic influenza A (H1N1) (pH1N1) in Illinois were reported. On-going, sustained local transmission resulted in an estimated 500,000 infected persons. We conducted a mixed method analysis using both quantitative (surveillance) and qualitative (interview) data; surveillance data was used to analyze demographic distribution of hospitalized cases and follow-up interview data was used to assess health seeking behavior. Invitations to participate in a telephone interview were sent to 120 randomly selected Illinois residents that were hospitalized during April–December 2009. During April–December 2009, 2,824 pH1N1 hospitalizations occurred in Illinois hospitals; median age (interquartile range) at admission was 24 (range: 6–49) years. Hospitalization rates/100,000 persons for blacks and Hispanics, regardless of age or sex were 2–3 times greater than for whites (blacks, 36/100,000 (95% Confidence Interval ([95% CI], 33–39)); Hispanics, 35/100,000 [95%CI,32–37] (; whites, 13/100,000[95%CI, 12–14); p<0.001). Mortality rates were higher for blacks (0.9/100,000; p<0.09) and Hispanics (1/100,000; p<0.04) when compared with the mortality rates for whites (0.6/100,000). Of 33 interview respondents, 31 (94%) stated that they had heard of pH1N1 before being hospitalized, and 24 (73%) did not believed they were at risk for pH1N1. On average, respondents reported experiencing symptoms for 2 days (range: 1–7) before seeking medical care. When asked how to prevent pH1N1 infection in the future, the most common responses were getting vaccinated and practicing hand hygiene. Blacks and Hispanics in Illinois experienced disproportionate pH1N1 hospitalization and mortality rates. Public health education and outreach efforts in preparation for future influenza pandemics should include prevention messaging focused on perception of risk, and ensure community wide access to prevention messages and practices.     

COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease

BackgroundData regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited.ObjectivesTo compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF.MethodsRetrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated.ResultsAmong 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54–74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11–1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31–1.74] vs. OR 1.04 [95% CI 0.90–1.20], p_interaction <0.001).ConclusionsCo-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).     

Factors associated with early atherosclerosis and arterial calcifications in young subjects with a benign phenotype of obesity

We assessed (i) the association between early arterial disease and factors linked to adiposity, dietary habits, and family in a young cohort of 151 obese children and adolescents with less than or equal to one cardiovascular (CV) risk factor, (ii) whether in subjects with carotid calcifications there was an imbalance of calcium‐phosphorus homeostasis. Measurement included: carotid ultrasound, oral glucose tolerance test, anthropometry, body composition, dietary history, white blood cells count, lipids, uric acid, adiponectin, insulin, C‐reactive protein, plasminogen activator inhibitor 1 (PAI‐1), 25‐hydroxyvitamin D, parathyroid hormone (PTH), calcium and phosphorus. Obese children with carotid artery intima media thickness (cIMT) values >75° percentile (0.55 mm), compared to those with lower cIMT, were more obese, more often pubertal and had higher prevalence of family history of CV disease (CVD) (P < 0.05), higher plasma PAI‐1 and uric acid (P < 0.001) and lower adiponectin (P < 0.05) and high‐density lipoprotein (HDL) cholesterol levels (P < 0.05). After adjustment for sex, age, puberty, obesity, and insulin levels, only PAI‐I remained significantly different between the two groups (10.9 (7.2–29.8) vs. 6.2 (4.3–10.6) ng/ml, P < 0.001). Dietary intake did not affect cIMT values. Eight percent of subjects showed nonatherosclerotic carotid calcifications with patchy pattern. These children had a worse lipid profile (P < 0.05) and higher plasma PTH levels (48.6 ± 21.5 vs 38.5 ± 16.9 pg/ml, P < 0.05) that were inversely associated with 25‐hydroxyvitamin D levels (r = 0.245, P < 0.01). Present results suggest that (i) several adiposity‐related factors may play a role in promoting the development of early arterial diseases in young subjects with a benign phenotype of obesity, (ii) a PTH rise resulting from a subclinical imbalance in calcium‐phosphorus homeostasis may affect the biological process of vascular calcifications.     

BMI and Cervical Cancer Screening among White,African‐American,and Hispanic Women in the United States

Objectives: We examined cervical cancer screening by BMI in white, African‐American, and Hispanic women and explored women's reasons for not undergoing screening. Research Methods and Procedures: We used logistic regression to examine Pap testing in the preceding 3 years across BMI groups for white (n = 6419), African‐American (n = 1715), and Hispanic women (n = 1859) age 18 to 75 years who responded to the 2000 National Health Interview Survey. We used bivariable analyses to describe women's reasons for not undergoing testing and examined whether unscreened women received physician recommendations for screening. Results: Of 12, 170 women, 50% were normal weight, 26% were overweight, and 21% were obese. The proportion who reported Pap testing in the last 3 years was 86% in whites, 88% in African Americans, and 78% in Hispanics. After adjustment for sociodemographics, health care access, and illness burden, severely obese white women (BMI = 40+ kg/m²) were significantly less likely to undergo Pap testing (relative risk, 0.92; 95% CI, 0.83 to 0.99) compared with normal weight women. BMI was not associated with screening in African Americans or Hispanics. A higher proportion of obese white women than normal weight women cited putting off the test or embarrassment or discomfort as the primary reason for not undergoing screening. Among the unscreened, obese women were as likely as normal weight women to receive a physician recommendation to undergo screening. Discussion: Disparities in cervical cancer screening by body weight persist for white women with severe obesity. Disparities were not explained by differences in the rate of physician recommendations for screening, but obese white women may be more likely to delay screening or to find screening painful, uncomfortable, or embarrassing than normal weight white women. Efforts to increase screening among obese women should address women's reservations about screening.