Socioeconomic status during childhood and health status in adulthood: the Wrocław growth study

It has been widely observed that socioeconomic status (SES) is associated with frequency of cardiovascular disease. Both men and women of low socioeconomic position have increased risk of cardiovascular disease morbidity and premature death. In this study the relationship between SES in childhood, and health status at the age of 50 years was examined. Socioeconomic status in childhood was measured using objective (father's educational level and number of children in the family) and subjective (self-assessed SES in childhood declared in early adulthood) indicators. Data from the Wroclaw Growth Study were completed when subjects were 50 years old, and information concerning health status was added. The results indicated that the objective, universally used measures of SES in childhood such as father's educational level and size of family did not show any essential relationships with health outcomes in adulthood, both for men and women. By contrast, retrospective, self-assessed SES (as better, average or worse as compared with peers) in childhood was significantly associated with the appearance of cardiovascular disease among women aged 50 years. Women who at the beginning of their adult life declared better socioeconomic condition in childhood were significantly healthier at the age of 50 years (OR=3.43; p=0.02). Moreover, this appeared to be independent of BMI, SES and life-style in adulthood. For men, retrospective self-assessed SES showed no relation to health status at the age of 50 years. The gender differences in the relationships between self-assessed SES in childhood and health status in adulthood are explained by possible selective premature mortality among men from lower childhood SES and/or sex differences in cognitive abilities.     

Framingham risk score and alternatives for prediction of coronary heart disease in older adults

Background

Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS.

Methods

Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization.

Results

During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS.

Conclusions

The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.     

Prediction of Risk Factors for Coronary Heart Disease Using Framingham Risk Score in Korean Men

Background

Currently, there is sparse data available on the relationship between coronary heart disease (CHD) and its risk factors estimated by the Framingham Risk Score (FRS) in Korea. This is particularly true when looking at risk factors of CHD associated with the FRS after adjustment for other covariates especially in healthy subjects.

Methodology/Principal Findings

We conducted a prospective cohort study to examine the association between the risk factors of CHD and the risk for CHD estimated by FRS in 15,239 men in 2005 and 2010. The FRS is based on six coronary risk factors: gender, age, total cholesterol, high-density lipoprotein (HDL)-cholesterol, systolic blood pressure (BP), and smoking habit. Multiple linear regression analysis was used to analyze the relationships between the FRS and risk factors for CHD. This study reported that apolipoproetein B (apoB), apoA-I, apoB/apoA-I, alcohol intake, log-transformed TG, log-transformed hsCRP, LDL-cholesterol, hypertension, diabetes, regular exercise, and BMI were significantly associated with the FRS. Above all, the partial R-square of apoB was 14.77%, which was overwhelmingly bigger than that of other variables in model V. This indicated that apoB accounted for 14.77% of the variance in FRS.

Conclusion/Significance

In this study, apoB was found to be the most important determinant for the future development of CHD during a 5-year follow-up in healthy Korean men.     

β3-Adrenergic receptor Trp64Arg polymorphism does not predict incident CHD or carotid intima-media thickness in a community-based sample of whites: the ARIC study

The beta3-adrenergic receptor (beta3-AR) is expressed in adipose tissue and plays a significant role in controlling energy expenditure through the regulation of lipolysis and thermogenesis. The possible clinical importance of the beta3-AR Trp64Arg polymorphism has prompted us to investigate the association between it and the extent of atherosclerosis and risk of incident coronary heart disease (CHD). The ability of the beta3-AR Trp64Arg polymorphism to predict the extent of atherosclerosis and incident CHD has been evaluated in participants of the Atherosclerosis Risk in Communities (ARIC) study. Incident CHD cases (n=271) were compared with a stratified random sample of the ARIC cohort (n=700). Comparisons were also made between a group with increased intimamedia thickness (IMT) of the carotid artery walls, but without prevalent CHD (n=324), and a thin-walled control group (n=407). The frequency of the Arg64 allele was 0.081 and 0.069 in the incident CHD cases and cohort sample, respectively, and 0.062 and 0.057 in the IMT cases and thin-walled controls, respectively. Comparison of incident CHD cases and the cohort sample by Cox proportional hazards modeling indicated that the Arg64 allele was not a significant predictor of incident CHD, either alone (RR=0.99, P=0.98) or after inclusion of body mass index (BMI) and fasting insulin and glucose measurements (RR=1.02, P=0.93). A comparison of IMT cases and thin-walled controls by multivariate logistic regression analysis suggested that the Arg64 allele was not a significant predictor of carotid artery intima-media thickness when evaluated alone (OR=1.32, P=0.29) or after BMI and fasting insulin and glucose measurements were added to the model (OR=1.28, P=0.35). We infer that the beta3-AR Trp64Arg polymorphism is not a major predictor of atherosclerosis or incident CHD in this sample of middle-aged white Americans.     

Independent effects of social position and parity on body mass index among Polish adult women

This study evaluated the strength of the independent effects of social position (expressed by educational level) and number of childbirths on body mass index (BMI) variation of Polish adult females. The material comprised 2045 pre-menopausal women aged 35-50, who were healthy and occupationally active inhabitants of the city of Wroc?aw, Lower Silesia, Poland. Two-way analysis of variance (ANOVA) revealed that both educational level (F = 34.7; p = 0.0001) and parity (F = 5.6; p = 0.001) exerted independent significant effects on BMI. The mean BMI of women who had attended basic vocational or trade school at the very most (27.0 kg/m2) was greater than that of women who had completed secondary school education or had graduated from university (25.3 kg/m2). However, it is worthy of note that there were no social differences in BMI values between childless women. Nevertheless, an increasing number of childbirths was essentially related to increasing female BMI in each social group, and this tendency was most marked among women of lower social position. Regardless of educational level, the highest prevalence of obesity (BMI exceeding 30 kg/m2) was found among females with at least three children (15.6%, and 26.4% of women from higher or lower social groups, respectively).     

Salivary hormone concentrations in mothers and fathers becoming parents are not correlated

A time- and date-matched set of saliva samples (N = 229) from nine couples first expecting, and then caring for, their first child were used to test whether hormone changes in the father could be predicted by the hormonal status of the mother. Testosterone, cortisol, and estradiol were quantified from saliva. Neither testosterone nor estradiol concentration was correlated within couples before or after the birth, although there was a positive correlation for cortisol concentration in the mother and father before the birth. As the hormone that might be influenced by chemical signals, that already played a similar role in men and women, and that had been empirically linked to paternal behavior, cortisol concentration was also compared with sex steroid concentrations. The mother's cortisol concentration was positively correlated to the father's testosterone concentration, and the mother's testosterone concentration was positively correlated with the father's cortisol concentration. However, both effects were similar in magnitude to the cortisol to cortisol correlation, and all could parsimoniously be explained by similar responses to a shared environment. Thus, this analysis rejects parallels in peripheral hormone concentrations of estradiol, testosterone, and cortisol in mothers and fathers. However, the available data were not able to test or reject hypotheses about local neuroendocrine homology, nor to control for masking effects of other hormonal demands on men and women, nor to determine the relative importance of shared environment versus mother-father signaling.     

Women Up, Men Down: The Clinical Impact of Replacing the Framingham Risk Score with the Reynolds Risk Score in the United States Population

Background

The Reynolds Risk Score (RRS) is one alternative to the Framingham Risk Score (FRS) for cardiovascular risk assessment. The Adult Treatment Panel III (ATP III) integrated the FRS a decade ago, but with the anticipated release of ATP IV, it remains uncertain how and which risk models will be integrated into the recommendations. We sought to define the effects in the United States population of a transition from the FRS to the RRS for cardiovascular risk assessment.

Methods

Using the National Health and Nutrition Examination Surveys, we assessed FRS and RRS in 2,502 subjects representing approximately 53.6 Million (M) men (ages 50–79) and women (ages 45–79), without cardiovascular disease or diabetes. We calculated the proportion reclassified by RRS and the subset whose LDL-C goal achievement changed.

Results

Compared to FRS, the RRS assigns a higher risk category to 13.9% of women and 9.1% of men while assigning a lower risk to 35.7% of men and 2% of women. Overall, 4.7% of women and 1.1% of men fail to meet newly intensified LDL-C goals using the RRS. Conversely, 10.5% of men and 0.6% of women now meet LDL-C goal using RRS when they had not by FRS.

Conclusion

In the U.S. population the RRS assigns a new risk category for one in six women and four of nine men. In general, women increase while men decrease risk. In conclusion, adopting the RRS for the 53.6 million eligible U.S. adults would result in intensification of clinical management in 1.6 M additional women and 2.10 M fewer men.     

Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial.

This evaluation of the Multiple Risk Factor Intervention Trial database investigated the effects of dietary PUFA on disease outcomes that may relate to polyunsaturated fatty acid (PUFA) biochemistry. The Multiple Risk Factor Intervention Trial was a randomized clinical trial in coronary heart disease (CHD) primary prevention involving 12,866 middle-aged men determined to be at high risk of CHD. They were assigned to either a special intervention group or a usual care group and returned to clinics on an annual basis for assessment of risk factor status. Only data on the usual care men (n = 6,250) are presented, since the multi-intervention effects on the special intervention group introduce considerable analytic complexities. Mean PUFA intake estimates were calculated from four dietary recall interviews at baseline and follow-up Years 1, 2, and 3 and estimates for PUFA were established using absolute grams, percentage of total kilocalories, and ratios. Proportional hazards regression analysis controlling for age, race and baseline diastolic blood pressure, smoking, high and low density lipoprotein cholesterol levels, and alcohol was used to analyze dietary PUFA intakes on 10.5-year mortality rates. Results were more significant when PUFA were expressed as percentage of total kilocalories. No significant associations with mortality were detected for linoleic acid (18:2n-6), the predominant dietary PUFA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Waist-to-hip ratio and woman's education level as predictors of breastfeeding duration

The possible existence of a relationship between breastfeeding duration, educational status and waist-hip ratio (WHR) as a measure of fertility and biological fitness in a sample of the Polish population is examined in this article. Data on age, height, weight, waist and hip circumferences, educational level (as a proxy for socio-economic status), and duration of breast feeding were collected for women using questionnaires in 11 outpatients' surgeries for healthy children, and in 5 general practices in three districts of Wroclaw, Poland. An ordinal multinominal linear model with logit link was used to determine the extent to which duration of lactation was influenced by maternal WHR and level of education. The best single predictor for the duration of lactation was WHR. While WHR decreases according to increasing duration of lactation for mothers with university or high school education, no such differences were observed among women at the lowest level of education. This study confirms the greater biological fitness of women with low WHR in the Polish population, and shows that this is mediated by level of educational attainment of the women.     

Musculoskeletal capacity of middle-aged women and men in physical, mental and mixed occupations. A 3.5-year follow-up

The musculoskeletal capacity of 44 women and 39 men, mean age 55.0 +/- 3.4 years, was studied at the beginning and end of a 3.5 year period. The measurements included anthropometrics, maximal isometric trunk flexion and extension strength, maximal isometric hand grip strength and back mobility. According to a job analysis the subjects were divided into three dominating work groups: physical, mental and mixed groups. The results showed significant changes in anthropometrics, maximal isometric muscle strength and in mobility. The body weight and body mass index among women and the body mass index among men increased significantly during the period. The body height and sum of the skinfolds had on the other hand decreased significantly for both women and men. Women showed significant decreases of 9% and 10% (p less than 0.05 and p less than 0.01) in isometric trunk flexion and extension strength, and an increase of 9% in back mobility (p less than 0.05). In mental work, most of the significant changes occurred among women. Men had significant decreases in isometric trunk flexion and extension, 22% and 16% respectively (p less than 0.001) and an increase of 13% in back mobility (p less than 0.001). The men doing physical work had most of the significant changes in musculoskeletal capacity. The results revealed accelerated changes in musculoskeletal capacity in middle-aged employees.     

Obesity as Assessed by Body Adiposity Index and Multivariable Cardiovascular Disease Risk

To assess the role of body adiposity index (BAI) in predicting cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, in comparison with body mass index (BMI), waist circumference (WC), and the waist circumference to hip circumference ratio (WHR). This study was a prospective 15 year mortality follow-up of 4175 Australian males, free of heart disease, diabetes and stroke. The Framingham Risk Scores (FRS) for CHD and CVD death were calculated at baseline for all subjects. Multivariable logistic regression was used to assess the effects of the measures of obesity on CVD and CHD mortality, before adjustment and after adjustment for FRS. The predictive ability of BAI, though present in the unadjusted analyses, was generally not significant after adjustment for age and FRS for both CVD and CHD mortality. BMI behaved similarly to BAI in that its predictive ability was generally not significant after adjustments. Both WC and WHR were significant predictors of CVD and CHD mortality and remained significant after adjustment for covariates. BAI appeared to be of potential interest as a measure of % body fat and of obesity, but was ineffective in predicting CVD and CHD.     

Postprandial triacylglycerol responses in simulated night and day shift: gender differences.

A number of reports suggest that shift workers have an increased risk of coronary heart disease (CHD). One contributing factor may be the consumption of meals at night with consequent altered postprandial responses. This study investigated circulating triacylglycerol (TAG), a possible risk factor for CHD, after meals during a simulated day and night shift. Twenty-five healthy participants (10 women and 15 men) were studied. They were given a pre-meal at 0800 h and a test meal at 1330 h on a simulated day shift and then an identical pre-meal at 2000 h and test meal at 0130 h, respectively, on a simulated night shift with maintained wakefulness. Blood was sampled for 9 h after the test meal for analysis of basal and postprandial plasma TAG levels. ANOVA for repeated measures indicated higher TAG in men compared with women (p < 0.0001) and higher responses at night in both genders (p = 0.027). Incremental area under the curve (IAUC) analysis indicated that men had significantly increased postprandial TAG levels at night compared with the day: (IAUC 0-540 min, mean +/- SEM) 253.29 +/- 28.73 versus 148.33 +/- 17.28 mmol/L x min, respectively, p = 0.025. In women, night and day responses (61.16 +/- 8.93 versus 34.09 +/- 7.87 mmol/L x min, respectively, p = 0.457) were not significantly different. Circulating TAG remained elevated for longer at night in the men compared with the women (p = 0.009). This study demonstrates the existence of gender and time-of-day differences in TAG responses to a meal. These raised TAG levels at night, for a prolonged time in men, may be relevant to the increased risk of CHD in shift workers.     

Social Mobility and Mental Disorders at 30 Years of Age in Participants of the 1982 Cohort,Pelotas, Rio Grande Do Sul – RS

This study aimed to evaluate the relationship between mental disorders at 30 years of age and social mobility by formally testing three hypotheses: Risk Accumulation; Critical Period; and Social Mobility. The study was performed using data from the 30-year follow-up of the Pelotas Birth Cohort Study, conducted in 1982, and data from previous follow-ups. The tool used to evaluate mental health was the Self Report Questionnaire (SRQ-20). For the statistical analysis, the chi-square test with the Yates correction was used to estimate the prevalence of mental disorder, and the Poisson regression with robust variance was used to formally test the hypotheses according to the Risk Accumulation, Critical Period and Social Mobility Models. The analyses were stratified by gender. The prevalence of Common Mental Disorders (CMDs) was 24.3% (95% CI 22.9–25.7) when the whole sample was considered. The highest prevalence, 27.1% (95% CI 25.1–29.2), was found in women, and the difference between genders was significant (p < 0.001). CMDs were more frequent in participants who remained “poor” in the three follow-ups. In both men and women, the best fit was obtained with the Risk Accumulation Model, with p = 0.6348 and p = 0.2105, respectively. The results indicate the need to rethink public income maintenance policies. Finally, we suggest further studies to investigate the role of different public policies in decreasing the prevalence of mental disorders and thus contribute proposals of new policies that may contribute to the prevention of these disorders.     

Association of tocopherols with circulating autoantibody levels against an oxidized DNA nucleoside in humans

Autoantibodies against oxidized DNA bases are found in vivo and have been used as an indicator of oxidative damage, yet little is known concerning their individual variation and relation to serum micronutrients. Human plasma anti-5-hydroxymethyl-2'-deoxyuridine (HMdU) autoantibody (aAb) levels were repeatedly determined in 41 women and 11 men, and found to have small within-individual variation over time, but large between-individual differences. A positive association in both women (r = .5762, p = .0001) and men (r = .415, p = .2) between plasma total tocopherols and antibody levels was observed. Autoantibody levels were lower in postmenopausal women (8.37 +/- 1.61 vs. 17.18 +/- 2.85 in premenopausal women, p < .01), independently of plasma tocopherol. However, aAb titers in postmenopausal women were still significantly associated with plasma tocopherol levels and adjustment for menopausal status in women yielded a highly significant correlation between HMdU aAb levels and total tocopherol (r = .7342, p = .0001). Plasma malondialdehyde equivalents (MDA), a measure of lipid peroxidation, were also higher in individuals with either high plasma alpha-tocopherol or high beta+gamma-tocopherol levels. The positive association of tocopherols with markers of oxidative damage may reflect a response to the generation of endogenous oxidants associated with enhanced immune function. The decrease in aAb level in postmenopausal women may similarly reflect decreased immune function associated with decreased estrogen levels.     

Inter-generational educational advancement and body height

This study investigates the association between body height and inter-generational social advancement through education. Questionnaire data were collected from 2800 students (1023 men and 1777 women) from the universities of Wroclaw, Poland. The questions referred to three generations: the students and their parents and grandparents. Information was collected on the age, body height and weight of the students and their parents, and on the parents' and grandparents' education. The lowest body heights were typically found for individuals from families with the lowest educational levels, whereas the greatest body heights were found for those brought up in families with a high educational status or in families who had upgraded their status. The size of the change in the educational level of parents is only associated with fathers' and female students' body height. Individuals who had advanced from a middle educational level or who came from families with this type of advancement were found to be significantly taller, on average, than those upgrading their educational level from the lowest position. The results show that, for men, educational advancement during the course of their lives or in the earlier generation is more favourable to achieving higher stature, whereas for women, the multi-generational tradition of a high educational status is of greater significance.     

Polygyny and fertility differentials among the Yoruba of western Nigeria

Data are analysed from the 1973 surveys of the Nigerian segment of the Changing African Family (CAFN) Project, which covered Yoruba women and men in Ibadan and the Western State of Nigeria. Of the 5874 women who were in union during the CAFN 1 survey, 54% reported that their husband had only 1 wife and 46% that their husband had more than 1 wife. Of the 1234 women in unions in the CAFN 2 survey, 49% reported monogamous husbands and 51% polygynous husbands. Differentials in fertility levels between women in monogamous unions and those in polygynous ones are investigated using mean number of children ever born as the measure of fertility. Factors examined include proportion of childless and infertile women, frequency of intercourse, age, educational level, religion, marital mobility (divorce) rank of wife and sexual abstinence. The CAFN 1 survey shows that wives of polygynists tend to be older than those of monogamists. Because of this the reported mean number of children ever born was higher for the wives of polygynists than for the wives of monogamists. When the data are standardized for the difference in age, the fertility levels of the women in the 2 types of unions were much closer to each other. When religion, education, abstinence, and occupation are also taken into account, it is observed that the 2 groups of women have similar levels of fertility. A multiple classification analysis was performed using number of wives of husband, educational level, religion and father's occupation as variables and occupation of spouse, place of birth, length of abstinence, contraceptive practice and age as covariates. The result also shows that the number of wives of the husband does not significantly affect the fertility level of women when other factors are taken into account. A high proportion of the Yoruba women are in polygynous unions and most of those in monogamous unions are potential wives of polygynists. Because of this, and particularly because most women try to have as many children as they can, the women in the 2 types of unions experience similar levels of fertility.     

Gender differences in health-related quality of life among healthy aged and old-aged austrians: Cross-sectional analysis

Background: Although they experience lower mortality rates and lower rates of several chronic diseases than do their male counterparts, aging women are more likely to experience functional impairment in mobility and a general diminished health-related quality of life (HRQoL). The determinants of these gender differences have been the subject of controversy.Objective: This study analyzed gender differences in HRQoL in relation to social and biomedical factors such as age, marital status, educational level, and living arrangements.Methods: Participants were recruited via snowball sampling. All were healthy and lived independently in private homes. Data were obtained from personal interviews, based on a 30-item questionnaire, in the private homes of the participants. Additionally, HRQoL was assessed by means of the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) 26-item questionnaire, which contains 1 general health item, 1 general QoL item, and 24 specific items covering 4 broad domains: physical (DOM I), psychological (DOM II), social (DOM III), and environmental (DOM IV).Results: The participants (98 women, 62 men) enrolled in the study ranged in age from 57 to 95 years (mean [SD] age: 71.8 [8.6] years). The younger age group (aged 57-70 years) comprised 54 women and 25 men, and the older age group (aged >70 years) comprised 44 women and 37 men. Women aged ≤70 years rated their health and QoL significantly higher than did men in the same age group (P = 0.02). These women rated physical capacity (DOM I), social relationships (DOM III), and environment (DOM IV) higher, but not statistically significantly different, than did same-aged men. Women and men exhibited nearly identical psychological health (DOM II) values. Physical capacity (DOM I) differed significantly between women and men aged >70 years (P = 0.03). Women aged >70 years rated their QoL lower than their male counterparts did, although not significantly so. These women depended more on medical treatment, felt significantly less safe in everyday life (P = 0.03), and were less satisfied with themselves.The results of the multiple regression analyses suggest that gender may have a significant impact on general QoL for both age groups (P < 0.01 for the younger age group; P > 0.04 for the older age group). In these analyses, gender also had a significant impact on 2 domains, physical capacity and social relationships (P < 0.02 for both domains), among the participants of the younger age group.Conclusion: Depending on the age group (≤70 vs >70 years) in this small sample of Austrian women and men, gender influenced HRQoL.     

Number of siblings, family background, and the process of educational attainment

The effects of number of siblings on educational attainment were analyzed in probability samples of 57,000 white men in the US. Also addressed was the relative importance of sibship size compared with father's education, father's socioeconomic status, farm background, and a broken family. The data revealed a marked linear association between sibsize and total years of education. The difference between the extremes of sibsize was more than double the racial difference and 3 times the age difference. Sibsize operates not simply by diluting parental economic resources for postsecondary education, but by impinging on education at the graded level. Males from large versus small families lose an average of 1 year of graded schooling, which implies large differences in proportions graduating from high school. Sibsize influences college attendance much less than it influences graded schooling; at higher levels of education, IQ, performance, and motivation are more decisive factors. Whereas father's education and sibsize are the most important determinants of total years of education and years of graded schooling, college schooling is more dependent on the father's socioeconomic status than other family background variables.     

The relationship between quality of life, binge-eating disorder, and obesity status in an ethnically diverse sample

This study examined the relationship between obesity status, binge-eating disorder (BED), and quality of life (QOL) in a large, ethnically diverse community sample of adult men and women. Using data from the Collaborative Psychiatric Epidemiological Surveys (N = 20,013), individuals were categorized into four groups: nonobese with BED (n = 142), nonobese without BED (n = 14,301), obese with BED (n = 136), and obese without BED (n = 4,863). Results indicated obese individuals with BED consistently reported the poorest QOL. Findings suggested that obesity status was more strongly related to physical health-related QOL variables (e.g., number of physical conditions, mobility impairment) whereas diagnostic status was more predictive of mental health and social functioning QOL variables (e.g., cognitive impairment, social interaction impairment, time out of role). The degree to which lifetime BED diagnosis was associated with impairment in social interaction differed across ethnic groups. For black individuals, the number of physical health conditions was associated with BED presence moreso than weight status.