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Summary: Background: Limited research on alanine aminotransferase (ALT) screening for metabolic dysfunction‐associated steatotic liver disease (MASLD) among US Asian/Pacific Islander (PI) children necessitates investigation in this heterogeneous population. Objective: Examine ALT elevation among Asian/PI children with overweight or obesity. Methods: Elevated ALT prevalence (clinical threshold) and association with body mass index ≥85th percentile were compared among 18 402 Asian/PI and 25 376 non‐Hispanic White (NHW) children aged 9–17 years using logistic regression. Results: ALT elevation was more prevalent among Asian/PI (vs. NHW) males with overweight (4.0% vs. 2.7%), moderate (7.8% vs. 5.3%) and severe obesity (16.6% vs. 11.5%), and females with moderate (5.1% vs. 3.0%) and severe obesity (10.2% vs. 5.2%). Adjusted odds of elevated ALT were 1.6‐fold and ~2‐fold higher for Asian/PI (vs. NHW) males and females (with obesity), respectively. Filipino, Chinese and Southeast Asian males had 1.7–2.1‐fold higher odds, but Native Hawaiian/PI (NHPI) and South Asian males did not significantly differ (vs. NHW). Filipina and Chinese females with obesity had >2‐fold higher odds, Southeast and South Asian females did not differ and NHPI findings were mixed (vs. NHW). Conclusion: High elevated ALT prevalence among Asian/PI children with overweight and obesity emphasizes the need for MASLD risk assessment and examination of ethnic subgroups. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Patients are being encouraged to complete forms electronically using patient portals rather than on paper, but willingness of older adults to make this transition is uncertain. METHODS: The authors analyzed data for 4105 Kaiser Permanente Northern California 2020 Member Health Survey respondents aged 65-85 years who answered a question about willingness to complete online forms and questionnaires using a patient portal. Data weighted to the Kaiser Permanente Northern California membership were used to estimate percentages of older adults willing to complete patient portal forms and questionnaires. Chi-square tests and log-Poisson regression models that included sociodemographic, internet use, and patient portal variables were used to identify factors predictive of willingness. RESULTS: Overall, 59.6% of older adults were willing to complete patient portal forms, 17.6% were not willing, and 22.8% were not sure. Adults aged 75-85 (49.5%) vs 65-74 years (64.8%) and Black (51.9%) and Latino (46.5%) vs White (62.8%) adults were less likely to indicate willingness. In addition to racial and ethnic differences and younger age, higher educational attainment, use of the internet alone (vs internet use with help or not at all), having an internet-enabled computer or tablet, and having sent at least 1 message through the patient portal increased likelihood of being willing. CONCLUSIONS: Health care teams should assess older adults' capabilities and comfort related to completion of patient portal-based forms and support those willing to make the digital transition. Paper forms and oral collection of information should remain available for those unable or unwilling to make this digital transition. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Bone mineral density (BMD) and fracture risk calculators (eg, the Fracture Risk Assessment Tool [FRAX]) guide primary prevention care in postmenopausal women. BMD scores use non-Hispanic White (NHW) reference data for T-score classification, whereas FRAX incorporates BMD, clinical risk factors, and population differences when calculating risk. This study compares findings among Asian, Black, and NHW women who underwent osteoporosis screening in a US health care system. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Asian, Black, and NHW women aged 65 to 75 years who underwent BMD testing (with no recent fracture, osteoporosis therapy, metastatic cancer, multiple myeloma, metabolic bone disorders, or kidney replacement therapy) were compared across the following measures: femoral neck BMD (FN-BMD) T-score (normal --1, osteoporosis --2.5), high FRAX 10-year hip fracture risk (FRAX-Hip 3%), FRAX risk factors, and diabetes status. RESULTS: Among 3640 Asian women, 23.8% had osteoporosis and 8.7% had FRAX-Hip scores of at least 3% (34.5% among those with osteoporosis). Among 11,711 NHW women, 12.3% had osteoporosis and 17.2% had FRAX-Hip scores of at least 3% (84.8% among those with osteoporosis). Among 1711 Black women, 68.1% had normal FN-BMD, 4.1% had BMD-defined osteoporosis, and 1.8% had FRAX-Hip scores of at least 3% (32.4% among those with osteoporosis). Fracture risk factors differed by group. Diabetes was 2-fold more prevalent in Black and Asian (35% and 36%, respectively) vs NHW (16%) women. CONCLUSIONS: A large subset of Asian women have discordant BMD and FRAX scores, presenting challenges in osteoporosis management. Furthermore, FN-BMD and especially FRAX scores identified few Black women at high fracture risk warranting treatment. Studies should examine whether fracture risk assessment can be optimized in understudied racial minority populations, particularly when findings are discordant. [ABSTRACT FROM AUTHOR]

Abstract Background Women with history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes within 5 years after delivery. Evidence that lactation duration influences incident type 2 diabetes after GDM pregnancy is based on one retrospective study reporting a null association. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM pregnancy (SWIFT) is a prospective cohort study of postpartum women with recent GDM within the Kaiser Permanente Northern California (KPNC) integrated health care system. The primary goal of SWIFT is to assess whether prolonged, intensive lactation as compared to formula feeding reduces the 2-year incidence of type 2 diabetes mellitus among women with GDM. The study also examines whether lactation intensity and duration have persistent favorable effects on blood glucose, insulin resistance, and adiposity during the 2-year postpartum period. This report describes the design and methods implemented for this study to obtain the clinical, biochemical, anthropometric, and behavioral measurements during the recruitment and follow-up phases. Methods SWIFT is a prospective, observational cohort study enrolling and following over 1, 000 postpartum women diagnosed with GDM during pregnancy within KPNC. The study enrolled women at 6-9 weeks postpartum (baseline) who had been diagnosed by standard GDM criteria, aged 20-45 years, delivered a singleton, term (greater than or equal to 35 weeks gestation) live birth, were not using medications affecting glucose tolerance, and not planning another pregnancy or moving out of the area within the next 2 years. Participants who are free of type 2 diabetes and other serious medical conditions at baseline are screened for type 2 diabetes annually within the first 2 years after delivery. Recruitment began in September 2008 and ends in December 2011. Data are being collected through pregnancy and early postpartum telephone interviews, self-administered monthly mailed questionnaires (3-11 months postpartum), a telephone interview at 6 months, and annual in-person examinations at which a 75 g 2-hour OGTT is conducted, anthropometric measurements are obtained, and self- and interviewer-administered questionnaires are completed. Discussion This is the first, large prospective, community-based study involving a racially and ethnically diverse cohort of women with recent GDM that rigorously assesses lactation intensity and duration and examines their relationship to incident type 2 diabetes while accounting for numerous potential confounders not assessed previously.

The article presents a study on the differences in the proximal humerus and wrist fracture incidence among Asian American subgroups as compared to non-Hispanic White (NHW) adults. Also cited are the use of the log-Poisson regression method in the research, and the sex-specific proximal humerus fracture incidence rate ratios (IRR) in terms of race and ethnicity of the subjects.

Background: Dementia risk is lower for US Asian adults in aggregate compared to non‐Hispanic White (NHW) adults. However, examining Asian adults in aggregate masks subgroup heterogeneity as previously reported, including higher risk and slightly higher risk among 6210 Filipino and 4478 Japanese adults, respectively, and non‐significantly lower risk among 197 South Asian adults compared to 8384 Chinese adults (Mayeda, et al. PMID 28406845). We build on this prior work by examining sex‐specific dementia incidence in an expanded contemporary cohort of US Asian/Pacific Islander (PI) and NHW adults in the same integrated healthcare delivery system. Methods: Among 479,250 NHW adults and 34,222 Chinese, 34,637 Filipino, 9,355 Japanese, 6,246 South Asian, 3,913 Vietnamese, 2,779 Korean, 2,343 Native Hawaiian/PI (NHPI), and 14,967 other/ethnicity‐unspecified Asian/PI members of a northern California health plan aged ≥65 years in 2010‐2019 (with five years prior membership and without prior dementia), incident dementia up to 2022 was identified by hospital, institutional stay, ambulatory (or virtual care) encounter diagnoses. Race and ethnicity were obtained from self‐reported data sources. Dementia incident rate ratios (IRR) were examined using log‐Poisson regression, adjusting for 5‐year age group and calendar year. Results: Among 479,250 (54.9% female) NHW and 108,462 (54.4% female) Asian/PI adults, mean age at entry was 70.4±7.1 and 69.3±6.1 years and mean follow‐up 7.6±4.0 and 7.4±3.9 years, respectively. Overall, 12.0% of NHW and 8.7% of Asian/PI adults developed incident dementia. Among men, dementia IRRs (reference: NHW) were significantly lower for Asian men in all subgroups but higher for NHPI men (Figure 1). Among women, dementia IRRs were significantly lower for Chinese and Japanese women, but not Filipina, Vietnamese, Korean, South Asian, and NHPI women (Figure 2). NHPI, Filipino and Japanese men and NHPI, Filipina, South Asian, Vietnamese, and Korean women had significantly higher incidence of dementia than Chinese counterparts (Table). Conclusion: This study further characterizes the heterogeneity in dementia diagnosis incidence among Asian/PI subgroups, including sex‐specific differences. Further research is needed to identify environmental, social, clinical, and genetic factors that may explain the observed heterogeneity in dementia risk among Asian/PI ethnicities, which could inform interventions aimed to improve healthy brain aging for everyone. [ABSTRACT FROM AUTHOR]

Background: Asian and Pacific Islander (Asian/PI) adults have lower hip fracture incidence than non‐Hispanic White (NHW) adults, but data regarding Asian/PI subgroups are limited. We compared hip fracture incidence among older US Asian/PI and NHW populations, including ethnic subgroup differences. Methods: Using observational data from a California healthcare system, we identified Asian/PI and NHW adults aged ≥50 years (2000–2019) and followed subjects to 2021 for hip fracture determined by principal/primary hospital diagnosis or by secondary hospital diagnosis with hip/femur procedure codes. Age‐adjusted hip fracture incidence was calculated with 95% confidence intervals (CIs). Log‐Poisson regression was used to determine fracture incidence rate ratios (IRRs, [CI]; NHW or Chinese as reference) adjusting for age and year. Results: Among 215,359 Asian/PI and 776,839 NHW women, hip fracture incidence was 1.34 (1.28–1.40) and 2.97 (2.94–3.01) per 1000 person‐years, respectively, with IRR 0.45 (0.43–0.47). Among 188,328 Asian/PI and 697,046 NHW men, hip fracture incidence was 0.62 (0.58–0.67) and 1.81 (1.78–1.84) per 1000 person‐years, respectively, with IRR 0.34 (0.32–0.37). For the four largest Asian/PI subgroups, Filipina women (IRR 0.85 [0.75–0.96]) had lower, and Japanese (IRR 1.36 [1.20–1.54]) and South Asian (IRR 1.36 [1.07–1.72]) women had higher hip fracture incidence compared to Chinese women. Hip fracture incidence was only higher among South Asian (IRR 1.61 [1.21–2.14]) compared to Chinese men. Conclusion: Hip fracture incidence among US Asian/PI adults was 55% (women) and 66% (men) lower than NHW adults, but incidence varied by Asian/PI subgroup. The heterogeneity among Asian/PI adults highlights the importance of examining fracture risk by ethnic subgroup. [ABSTRACT FROM AUTHOR]