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The objective of this study is to characterize suspected nonalcoholic fatty liver disease (NAFLD) using elevated alanine aminotransferase (ALT) in a diverse and nationally representative cohort of adolescents and to characterize higher ALT elevation in adolescents with obesity. Data from the National Health and Nutrition Examination Survey 2011–2018 were analyzed for adolescents 12–19 years. Participants with causes for elevated ALT other than NAFLD were excluded. Race and ethnicity, sex, body mass index (BMI), and ALT were examined. Elevated ALT was defined as >22 U/L (females) and >26 U/L (males) using the biologic upper normal limit (ULN). Elevated ALT thresholds up to 2X-ULN were examined among adolescents with obesity. Multivariable logistic regression was used to determine the association of race/ethnicity and elevated ALT, adjusting for age, sex, and BMI. Prevalence of elevated ALT in adolescents was 16.5% overall and 39.5% among those with obesity. For White, Hispanic, and Asian adolescents, prevalence was 15.8%, 21.8%, and 16.5% overall, 12.8%, 17.7%, and 27.0% in those with overweight, and 43.0%, 43.5%, and 43.1% in those with obesity, respectively. Prevalence was much lower in Black adolescents (10.7% overall, 8.4% for overweight, 20.7% for obesity). Prevalence of ALT at 2X-ULN was 6.6% in adolescents with obesity. Hispanic ethnicity, age, male sex, and higher BMI were independent predictors of elevated ALT. Prevalence of elevated ALT in U.S. adolescents is high, affecting 1 in 6 adolescents during 2011–2018. The risk is highest in Hispanic adolescents. Asian adolescents with elevated BMI may comprise an emerging risk group for elevated ALT.

Objective: There is increasing recognition that cardiovascular disease (CVD) risk factors vary by Asian subgroups. We examined CVD risk factor prevalence among Vietnamese adults in a northern California health plan.Methods: We used electronic health record data to examine smoking, overweight/obesity (body mass index ≥23.0 kg/m2), obesity (body mass index ≥27.5 kg/m2), prediabetes, diabetes, and hypertension among middle-aged (n = 12 757; aged 45-64 years) and older (n = 3418; aged 65-84 years) Vietnamese adults, including 37.8% whose preferred language was Vietnamese. Findings were compared with East Asian adults.Results: Current smoking prevalence was 20.3% for middle-aged men, 7.0% for older men, and <1% for women in both age groups. Obesity prevalence was 12.0% for older men, 17.9% for middle-aged men, and 10% for women in both age groups. Among middle-aged men and women, 20.9% and 17.0% had hypertension and 13.5% and 8.5% had diabetes, respectively. Among older men and women, 64.0% and 60.0% had hypertension and 32.8% and 29.3% had diabetes, respectively. In both age groups, Vietnamese language preference was associated with higher risk of smoking (men only) and of diabetes and hypertension (women only). Compared with East Asian adults, Vietnamese adults had lower obesity prevalence but similar prevalence of diabetes, prediabetes, and hypertension. Vietnamese men were more likely and Vietnamese women less likely than East Asian adults to be current smokers.Conclusions: Study results suggest that more research on health conditions, lifestyle, and social factors among Vietnamese American adults is needed to develop culturally competent interventions to reduce CVD risk in this growing ethnic group.

•Hypertension prevalence in Filipino adults is high, in the range of Black adults•Hypertension prevalence is higher in Filipino than White and Hispanic adults•Hypertension prevalence is higher in Filipino than South Asian and Chinese adults•These differences in prevalence are observed across age decades from ages 30 to 79

Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance at onset of pregnancy (or first recognition), affects ~4-7% of pregnancies overall (1-6). Common risk factors include nonwhite race/ethnicity, older age, obesity, [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.11.044 Byline: Kavitha T. Ram (a)(c), Paul Bobby (a), Susan M. Hailpern (b), Joan C. Lo (d), Miriam Schocken (e), Joan Skurnick (f), Nanette Santoro (c) Keywords: lactation; metabolic syndrome; parity Abstract: The objective of the study was to evaluate whether lactation duration is associated with lower prevalence of metabolic syndrome (MetSyn) in midlife, parous women. Author Affiliation: (a) Department of Obstetrics and Gynecology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (b) Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (c) Department of Obstetrics-Gynecology, Albert Einstein College of Medicine, Bronx, NY (d) Division of Research, Kaiser Permanente Northern California, Oakland, CA (e) Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA (f) Department of Preventive Medicine and Community Health, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark, NJ. Article History: Received 6 June 2007; Revised 14 September 2007; Accepted 21 November 2007 Article Note: (footnote) The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health, Department of Health and Human Services, through the National Institute on Aging, the National Institute of Nursing Research, and the National Institutes of Health Office of Research on Women's Health (Grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495)., Cite this article as: Ram KT, Bobby P, Hailpern SM, et al. Duration of lactation is associated with lower prevalence of the metabolic syndrome in midlife -- SWAN, the study of women's health across the nation. Am J Obstet Gynecol 2008;198:268.e1-268.e6.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2006.07.009 Byline: Joan C. Lo (a), Xinhua Zhao (b), Angelo Scuteri (c), Sarah Brockwell (b), MaryFran R. Sowers (d) Keywords: Diabetes mellitus; Genetics; Haplotype; 17-Hydroxysteroid dehydrogenase; Insulin sensitivity; Metabolic syndrome Abstract: We evaluated associations of insulin sensitivity, metabolic syndrome, and diabetes mellitus with single nucleotide polymorphism (SNP) variants from sex hormone biosynthesis and action in women of 4 races/ethnicities. DNA was extracted from transformed cell samples of 1,538 women in the Study of Women's Health Across the Nation (SWAN). African American, Caucasian, Chinese, and Japanese women in SWAN enrolled in the Sex Steroid Hormone Genetics Protocol from whom fasting glucose and insulin measures (for estimating insulin sensitivity), diabetes status, and metabolic syndrome classification were obtained. SNPs from the genes encoding aromatase (CYP 19), 17[beta]-hydroxysteroid dehydrogenase (17HSD) type 1, and the estrogen receptors-[alpha] (ESR1) and -[beta] (ESR2) were measured. The prevalence of metabolic syndrome was 20% in Chinese women, 22% in Japanese women, 28% in Caucasian women, and 43% in African American women. The prevalence of diabetes was 3% in Chinese women, 4% in Japanese women, 7% in Caucasian women, and 19% in African American women. Significant associations of CYP 19 genotypes and insulin sensitivity were observed in African American, Caucasian, and Japanese women. Selected ESR1 and ESR2 genotypes were associated with insulin sensitivity and metabolic syndrome only in Japanese and Chinese women. The strongest associations related 17HSD genotypes to diabetes in Caucasian women, with odds ratios ranging from 4.4 to 7.5 and confidence intervals that excluded the null value. We observed strong associations between variations in sex hormone biosynthesis and function genes with insulin sensitivity, the metabolic syndrome, and diabetes that varied by race/ethnicity. The strong association of 17HSD and diabetes in Caucasian women has not been previously reported and should be further investigated. Author Affiliation: (a) Division of Research, Kaiser Permanente Northern California, Oakland, California, USA, and Department of Medicine, University of California-San Francisco, San Francisco, California, USA (b) Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA (c) Laboratory of Cardiovascular Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA, and Unita Operativa Geriatria, Italian National Research Center on Aging, Rome, Italy (d) Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA Article Note: (footnote) The Study of Women's Health Across the Nation (SWAN) and the SWAN Repository were supported by grants from the National Institutes of Health (NIH), Department of Health and Human Services, through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women's Health (Grant Nos. AG017719, NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). The Sex Steroid Hormone Genetics Protocol was supported by the SWAN Repository. This report is based on samples from the SWAN DNA Repository. Scientists interested in developing studies based on this resource can find a description of the SWAN Core Repository and DNA Repository and information on obtaining access to the resources at www.swanrepository.org.

IMPORTANCE: Associations between retinopathy and kidney disease have been previously described. The association between the progression of retinopathy and concurrent progression of chronic kidney disease is unknown. OBJECTIVE: To assess the association between progression of retinopathy and concurrent progression of chronic kidney disease (CKD) among persons with CKD enrolled in a prospective cohort study. DESIGN, SETTING, AND PARTICIPANTS: A total of 1936 patients with chronic kidney disease enrolled in the multicenter, prospective Chronic Renal Insufficiency Cohort (CRIC) Study were invited to have 2 nonmydriatic fundus photography sessions separated by a mean (SD) of 3.5 (0.5) years. The study was conducted from May 12, 2006, to June 29, 2011. Data analysis was performed from March 16, 2016, to November 17, 2017. MAIN OUTCOMES AND MEASURES: Fundus photographs obtained at baseline and then at a follow-up at 3.5 years were reviewed by masked graders for presence and severity of retinopathy, and vessel calibers were assessed using standard protocols. The associations of the changes in retinal features with progression of CKD (50% estimated glomerular filtration rate [eGFR] loss or incident end-stage renal disease, and differences in eGFR slope in the same time period) were assessed with univariable and multivariable logistic regression models. RESULTS: Among 1583 CRIC participants who had baseline fundus photography, had additional follow-up in CRIC, and were at risk for retinopathy progression, 1025 patients (64.8%) had follow-up photography. The odds ratio (OR) for CKD progression associated with worsening of retinopathy in comparison with participants with stable retinopathy was 2.24 (95% CI, 1.28-3.91; P = .005) in univariable analysis among participants with baseline and follow-up photography. In the multivariable analysis, the OR was 1.62 (95% CI, 0.77-3.39; P = .20). The multiple imputation analysis provided similar results. CONCLUSIONS AND RELEVANCE: Progression of retinopathy appears to be associated with progression of CKD on univariable analysis but not on multivariable analysis suggesting that similar risk factors may be affecting the progression of both retinal and chronic kidney disease.

Sex steroid hormones have been linked to fractures in older women.

To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model.

Introduction:Hypertension risk increases with higher age and body mass index (BMI). We previously found that the prevalence of diagnosed hypertension among Filipino adults is similar to Black adults and higher than White, Chinese, and South Asian adults aged 45-84y. Among young women, the difference between Filipina and Chinese adults was >2-fold. We now examine disparities in hypertension prevalence across the adult lifespan, accounting for differences in weight status.Methods:This cross-sectional study used electronic health record data for 1,018,159 non-Hispanic White (White), 146,517 Black, 348,715 Hispanic, 128,124 Filipino, 126,321 Chinese, and 80,723 South Asian adults aged 30-79 who were members of a Northern California health plan in 2016. Hypertension prevalence (ICD 9/10 diagnosis in 2016) was examined by race/ethnicity and sex for ages 30-39, 40-49, 50-59, 60-69, 70-79y. Poisson regression was used to estimate prevalence ratios (aPRs) for hypertension compared to White adults in each age decade, adjusting for age, English language, current smoking, and BMI category (underweight, healthy weight, overweight, obesity class 1, 2, 3). Lower BMI thresholds were used for Asian adults.Results:Across all age decades, Filipino adults had a prevalence of hypertension similar to Black adults and higher than White, Chinese, and South Asian adults. In each age decade, the Filipino:White aPRs approached or exceeded the Black:White aPRs and were much higher than South Asian:White and Chinese:White aPRs (Figure). Differences in hypertension risk were greatest for those aged 30-59y.Conclusions:Filipino adults, similar to Black adults, had earlier onset and higher prevalence of hypertension than White, Chinese, and South Asian adults across 5 age decades, a disparity that persisted after adjusting for weight status, smoking, and language. These results support the need for earlier and more aggressive blood pressure screening in high-risk populations.

Introduction:We previously reported that Chinese, Filipino, and South Asian adults have higher prevalence of prediabetes (PreDM) than non-Hispanic White (White) adults, with nearly twice the burden in healthy BMI ranges. This study further examines the differential burden of diabetes (DM) in these Asian subgroups using Asian specific BMI categories.Methods:283,110 White, 33,263 Chinese, 38,766 Filipino, and 17,959 South Asian adults aged 45-64y in a 2016 Northern California health plan with height and weight were examined. PreDM and DM were classified based on lab data, diagnoses, or DM treatment. Modified log Poisson regression was used to determine Asian group vs. White prevalence ratios (PRs) for DM and preDM, adjusted for age and BMI within healthy weight, overweight, and obesity ranges (BMI 18.5 to <25, 23 to <30, ≥30 kg/m2 for Whites; BMI 18.5 to <23, 23 to <27.5, ≥27.5 kg/m2 for Asians).Results:Across all BMI categories, DM prevalence was higher for the Asian groups than White adults. DM prevalence was also higher for Filipino and South Asian vs White than Chinese vs White, especially at healthy BMI levels. PRs for South Asian men/women at healthy BMI were 1.8/2.8 for preDM and 5.9/8.0 for DM (Figure). PRs for Filipino men/women at healthy BMI were 1.8/2.6 for preDM and 5.0/7.5 for DM, respectively. For Chinese men/women at healthy BMI, the PRs for preDM were similar (2.1/2.9) to the other Asian groups, but the PRs for DM were lower (2.1/3.4).Conclusion:The largest difference in DM prevalence relative to White adults was observed in the healthy BMI range for South Asian and Filipino adults. While PreDM risk in these 2 groups was similar to the preDM risk in Chinese compared with White adults at healthy BMI, their DM risk was 5-8 times greater than White adults at healthy BMI. Our data emphasize the disproportionate metabolic risk among middle-aged adults of different Asian groups and underscore the need for DM screening among high-risk Asian subgroups at healthy BMI levels.

Context:Low levels of serum 25 Hydroxyvitamin D [25(OH)D] have been linked to greater fracture risk in older women.Objective:This study aimed to determine whether higher 25(OH)D is associated with slower loss of bone mineral density (BMD) and lower fracture risk during the menopausal transition.Design, Setting, and Participants:This was a prospective cohort study at five clinical centers in the United States. Mean age was 48.5 ± 2.7 years. The fracture analysis included 124 women with an incident traumatic fracture, 88 with incident nontraumatic fracture, and 1532 women without incident fractures; average followup was 9.5 years. BMD analysis included 922 women with a documented final menstrual period.Main Outcome Measures:Serum 25(OH)D was measured by liquid chromatography tandem mass spectrometry at the third annual clinic visit. BMD was measured and incident fractures ascertained at each annual visit.Results:The mean 25(OH)D was 21.8 ng/mL; seven-hundred two (43%) of the women had 25(OH)D values <20 ng/mL. There was no significant association between 25(OH)D and traumatic fractures. In multivariate adjusted hazards models, the hazard ratio (HR) for nontraumatic fractures (95% confidence interval [CI]) was 0.72 (0.54–0.96) for each 10-ng/mL increase in 25(OH)D. Comparing women whose 25(OH)D was ≥20 vs <20 ng/mL, the HR (95% CI) for fracture was 0.54 (0.32–0.89). Changes in lumbar spine and femoral neck bone mineral density across menopause were not significantly associated with serum 25(OH)D level.Conclusion:Serum 25(OH)D levels are inversely associated with nontraumatic fracture in mid-life women. Vitamin D supplementation is warranted in midlife women with 25(OH)D levels <20 ng/mL.

Integrated guidelines on cardiovascular health and risk reduction in children issued in 2011 newly recommended universal screening for dyslipidemia in children at 9 to 11 years and 17 to 21 years.

This study examined rates and determinants of vitamin D supplementation among Chronic Renal Insufficiency Cohort (CRIC) participants and determined the association between dose and 25-hydroxyvitamin D (25(OH)D) level. The 2010 Institute of Medicine Report noted a significant increase in vitamin D supplementation in the general population, but use in chronic kidney disease (CKD) is unknown.

Bone turnover markers (BTMs) predict fracture in older women, whereas data on younger women are lacking. To test the hypothesis that BTMs measured before and after menopause predict fracture risk, we performed a cohort study of 2,305 women.

OBJECTIVE To investigate the association between retinopathy and chronic kidney disease. METHODS In this observational, cross-sectional study, 2605 patients of the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter study of chronic kidney disease, were offered participation. Nonmydriatic fundus photographs of the disc and macula in both eyes were obtained in 1936 of these subjects. The photographs were reviewed in a masked fashion at a central photograph reading center using standard protocols. Presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed by trained graders and a retinal specialist using protocols developed for large epidemiologic studies. Kidney function measurements and information on traditional and nontraditional risk factors for decreased kidney function were obtained from the CRIC study. RESULTS Greater severity of retinopathy was associated with lower estimated glomerular filtration rate after adjustment for traditional and nontraditional risk factors. The presence of vascular abnormalities usually associated with hypertension was also associated with lower estimated glomerular filtration rate. We found no strong direct relationship between estimated glomerular filtration rate and average arteriolar or venular calibers. CONCLUSIONS Our findings show a strong association between severity of retinopathy and its features and level of kidney function after adjustment for traditional and nontraditional risk factors for chronic kidney disease, suggesting that retinovascular pathology reflects renal disease.

Background

Introduction:Prevalence of polycystic ovary syndrome (PCOS) and diabetes (DM), two cardiometabolic conditions (CMCs), vary by ethnicity in Asian women. Hypertension (HTN) also varies by ethnicity, but this has not been well studied in young Asian women with CMCs. We examined whether HTN diagnosis (Dx) in Asians varies by ethnicity, independent of body mass index (BMI), PCOS and DM.Methods:We used electronic health record data from a large US health plan to examine prevalence of HTN (≥2 Dx) in a cohort of 19,258 Chinese, 23,213 Filipina, and 19,108 South Asian women aged 21-44 years for whom BMI, PCOS (≥2 Dx) and DM (≥2 Dx + DM treatment) were ascertained. The associations of ethnicity and CMCs with HTN were examined using multivariable logistic regression.Results:Prevalence of HTN was 2% among Chinese and South Asian and 8% among Filipina women. Across all ethnic groups, compared to women with no CMCs, HTN prevalence was highest among those with DM and somewhat higher among those with PCOS and obesity. For all CMCs, Filipinas had the highest HTN prevalence (Figure). Adjusting for age, smoking, BMI, CMCs, and ethnicity, the odds of HTN were higher for Filipinas (2.6; CI 2.3-2.9) and slightly lower for South Asians (0.9; CI 0.7-0.98) compared to Chinese women; DM was associated with 4.7-fold higher odds (CI 4.1-5.3) and PCOS 1.4-fold higher odds (CI 1.1-1.8) of HTN.Conclusion:In young Asian women, DM, PCOS and obesity are associated with greater HTN burden. Compared to Chinese women, Filipinas have higher odds and South Asian women lower odds of HTN independent of BMI, PCOS, and DM. These data suggest a need for heightened BP surveillance in young Filipina women and Asian women with obesity or CMCs.

The metabolic syndrome is a constellation of physical and laboratory abnormalities including hypertension, hyperglycemia, hyperlipidemia and abdominal obesity. Over the past decade, the metabolic syndrome has emerged as a critically important risk factor for cardiovascular disease.

To review recent literature about the relationship between non-dialysis-requiring chronic kidney disease and cardiovascular disease as well as possible explanatory factors.

Bone loss accelerates after menstruation ends, but it is not clear when bone loss begins or at what rate bone is lost at various stages of the transition to menopause. Such knowledge would help to determine when to screen for osteoporosis and when to consider treatment. The SWAN (Study of Women’s Health Across the Nation), a longitudinal multiethnic cohort study of menopausal transition, provided an opportunity to track bone mineral density (BMD) at the lumbar spine and proximal femur in 1902 African American, Caucasian, Chinese, and Japanese women who, at baseline, were premenopausal or at the early perimenopausal stage and ranged in age from 42 to 52 years. The women were evaluated at up to 6 annual visits.

Assessing fall risk is important for anticoagulation decision-making in adults with atrial fibrillation (AF). We investigated the prevalence of patient self-reported falls, and identified factors associated with falls and initiation of fall prevention programs in AF. The ATRIA2-CVRN study included adults with incident AF between 1/1/2006 - 6/30/2009 from Kaiser Permanente Northern and Southern California. We conducted surveys via mail and telephone to ascertain self-reported health and functional behaviors, including history of falls (fallen to the ground more than once in the past year), severe falls (falls requiring medical care), and initiation of fall prevention programs (physical therapy or exercise program) after a fall. Electronic health records provided clinical features. Associations between patient characteristics and falls and initiation of fall prevention programs were examined using multivariable logistic regression. Among 12,949 AF patients who completed the questionnaire (response rate = 55%; mean age 71y, 43% women), 56% were on anticoagulant therapy. Overall, 15% and 6% reported falls and serious falls, respectively (28% and 12% for ages ?85y). Older age, physical inactivity, disordered sleep pattern, unstable warfarin, and higher predicted risks of stroke and bleeds were associated with falls (Table). A minority of patients who experienced falls reported interactions with health care professionals about how to avoid falling (36%), behavior changes after the fall (30%), or initiation of fall prevention programs (22%). Experiencing severe falls, prior intracranial hemorrhage, and older age were significant factors for initiation of fall prevention programs.Falls were prevalent in older AF patients. Older adults who experienced severe falls were more likely to initiate fall prevention programs. Future research should consider the identified factors to develop effective fall assessment tools and fall prevention programs in AF.

Background:A 2011 guideline on cardiovascular risk reduction in children recommended universal screening for dyslipidemia in children at age 9-11 and again at age 17-21.