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Background: Both the incidence of diabetes mellitus and consumption of sugar-sweetened beverages are high in the Hispanic/Latino population in the United States. The associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers in the diverse Hispanic/Latino population in the United States are unknown.Objectives: The objective of this study was to examine the cross-sectional associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers such as fasting glucose and insulin, 2-h oral-glucose-tolerance test, HOMA-IR, HOMA index for β-cell function (HOMA-B), and glycated hemoglobin (HbA1c) among US Hispanic/Latino adults.Methods: Using baseline data from the Hispanic Community Health Study/Study of Latinos (2008-2011), beverage consumption was ascertained using two 24-h dietary recalls and a food propensity questionnaire. Diabetes/prediabetes status was defined by self-report, antihyperglycemic medication use, and American Diabetes Association laboratory criteria. Among 9965 individuals without diabetes (5194 normoglycemia, 4771 prediabetes) aged 18-74 y, the associations of beverage consumption with prediabetes and glucose metabolism markers were analyzed using logistic and linear regressions, respectively, accounting for complex survey design.Results: Compared with individuals who consumed <1 serving/d (<240 mL/d) of sugar-sweetened beverages, individuals who consumed >2 servings/d (>480 mL/d) had 1.3 times greater odds of having prediabetes (95% CI: 1.06, 1.61) and higher glucose metabolism markers including fasting glucose, fasting insulin, HOMA-IR, and HbA1c. Consumption of artificially sweetened beverages showed an inverse association with β-cell function (HOMA-B). Intake of 100% fruit juice was not significantly associated with prediabetes nor with glucose metabolism markers.Conclusions: Among US Hispanic/Latino adults, higher sugar-sweetened beverage consumption was associated with increased odds of prediabetes and higher glucose metabolism markers. Public health initiatives to decrease sugar-sweetened beverage consumption could potentially reduce the burden of diabetes among Hispanics/Latinos in the United States. [ABSTRACT FROM AUTHOR]

Background Trimethylamine- N -oxide (TMAO), a diet-derived and gut microbiota–related metabolite, is associated with cardiovascular disease (CVD). However, major dietary determinants and specific gut bacterial taxa related to TMAO remain to be identified in humans. Objectives We aimed to identify dietary and gut microbial factors associated with circulating TMAO. Methods This cross-sectional study included 3972 participants (57.3% women) aged 18–74 y from the Hispanic Community Health Study/Study of Latinos in the United States. Dietary information was collected by 24-h dietary recalls at baseline interview (2008–2011), and baseline serum TMAO and its precursors were measured by an untargeted approach. Gut microbiome was profiled by shotgun metagenomic sequencing in a subset of participants (n  = 626) during a follow-up visit (2016–2018). Logistic and linear regression were used to examine associations of inverse-normalized metabolites with prevalent CVD, dietary intake, and bacterial species, respectively, after adjustment for sociodemographic, behavioral, and clinical factors. Results TMAO was positively associated with prevalent CVD (case number = 279; OR = 1.34; 95% CI: 1.17, 1.54, per 1-SD). Fish (P  = 1.26 × 10−17), red meat (P  = 3.33 × 10−16), and egg (P  = 3.89 × 10−5) intakes were top dietary factors positively associated with TMAO. We identified 9 gut bacterial species significantly associated with TMAO (false discovery rate <0.05). All 4 species positively associated with TMAO belong to the order Clostridiales , of which 3 might have homologous genes encoding carnitine monooxygenase, an enzyme converting carnitine to trimethylamine (TMA). The red meat–TMAO association was more pronounced in participants with higher abundances of these 4 species compared with those with lower abundance (P interaction = 0.013), but such microbial modification was not observed for fish–TMAO or egg–TMAO associations. Conclusion In US Hispanics/Latinos, fish, red meat, and egg intakes are major dietary factors associated with serum TMAO. The identified potential TMA-producing gut microbiota and microbial modification on the red meat–TMAO association support microbial TMA production from dietary carnitine, whereas the fish–TMAO association is independent of gut microbiota. [ABSTRACT FROM AUTHOR]

Background The association between accelerometer-assessed physical activity and risk of diabetes remains unclear, especially among US Hispanic/Latino adults who have lower levels of physical activity and a higher diabetes burden compared with other racial/ethnical populations in the country. Objectives To examine the association between accelerometer-assessed physical activity and incident diabetes in a US Hispanic/Latino population. Methods We included 7280 participants of the Hispanic Community Health Study/Study of Latinos who aged 18–74 y and free of diabetes at baseline. Data on moderate-to-vigorous physical activity (MVPA) were collected using a 7-d accelerometer measurement. Incident diabetes was assessed after a mean ± SD of 6.0 ± 0.8 y using standard procedures including blood tests. RRs and 95% CIs of diabetes associated with MVPA were estimated using survey Poisson regressions. The associations of MVPA with 6-y changes in adiposity measures were also examined. Results A total of 871 incident cases of diabetes were identified. MVPA was inversely and nonlinearly associated with risk of diabetes (P -nonlinearity = 0.006), with benefits accruing rapidly at the lower end of MVPA range (<30 min/d) and leveling off thereafter. The association differed by population age (P -interaction = 0.006). Higher MVPA was associated with lower risk of diabetes among individuals older than 50 y (RRQ4 versus Q1 = 0.50; 95% CI: 0.35, 0.73; P -trend < 0.001) but not among younger individuals (RRQ4 versus Q1 = 0.98; 95% CI: 0.66, 1.47; P -trend = 0.92). An inverse association between MVPA and 6-y gain in waist circumference was also limited to the older group (P -interaction with age < 0.001). Conclusions Among US Hispanic/Latino adults, baseline accelerometer-derived MVPA was inversely associated with incident diabetes only among individuals aged 50 y and older. Further studies are needed to confirm our findings and to clarify potential mechanisms underlying the possible age differences in the MVPA–diabetes association. This study was registered at clinicaltrials.gov as NCT02060344. [ABSTRACT FROM AUTHOR]

Background Genetic or pharmacological inhibition of de novo sphingolipid synthases prevented diabetes in animal studies. Objectives We sought to evaluate prospective associations of serum sphingolipids with incident diabetes in a population-based cohort. Methods We included 2010 participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) aged 18–74 y who were free of diabetes and other major chronic diseases at baseline (2008–2011). Metabolomic profiling of fasting serum was performed using a global, untargeted approach. A total of 43 sphingolipids were quantified and, considering subclasses and chemical structures of individual species, 6 sphingolipid scores were constructed. Diabetes status was assessed using standard procedures including blood tests. Multivariable survey Poisson regressions were applied to estimate RR and 95% CI of incident diabetes associated with individual sphingolipids or sphingolipid scores. Results There were 224 incident cases of diabetes identified during, on average, 6 y of follow-up. After adjustment for socioeconomic and lifestyle factors, a ceramide score (RR Q4 versus Q1 = 2.40; 95% CI: 1.24, 4.65; P -trend = 0.003) and a score of sphingomyelins with fully saturated sphingoid-fatty acid pairs (RR Q4 versus Q1 = 3.15; 95% CI: 1.75, 5.67; P -trend <0.001) both were positively associated with risk of diabetes, whereas scores of glycosylceramides, lactosylceramides, or other unsaturated sphingomyelins (even if having an SFA base) were not associated with risk of diabetes. After additional adjustment for numerous traditional risk factors (especially triglycerides), both associations were attenuated and only the saturated-sphingomyelin score remained associated with risk of diabetes (RR Q4 versus Q1 = 1.98; 95% CI: 1.09, 3.59; P -trend = 0.031). Conclusions Our findings suggest that a cluster of saturated sphingomyelins may be associated with elevated risk of diabetes beyond traditional risk factors, which needs to be verified in other population studies. This study was registered at clinicaltrials.gov as NCT02060344. [ABSTRACT FROM AUTHOR]

Objectives: Usual physical activity (PA) is a complex exposure and typical instruments to measure aspects of PA are subject to measurement error, from systematic biases and biological variability. This error can lead to biased estimates of associations between PA and health outcomes. We developed a calibrated physical activity measure that adjusts for measurement error in both self-reported and accelerometry measures of PA in adults from the US Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a community-based cohort study.Design: Total energy expenditure (TEE) from doubly labeled water and resting energy expenditure (REE) from indirect calorimetry were measured in 445 men and women aged 18-74years in 2010-2012, as part of the HCHS/SOL Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS). Measurements were repeated in a subset (N=98) 6months later.Method: Calibration equations for usual activity-related energy expenditure (AEE=0.90×TEE-REE) were developed by regressing this objective biomarker on self-reported PA and sedentary behavior, Actical accelerometer PA, and other subject characteristics.Results: Age, weight and height explained a significant amount of variation in AEE. Actical PA and wear-time were important predictors of AEE; whereas, self-reported PA was not independently associated with AEE. The final calibration equation explained fifty percent of variation in AEE.Conclusions: The developed calibration equations can be used to obtain error-corrected associations between PA and health outcomes in HCHS/SOL. Our study represents a unique opportunity to understand the measurement characteristics of PA instruments in an under-studied Hispanic/Latino cohort. [ABSTRACT FROM AUTHOR]

Background: Away-from-home foods (AFHFs) influence diet quality, a modifiable obesity risk factor, with limited generalizable evidence in Hispanic/Latino adults.Objective: We investigated associations between AFHF intake with diet quality and overweight or obesity among US Hispanic/Latino adults.Methods: Cross-sectional baseline (2008-2011) analyses included adults (n = 16,045) aged 18-74 y in the national Hispanic Community Health Study/Study of Latinos. Participants self-reported AFHF consumption frequency from 10 different settings and dietary intake (2-d 24-h recall). The Alternate Healthy Eating Index-2010 (AHEI-2010) was used to measure diet quality; higher scores indicated a healthier diet and scores were categorized into tertiles. WHO classifications categorized overweight [body mass index (BMI; kg/m2): 25.0-29.9] and obesity (BMI ≥30). Multivariate-adjusted associations of AFHF frequency or type with AHEI-2010, overweight, or obesity were assessed by using complex survey logistic regression (ORs and 95% CIs).Results: Almost half of participants (47.1%) reported eating AFHFs ≥5 times/wk. The mean ± SE AHEI-2010 score was 47.5 ± 0.2. More than one-third (37.2%) were classified as overweight and 39.6% classified as obese. Compared with consuming AFHFs ≥5 times/wk, consuming AFHFs <1 time/wk or 1-2 times/wk was associated with greater odds of being in higher AHEI-2010 tertiles, indicating a healthier diet [<1 time/wk-tertile 2: OR (95% CI): 1.6 (1.4, 1.9); tertile 3: 2.5 (2.1, 3.1); 1-2 times/wk-tertile 2: OR (95% CI): 1.4 (1.2, 1.6); tertile 3: 1.5 (1.2, 1.8)]. Consumption of AFHFs ≥1 time/wk from each AFHF setting, compared with consumption of any AFHFs <1 time/wk was associated with lower odds of being in higher AHEI-2010 tertiles. Increasing AFHF intake frequency was not associated with odds of overweight or obesity. Eating from on-street vendors ≥1 time/wk was associated with obesity (OR: 1.5; 95% CI: 1.1, 2.0).Conclusions: Consumption of AFHFs was prevalent among Hispanic/Latino adults and was associated with poorer diet quality. Findings may help to identify dietary targets to improve diet quality and prevent obesity in US Hispanics/Latinos. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to examine the association between verbal learning, fluency, and processing speed with anxious depression symptomatology (ADS) among diverse Hispanics. We hypothesized an inverse association of anxious depression with neurocognition among Hispanics of different heritage.Design: Data are from the Hispanic Community Health Study/Study of Latinos. The sample included 9,311participants aged 45-74 years (mean: 56.5 years). A latent class analysis of items from the Center for Epidemiological Studies for Depression scale and the Spielberger Trait Anxiety Inventory was used to derive an anxious depression construct. Neurocognitive measures included scores on the Brief Spanish English Verbal Learning Test (B-SEVLT, learning and recall trials), Word Fluency (WF), Digit Symbol Substitution (DSS) test, and a Global Cognitive Score (GCS). We fit survey linear regression models to test the associations between anxious depression symptomatology and cognitive function. We tested for effect modification by sex, Hispanic heritage, and age groups.Results: Among men, 71.6% reported low, 23.3% moderate, and 5.1% high ADS. Among women, 55.1% reported low, 33.2% moderate, and 11.8% high ADS. After controlling for age, sex, sociodemographic characteristics, cardiovascular risk factors and disease, and antidepressant use, we found significant inverse associations between moderate and high anxious depression (ref:low) with B-SEVLT learning and recall, DSS and GCS. Moderate, but not high, anxious depression was inversely associated with WF. Associations were not modified by sex, Hispanic heritage, or age.Conclusions: Increased anxious depression symptomatology is associated with decreased neurocognitive function among Hispanics. Longitudinal studies are needed to establish temporality and infer if negative emotional symptoms precede cognitive deficits. [ABSTRACT FROM AUTHOR]

Background: Healthful diet quality has been associated with a lower risk of metabolic syndrome (MetS) in several populations, but reports on Hispanic and Latino cohorts, grouped or by ethnic background, have been limited and inconsistent.Objective: We aimed to examine diet quality by using the 2010 Alternate Healthy Eating Index [(AHEI) range: 0-110, lowest to highest quality] and its cross-sectional association with MetS and its cardiometabolic components across 6 Hispanic and Latino backgrounds.Methods: We studied 12,406 US Hispanics and Latinos, aged 18-74 y and free of diabetes, from the multicenter, population-based Hispanic Community Health Study/Study of Latinos cohort. Food and nutrients were assessed from two 24-h recalls. MetS was defined by using the 2009 harmonized guidelines. Complex survey procedures were used in multivariable-adjusted linear regression models to test the association of the AHEI with continuous markers and in logistic regression models with MetS as an outcome.Results: The prevalence of MetS was 24.2%. Overall, Hispanics and Latinos had low scores for intakes of sugar-sweetened beverages and fruit juices, whole grains, and fruit and favorable scores for trans fats and nuts and legumes, according to AHEI criteria. Adjusted mean AHEI and its individual components differed by ethnic background (P < 0.001), ranging from 43.0 for Puerto Ricans to 52.6 for Mexicans. Overall, adjusted odds (95% CIs) of having MetS were 22% (9%, 33%) lower for each 10-unit increase in AHEI. This association was modified by ethnic background (P-interaction = 0.03), with significantly lower odds observed only for Mexicans (30%; 95% CIs: 13%, 44%) and Central Americans (42%; 95% CIs: 9%, 64%) for each 10-unit increase in AHEI. AHEI was inversely associated with waist circumference, blood pressure, and glucose among Mexicans and Puerto Ricans and with triglycerides among Mexicans only, and positively associated with HDL cholesterol among Puerto Ricans and Central Americans (all P < 0.05).Conclusions: Diet quality differed by Hispanic or Latino background. Although healthier diet quality was associated with lower odds of MetS in the overall Hispanic and Latino cohort, the association of AHEI and cardiometabolic factors varied by ethnic background. Nutrition-related research and interventions among ethnically diverse groups should consider individual ethnic backgrounds to optimally address diet quality and cardiometabolic health. This trial was registered at clinicaltrials.gov as NCT02060344. [ABSTRACT FROM AUTHOR]

Aims: To examine among Hispanics in the U.S., a population with increased reliance on informal healthcare support structures, (1) the association between cognitive function and control of diabetes; and (2) whether this association is modified by family support.Methods: The Digit Symbol Substitution Test (DSST), word fluency, and learning and delayed recall components of the Spanish English Verbal Learning Test were administered to 1794 Hispanic adults aged 45-76years with diagnosed diabetes. An executive function index and global cognitive function index (GCFI) were derived. Uncontrolled diabetes (HbA1c⩾7% [53mmol/mol]) was compared across quartiles of cognitive function using multivariable logit models with interaction terms for cognitive function and family support.Results: After adjustment, lower DSST scores were associated with uncontrolled diabetes (P=0.03). Family support modified the relationship between other measures of cognition and diabetes control (Pinteraction: 0.002, 0.09). Among individuals with low family support, as cognitive function declined, the odds of uncontrolled diabetes increased (P-trend across quartiles of the GCFI, 0.015). Among those with low family support, persons in the lowest quartile of global cognitive function were more than twice as likely to have uncontrolled diabetes as those in the highest performing quartile (OR=2.31; 95% CI: 1.17, 4.55). There was no similar effect among those with high family support.Conclusions: Family support may buffer the negative association between low cognitive functioning and diabetes control in US Hispanics/Latinos. Educational programs targeted at family members of middle-age and older persons with diabetes regardless of neurocognitive status may help improve population-level glycemic control. [ABSTRACT FROM AUTHOR]

Background: Seven national 2020 Strategic Impact Goals for cardiovascular health (Life's Simple 7 [LS7]) estimates for major ethnic/racial groups are available, but not for diverse Hispanics/Latinos. Herein, we describe and examine LS7 profiles of diverse Hispanic/Latino groups.Methods: HCHS/SOL (analytic n = 15,825; ages 18-74 years) data were used to estimate LS7 metrics. LS7 metrics were operationalized as Ideal, Intermediate, or Poor and indexed as an additive score. We calculated Hispanic/Latino group and sex-specific prevalence estimates for LS7 metrics and used survey-based regression models to examine (1) associations between LS7 scores and pertinent sociocultural characteristics and (2) relationships between LS7 scores and coronary heart disease, and stroke and transient ischemic attacks prevalence.Results: Few HCHS/SOL participants met all 7 Ideal LS7 criteria (<1%), and a similarly small proportion did not meet any Ideal LS7 criteria (1.1%). We found significant variability in LS7 distributions between men and women and across HCHS/SOL Hispanic/Latino heritages. We also found a substantial sex-adjusted age gradient in LS7 cardiovascular health (ie, ≥4 Ideal LS7s). Finally, higher Ideal LS7 scores were associated with decreased odds of both coronary heart disease and self-reported stroke/transient ischemic attack; these associations persisted after model covariate adjustments.Conclusions: Hispanic/Latino LS7s compared favorably with existing national estimates; however, we found areas for improvement. Several Hispanic/Latino LS7 strengths and weaknesses varied by sex and heritage, providing important information to guide targeted health promotion efforts toward achieving 2020 goals. [ABSTRACT FROM AUTHOR]

Background: Studies have suggested that the fat mass and obesity- associated (FTO) genotype is associated with individual variability in weight loss in response to diet/lifestyle interventions, but results are inconsistent. Objective: We aimed to provide a summary of the literature evaluating the relation between the FTO genotype and weight loss in response to diet/lifestyle interventions. Design: A search of English-language articles in the PubMed and Embase databases (through 30 April 2015) was performed. Eligible studies were diet/lifestyle weight-loss intervention studies conducted in adults that reported changes in body weight or body mass index (BMI) by the FTO variant rs9939609 (or its proxy). Differences in weight loss between FTO genotypes across studies were pooled with the use of fixed-effect models. Results: A meta-analysis of 10 studies (comprising 6951 participants) that reported the results of additive genetic models showed that individuals with the FTO TA genotype and AA genotype (those with the obesity-predisposing A allele) had 0.18-kg (95% CI: 20.09-, 0.45-kg; P = 0.19; NS) and 0.44-kg (95% CI: 0.09-, 0.79-kg; P = 0.015) greater weight loss, respectively, than those with the TT genotype. A metaanalysis of 14 studies (comprising 7700 participants) that reported the results of dominant genetic models indicated a 0.20-kg (20.43-, 0.04-kg) greater weight loss in the TA/AA genotype than in the TT genotype (P = 0.10). In addition, differences in weight loss between the AA genotype and TT genotype were significant in studies with a diet intervention only, adjustment for baseline BMI or body weight, and several other subgroups. However, the relatively small number of studies limited these stratified analyses, and there was no statistically significant difference between subgroups. Conclusions: This meta-analysis suggests that individuals carrying the homozygous FTO obesity-predisposing allele may lose more weight through diet/lifestyle interventions than noncarriers. Our data provide evidence for genetic variability in response to diet/lifestyle interventions on weight loss, although clinical applications of these findings need further investigations. [ABSTRACT FROM AUTHOR]

Objective Levels of insulin-like growth factor (IGF) proteins are associated with the risk of cancer and mortality. IGF assays produced by Diagnostic Systems Laboratories (DSL) were widely used in epidemiological studies, were not calibrated against recommended standards and are no longer commercially available. Design In a split sample study among 1471 adults participating in the Cardiovascular Health Study, we compared values obtained using DSL assays with alternative assays for serum IGF-I (Immunodiagnostic Systems, IDS), IGFBP-1 (American Laboratory Products Company, ALPCO) and IGFBP-3 (IDS). Results Results were compared using kernel density estimation plots, quartile analysis with weighted kappa statistics and linear regression models to assess the concordance of data from the different assays. Participants had a mean age of 77 years. Results between alternative assays were strongly correlated (IGF-I, r = 0.93 for DSL versus IDS; log-IGFBP-1, r = 0.90 for DSL versus ALPCO; IGFBP-3, r = 0.92 for DSL versus IDS). Cross tabulations showed that participants were usually in the same quartile categories regardless of the assay used (overall agreement, 74% for IGF-I, 64% for IGFBP-1, 71% for IGFBP-3). Weighted kappa also showed substantial agreement between assays (k w , 0.78 for IGF-I, 0.69 for IGFBP-1, 0.76 for IGFBP-3). Regressions of levels obtained with DSL assays (denoted X) to alternative assays were, IGF-I: 0.52X + 15.2 ng/ml, log-IGFBP-1: 1.01X − 1.73 ng/ml IGFBP-3: 0.87X + 791.1 ng/ml. Serum values of IGF-I, IGFBP-1 and IGFBP-3 measured using alternative assays are moderately correlated. Conclusions Care is needed in the interpretation of data sets involving IGF analytes if assay methodologies are not uniform. [ABSTRACT FROM AUTHOR]

Objective: Circulating free insulin-like growth factor (IGF)-I and its binding proteins, most notably, IGFBP-1 and IGFBP-2, have been prospectively associated with incident type 2 diabetes in women. However, little is known regarding the factors that may influence these IGF-axis protein levels. The aim is to study the relation of IGF-axis protein levels with adipcytokines, macronutrient consumption, and other factors related to diabetes. Design: Fasting plasma from 558 controls enrolled in a nested case-control study within the Nurses' Health Study of incident type 2 diabetes in women was tested for: IGF-axis proteins (free and total IGF-I, IGFBP-1, IGFBP-2, IGFBP-3), adipocytokines (leptin, adiponectin, resistin), soluble leptin receptor (sOB-R), inflammatory factors (IL-18 and C-reactive protein (CRP)), insulin, and glycated hemoglobin (HbA1C). Results: In multivariate models, each 1% increase in sOB-R (mean 34.9 ng/mL, standard deviation (SD) ± 11.3) was associated with - 0.20% total IGF-I (P = 0.0003) and - 0.42% free IGF-I (P = 0.002), as well as 0.73% higher IGFBP-1 (P < 0.0001) and 0.27% IGFBP-2 (P = 0.003). For example, a one SD change from the mean sOB-R level was associated with 11% lower free IGF-I. Insulin levels (mean 6.8 µU/mL ± 5.3) were inversely and adiponectin (mean 18.3 µg/mL ± 7.4) positively associated with IGFBP-1 and IGFBP-2 (all P < 0.01). Consumption of dairy protein, monounsaturated fats, and saturated fats, was also correlated with IGF-axis protein levels (all P < 0.05). Conclusions: Several molecular factors and macronutrients were independently associated with plasma IGF-axis protein levels. Which of these, if any, reflect biologic relationships that can be intervened upon to influence IGF-axis protein concentrations warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Prior national surveys capture smoking behaviors of the aggregated U.S. Hispanic/Latino population, possibly obscuring subgroup variation. Purpose: To describe cigarette use among Hispanic/Latino adults across subgroups of age, gender, national background, SES, birthplace, and degree of acculturation to the dominant U.S. culture. Methods: A cross-sectional survey of 16,322 participants in the Hispanic Community Health Study/Study of Latinos aged 18−74 years, recruited in Bronx NY, Chicago IL, Miami FL, and San Diego CA, was conducted during 2008–2011. Results: Prevalence of current smoking was highest among Puerto Ricans (men, 35.0%; women, 32.6%) and Cubans (men, 31.3%; women, 21.9%), with particularly high smoking intensity noted among Cubans as measured by pack-years and cigarettes/day. Dominicans had the lowest smoking prevalence (men, 11.0%; women, 11.7%). Individuals of other national backgrounds had a smoking prevalence that was intermediate between these groups, and typically higher among men than women. Non-daily smoking was common, particularly although not exclusively among young men of Mexican background. Persons of low SES were more likely to smoke, less likely to have quit smoking, and less frequently used over-the-counter quit aids compared to those with higher income and education levels. Smoking was more common among individuals who were born in the U.S. and had a higher level of acculturation to the dominant U.S. culture, particularly among women. Conclusions: Smoking behaviors vary widely across Hispanic/Latino groups in the U.S., with a high prevalence of smoking among population subgroups with specific, readily identifiable characteristics. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: HIV disease is associated with increased arterial stiffness, which may be related to inflammation provoked by HIV-related immune perturbation. We assessed the association of T cell markers of immune activation and immunosenescence with carotid artery stiffness among HIV-infected women. Methods: Among 114 HIV-infected and 43 HIV-uninfected women, we measured CD4+ and CD8+ T cell populations expressing activation (CD38+HLA-DR+) and senescence (CD28-CD57+) markers. We then related these measures of immune status with parameters of carotid artery stiffness, including decreased distensibility, and increased Young''s elastic modulus, as assessed by B-mode ultrasound. Results: HIV infection was associated with increased CD4+ T cell activation, CD8+ T cell activation and CD8+ T cell senescence. Among HIV-infected women, adjusted for age, HIV medications, and vascular risk factors, higher CD4+CD38+HLA-DR+ T cell frequency was associated with decreased carotid artery distensibility (β =−2.00, 95% confidence interval [CI]=−3.86, −0.14, P =0.04) and increased Young''s modulus (β =1.00, 95% CI=0.03, 1.97, P =0.04). These associations were affected little by further adjustment for CD4+ T cell count and viral load. Among HIV-infected women, higher frequencies of immunosenescent T cells, including CD4+CD28-CD57+ and CD8+CD28-CD57+ T cells, were also associated with decreased arterial distensibility. Among HIV-uninfected women, frequencies of activated or senescent T cells were not significantly associated with measures of carotid stiffness. Discussion: T cell activation and senescence are associated with arterial stiffness, suggesting that pro-inflammatory populations of T cells may produce functional or structural vascular changes in HIV-infected women. [Copyright &y& Elsevier]

Abstract: Objective: We assessed the association of genetic variation in MMP3 and MMP9 with risk of myocardial infarction and stroke. Methods: A case–control study was conducted among members of Group Health (GH), a large-integrated health care delivery system. Case subjects with incident non-fatal myocardial infarction (n =854), ischemic stroke (n =367), and hemorrhagic stroke (n =66) were identified and validated. A matched control group was selected from among GH members without myocardial infarction or stroke (n =2696). Haplotype-tagging sets of single-nucleotide polymorphisms (SNPs) in MMP3 and MMP9 were genotyped. Results: MMP3 haplotype 2 was associated with reduced risk of myocardial infarction (adjusted odds ratio (OR) per copy=0.80, 95% confidence interval 0.66, 0.98) and increased risk of hemorrhagic stroke (OR=1.69, 95% confidence interval 1.05, 2.75). Results for MMP3 haplotype 2 and ischemic stroke resembled those for myocardial infarction but did not achieve statistical significance (OR=0.85, 95% confidence interval 0.64, 1.12). No individual SNP identified MMP3 haplotype 2, and none of the individual MMP3 SNPs were associated with myocardial infarction or stroke. MMP9 haplotypes or SNPs were not associated with myocardial infarction or stroke. Conclusions: MMP3 haplotype may predict both cardiac events and stroke. [Copyright &y& Elsevier]

Background: Inflammatory and hemostasis-related biomarkers may identify women at risk of stroke. Methods: Hormones and Biomarkers Predicting Stroke is a study of ischemic stroke among postmenopausal women participating in the Women''s Health Initiative observational study (n = 972 case-control pairs). A Biomarker Risk Score (BRS) was derived from levels of 7 inflammatory and hemostasis-related biomarkers that appeared individually to predict risk of ischemic stroke: C-reactive protein (CRP), interleukin-6, tissue plasminogen activator, D-dimer, white blood cell count, neopterin, and homocysteine. The c index was used to evaluate discrimination. Results: Of all the individual biomarkers examined, CRP emerged as the only independent single predictor of ischemic stroke (adjusted odds ratio comparing Quartile4 v Quartile1 = 1.64, 95% confidence interval: 1.15-2.32, P = .01) after adjustment for other biomarkers and standard stroke risk factors. The BRS identified a gradient of increasing stroke risk with a greater number of elevated inflammatory/hemostasis biomarkers, and improved the c index significantly compared with standard stroke risk factors (P = .02). Among the subset of individuals who met current criteria for high-risk levels of CRP (>3.0 mg/L), the BRS defined an approximately 2-fold gradient of risk. We found no evidence for a relationship between stroke and levels of E-selectin, fibrinogen, tumor necrosis factor-α, vascular cell adhesion molecule-1, prothrombin fragment 1+2, Factor VIIC, or plasminogen activator inhibitor-1 antigen (P > .15). Discussion: The findings support the further exploration of multiple biomarker panels to develop approaches for stratifying an individual''s risk of stroke. [Copyright &y& Elsevier]

Background: Low levels of insulinlike growth factor 1 (IGF-I) may influence the development of age-related cardiovascular diseases including congestive heart failure (CHF). Insulinlike growth factor binding protein 1 (IGFBP-1), which increases during catabolic states and inhibits anabolic IGF-I effects, is increased in patients with CHF and has been associated prospectively with increased mortality among older adults and survivors of myocardial infarction. We investigated the association between fasting plasma levels of IGF-I, IGFBP-1, IGFBP-3, and insulin and risk of incident CHF in the prospective Cardiovascular Health Study.Methods: From among 5,888 adults 65 years old and older in the Cardiovascular Health Study, we studied 566 incident CHF cases and 1,072 comparison subjects after exclusion of underweight individuals (body mass index <18.5 kg/m(2)) and insulin users. Hazard ratios (HRs) with 95% CIs for CHF were estimated after adjustment for age, race, sex, hypertension, systolic blood pressure, lipid levels, left ventricular hypertrophy, coronary disease, C-reactive protein, health status, diabetes, and body mass index.Results: High baseline IGFBP-1 level was a significant predictor of CHF, independent of established CHF risk factors and inflammation markers. The HR per SD of IGFBP-1 was 1.22 (95% CI 1.07-1.39, P < .01). Relative to the lowest IGFBP-1 tertile, the HR was 1.29 (95% CI 0.96-1.74, P = .09) for the second IGFBP-1 tertile and 1.47 (95% CI 1.06-2.04; P = .02) for the highest IGFBP-1 tertile (tertile cut points 19.5 and 35.8 ng/mL). Total IGF-I, IGFBP-3, or insulin levels had no association with CHF after adjustment for CHF risk factors.Conclusions: High circulating IGFBP-1 level may be a CHF risk factor among older adults. [ABSTRACT FROM AUTHOR]

Abstract: Increasing evidence suggests that the insulin-like growth factor (IGF)-axis may play a role in glucose metabolism and may also be associated with systemic inflammation. The aim of this study was to evaluate the association of insulin-like growth factor-1 (IGF-I) and its binding proteins, IGFBP-1 and IGFBP-3, with glucose intolerance and inflammation among older adults. We conducted a cross-sectional analysis in a in a random subsample (n =922) of the Cardiovascular Health Study (CHS), a prospective cohort of men and women ⩾65 years. Mean IGFBP-1 levels were significantly lower in older adults with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and diabetes compared to those with normal fasting and post-load glucose. High IGFBP-1 was associated with a reduced prevalence of IGT and IFG; the multivariable OR between extreme quartiles of IGFBP-1 was 0.60 (95% CI: 0.37, 0.95; p-trend: 0.03) for IGT and 0.41 (95% CI: 0.26, 0.64; p-trend: <0.01) for IFG. We did not find any significant association between IGF-I and glucose intolerance in this study and the association for IGFBP-3 was less clear. However, low levels of IGF-I and IGFBP-3 were associated with increased levels of markers of inflammation including C-reactive protein and interleukin-6 levels. We conclude that among adults ⩾65 years, low IGFBP-1 levels are associated with increased prevalence of glucose intolerance. We did not confirm prior associations of low IGF-I with glucose intolerance in this cohort of older individuals. [Copyright &y& Elsevier]

Abstract: Background: An increasing number of epidemiologic studies are investigating the relationship between serum levels of insulin-like growth factor-I (IGF-I) and IGF binding proteins (IGFBPs) and risk of cancer, cardiovascular disease, and other diseases. However, little is known regarding the effects of blood specimen processing time on measured levels of total and free IGF-I, and on IGFBP-3, the major binding protein. Design: Two serum separation tubes were collected from each of 12 subjects. One tube was centrifuged as soon as possible following blood collection (a mean of 47min; range=30–80min), and serum aliquots were placed into −70°C storage either shortly after centrifugation, or following 2, 4, 10, or 24h at ambient temperature (measured from the time of blood draw). The second serum separation tube was maintained at ambient temperature for 24h before centrifugation and freezing. Total IGF-I, free IGF-I, and IGFBP-3 levels were determined using commercial enzyme linked immunosorbent assays (ELISAs) commonly employed in epidemiologic studies. The effects of time until centrifugation and freezing on seroassay results were evaluated using generalized estimating equation (GEE) linear regression models and Spearman correlation. Results: Total IGF-I and IGFBP-3 levels did not vary significantly with the amount of time at ambient temperature following centrifugation, even up to 24h, in blood specimens that were centrifuged soon after collection (all ). However, free IGF-I levels increased significantly with increasing time intervals between centrifugation and freezing in these same specimens (p trend <0.001). Total IGF-I/IGFBP-3 molar ratio, a crude measure of free IGF-I levels, showed no clear association. In blood specimens that were not centrifuged for 24h, total IGF-I, free IGF-I, and IGFBP-3 were each significantly elevated (each ) compared with results in blood specimens that were centrifuged and frozen soon after collection, whereas the total IGF-I/IGFBP-3 molar ratio was decreased . Nonetheless, all total IGF-I, free IGF-I, IGFBP-3, and total IGF-I/IGBFBP-3 molar ratio values altered by delays in processing were highly correlated with the values in specimens processed as soon as possible (all Spearman rank correlation coefficients ⩾0.84). Conclusions: Total IGF-I and IGFBP-3 can be fairly stably measured in serum with commonly used commercial assays regardless of the interval between blood collection and freezing, up to at least 24h, as long as centrifugation and serum aliquoting take place shortly after blood collection. Free IGF-I levels, however, increase steadily with the time interval until freezing, even if serum separation has been completed soon after blood collection. Because the altered serum values are highly correlated with the referent values, analysis of total IGF-I, free IGF-I, IGFBP-3, and total IGF-I/IGFBP-3 molar ratio data by quartile might help mitigate concerns regarding the effects of delays in processing time. [Copyright &y& Elsevier]

It is unknown whether the benefits of parenteral platelet glycoprotein (GP) IIb/IIIa inhibitors as an adjunct to percutaneous coronary intervention (PCI) demonstrated in randomized clinical trials extend to patients treated outside the setting of clinical trials. A contemporary registry of 10,847 consecutive PCI procedures was analyzed to determine the effect of GP IIb/IIIa inhibitor treatment on in-hospital major adverse coronary events ([MACEs] composite of death, urgent coronary artery bypass surgery, periprocedural myocardial infarction, abrupt closure, and stent thrombosis). In this registry, GP IIb/IIIa inhibitors were administered to 20.1% of patients. These patients were younger, more often men, and less often hypertensive than untreated patients. GP IIb/IIIa inhibitor-treated patients were more likely to present with acute myocardial infarction or unstable angina. Stents were placed in 79% of patients treated with GP IIb/IIIa inhibitors. MACEs occurred in 7.8% of GP IIb/IIIa inhibitor-treated patients compared with 3.8% of untreated patients (p <0.001). After multivariable adjustment for the propensity of GP IIb/IIIa inhibitor treatment as well as other possible confounders and interactions known to influence MACEs, GP IIb/IIIa inhibitor treatment was associated with a 57% increase in the risk of a MACE (odds ratio 1.57, 95% confidence interval 1.22 to 2.03; p = 0.0004). In a data set consisting of patients with a high degree of acuity predominantly treated with stent placement, GP IIb/IIIa inhibitor treatment is associated with an increase in thrombotic complications of PCI. [Copyright &y& Elsevier]

We identified predictors of prognosis among n = 2,677 health maintenance organization enrollees 30 to 79 years old who survived a first hospitalized myocardial infarction (MI) during 1986–1996 (mean follow-up 3.4 years). Independent risk factors for reinfarction/fatal coronary heart disease (CHD) (incidence = 49.0/1,000 person-years, 445 events) were age, diabetes, chronic congestive heart failure (CHF), angina, high body mass index (BMI), low diastolic blood pressure (DBP), high serum creatinine, and low/high-density lipoprotein (HDL) cholesterol. Independent risk factors for stroke (incidence = 13.0/1,000 person-years, 124 events) were age, diabetes, CHF, high DBP, and high creatinine. Independent predictors of death (incidence = 44.2/1,000 person-years, 431 events) were age, diabetes, CHF, continued smoking after MI, low DBP, high pulse rate, high creatinine, and low HDL cholesterol, while BMI had a significant U-shaped association with death (elevated risk at low and high BMI). The occurrence of study end points did not differ significantly between men and women after adjustment for other risk factors and use of preventive medical therapies, although men tended to have higher rates of reinfarction/CHD than women among older subjects. In summary, we demonstrated that the major cardiovascular risk factors age, diabetes, CHF, smoking, and dyslipidemia are important prognostic factors in the years after nonfatal MI. Elevated BMI was associated with increased risk of reinfarction/CHD and death and elevated DBP with increased risk of stroke, but we also observed high mortality among those with low BMI and high risk of recurrent coronary disease and death among those with low DBP. Finally, high creatinine was a strong, independent predictor of a variety of adverse outcomes after first MI. [Copyright &y& Elsevier]

To study associations between language acculturation level and changes in cigarette consumption among the diverse and growing U.S.-based Hispanic/Latino population and inform culturally tailored smoking prevention and cessation strategies. In the Hispanic Community Health Survey/Study of Latinos cohort, we used cigarette consumption behaviors at baseline (2008–2011) and follow-up (2014–2017) and a modified Short Acculturation Scale for Hispanics (SASH) language subscale to measure associations of language acculturation (unidimensional) with changes in cigarette consumption and quitting rates. Weighted multivariable linear and logistic regressions were stratified by daily (n = 1397) and nondaily (n = 633) smoking, and either sex, educational attainment, or migration status. Smokers at baseline (n = 2030) on average were aged 42 years old (SE = 0.5) with a mean SASH-language score of 2.3 (SE = 0.1; range = 1–5), indicating more Spanish language use. Among male daily smokers, we observed increases in smoked cigarettes-per-day (CPD) with unit increases in SASH-language score (1.08, 95% CI: 0.24–1.92). Associations with acculturation trended toward greater increases in CPD and lower odds of quitting as educational attainment increased. Language acculturation level is an important determinant for increased smoking behaviors, particularly among men. Our findings are significant in informing smoking reduction programs for the Hispanic/Latino population. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) continues to be the most frequent cause of death among women in the United States. Although elevated levels of clotting factors have been associated with CAD, few of these studies have been performed in women. Elevated levels of Factor XI have previously been associated with venous thrombosis, but little is known about its effect on arterial thrombosis. We selected women referred for cardiac catheterization who were found to have either normal coronaries or evidence of severe CAD and compared levels of homocysteine, anticardiolipin IgG/IgM antibodies, fibrinogen, platelet count, Factor VII, Factor VIII and Factor XI. Women with severe CAD had significantly higher levels of Factor XI than those without CAD (128% vs. 82%, p<0.04). Statistical adjustment for age, diabetes, hypertension, total cholesterol (TC), current smoking, or BMI had no effect on the independent association between CAD status and Factor XI. Factor XI was higher in women with total cholesterol levels >6.18 mmol/l (>239 mg/dl) compared with normocholesteremic women and was also higher in the upper tertile of age, but even when adjusted for these, the association remained significant. This initial study suggests that Factor XI may be an important parameter in arterial as well as venous thrombosis. [Copyright &y& Elsevier]

Although excess adiposity appears to increase the risk of coronary heart disease in the general population, its importance in patients with established coronary disease is less defined. We evaluated a population-based inception cohort of survivors to hospital discharge following first acute myocardial infarction (AMI) (n = 2,541) to assess the association between body mass index (BMI) and the risk of recurrent coronary events and to explore the mechanisms for this relation. Using Cox proportional-hazards regression, we assessed the risk of recurrent coronary events associated with levels of adiposity as defined by BMI and then investigated potential mechanisms through which adiposity conferred risk by examining how adjustment for diabetes mellitus, systemic hypertension, and dyslipidemia affected the association. Forty-one percent of the cohort were overweight (BMI 25 to 29.9), and 27.8% were obese (BMI > or =30). After adjustment for other risk factors, the risk of recurrent coronary events (n = 418) increased as BMI increased, especially among those who were obese. Using a BMI of 16 to 24.9 as the reference group, for mildly overweight patients (BMI 25 to 27.4), the relative risk (RR) was 0.93 (95% confidence interval [CI] 0.70 to 1.24); it was 1.16 for more severe overweight patients (BMI 27.5 to 29.9; 95% CI 0.87 to 1.55). For patients with class I obesity (BMI 30 to 34.9), the RR was 1.49 (95% CI 1.12 to 1.98), and for class II to III obesity (BMI > or =35), the RR was 1.80 (95% CI 1.30 to 2.48). We estimated that clinical measurements of diabetes, hypertension, and dyslipidemia explained approximately 43% of this risk. Thus, excess adiposity as measured by BMI was associated with an increased risk of recurrent coronary events following AMI, particularly among those who were obese. [ABSTRACT FROM AUTHOR]

Purpose: Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers.Methods: The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design.Results: After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs. Conclusions: Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases. [ABSTRACT FROM AUTHOR]

Introduction: Asthma prevalence is reportedly higher among U.S.-born relative to foreign-born Hispanics/Latinos. Little is known about rates of asthma onset before and after relocation to the U.S. in Latinos. Asthma rates were examined by U.S. residence and country/territory of origin.Methods: In 2015-2016, age at first onset of asthma symptoms was analyzed, defined retrospectively from a cross-sectional survey in 2008-2011, in relation to birthplace and U.S. residence among 15,573 U.S.-dwelling participants (aged 18-76 years) in the Hispanic Community Health Study/Study of Latinos.Results: Cumulative incidence of asthma through age 30 years ranged from 7.9% among Mexican background individuals to 29.4% among those of Puerto Rican background. Among those born outside the U.S. mainland, the adjusted hazard for asthma was 1.52-fold higher (95% CI=1.25, 1.85) after relocation versus before relocation to the U.S. mainland, with heterogeneity in this association by Hispanic/Latino background (p-interaction<0.0001). Among foreign-born Dominicans and Mexicans, rates of asthma were greater after relocation versus before relocation (adjusted hazard ratio [AHR] for after versus before relocation, 2.42, 95% CI=1.44, 4.05 among Dominicans; AHR=2.90, 95% CI=2.02, 4.16 among Mexicans). Puerto Ricans had modestly increased asthma onset associated with U.S. mainland residence (AHR=1.52, 95% CI=1.06, 2.17). No similar increase associated with U.S. residence was observed among Central/South American immigrants (AHR=0.94, 95% CI=0.53, 1.67). Asthma rates among Cuban immigrants were lower after relocation (AHR=0.45, 95% CI=0.24, 0.82).Conclusions: The effect of relocation to the U.S. on asthma risk among Hispanics is not uniform across Hispanic/Latino groups. [ABSTRACT FROM AUTHOR]

Aims: We hypothesized that Hispanic/Latino youth at high risk for diabetes would have elevated biomarkers of endothelial dysfunction.Methods: Among 1316 children 8-16years old from the Study of Latino Youth (SOL Youth), we used Poisson regression to obtain prevalence ratios (PRs) and 95% CIs for the cross-sectional association of quartiles of fasting glucose, HbA1c, and insulin resistance with E-selectin and plasminogen activator inhibitor-1 (PAI-1) levels above the median (≥48.1 and ≥2.02ng/mL, respectively).Results: Levels of E-selectin and PAI-1 were higher in children who were obese or had higher levels of hs-CRP (p<0.05). Insulin resistance was independently associated with higher levels of PAI-1 (adjusted PR and 95% CI for the highest versus lowest quartile (Q4 vs Q1): 2.25 [1.64, 3.09]). We found stronger evidence of associations of insulin resistance with higher levels of PAI-1 among boys as compared with girls (p-interaction = 0.10).Conclusions: Insulin resistance was associated with endothelial dysfunction, as measured by higher levels of PAI-1, in Hispanic/Latino youth. These biomarkers may be useful in risk stratification and prediction of diabetes and cardiovascular disease in high-risk youth. [ABSTRACT FROM AUTHOR]

Background: Single nucleotide polymorphisms (SNPs) in the Ryanodine receptor 3 (RYR3) gene are associated with common carotid intima media thickness (CCA cIMT) in HIV-infected men. We evaluated SNPs in the RYR3 gene among HIV-infected women participating in Women's Interagency HIV Study (WIHS). Methods: CCA cIMT was measured using B-mode ultrasound and the 838 SNPs in the RYR3 gene region were genotyped using the Illumina HumanOmni2.5-quad beadchip. The CCA cIMT genetic association was assessed using linear regression analyses among 1213 women and also separately among White (n = 139), Black (n = 720) and Hispanic (n = 354) women after adjusting for confounders. A summary measure of pooled association was estimated using a meta-analytic approach by combining the effect estimates from the three races. Haploblocks were inferred using Gabriel's method and haplotype association analyses were conducted among the three races separately. Results: SNP rs62012610 was associated with CCA cIMT among the Hispanics (p = 4.41 × 10−5), rs11856930 among Whites (p = 5.62 × 10−4), and rs2572204 among Blacks (p = 2.45 × 10−3). Meta-analysis revealed several associations of SNPs in the same direction and of similar magnitude, particularly among Blacks and Hispanics. Additionally, several haplotypes within three haploblocks containing SNPs previously related with CCA cIMT were also associated in Whites and Hispanics. Discussion: Consistent with previous research among HIV-infected men, SNPs within the RYR3 region were associated with subclinical atherosclerosis among HIV-infected women. Allelic heterogeneity observed across the three races suggests that the contribution of the RYR3 gene to CCA cIMT is complex, and warrants future studies to better understand regional SNP function. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This article describes the design and methodology of the Study of Latino Youth (SOL Youth) study, a multicenter study of Hispanic/Latino children living in the United States. Methods: Participants are children aged 8–16 years whose parents/legal guardians participated in the Hispanic Community Health Study/Study of Latinos, a large community-based cohort study of Hispanic/Latino adults living in the United States. Results: Between 2012 and 2014, 1600 children recruited from four field centers (Bronx, Chicago, Miami, and San Diego) will undergo a 3.5-hour examination to collect biospecimens, obtain anthropometric measures, blood pressure, fitness level, dietary intake, and physical activity. Psychosocial and environmental characteristics are assessed by questionnaire. Primary study aims are to examine associations of youth's lifestyle behaviors and cardiometabolic risk factors with (1) youth's acculturation and parent-child differences in acculturation; (2) parenting strategies, family behaviors, and parental health behaviors; and (3) youth's psychosocial functioning. Conclusions: SOL Youth will determine the prevalence and distribution of obesity-promoting lifestyle behaviors, cardiometabolic risk profiles, and novel biomarkers associated with obesity and insulin resistance. This article describes the study methodology and considers advantages and limitations of embedding a cohort of children within a well-characterized cohort of adults. [Copyright &y& Elsevier]

Abstract: Objective: We examined serum lipids in association with carotid artery intima-media thickness (CIMT) in HIV-infected and HIV-uninfected women. Methods: In 2003–4, among 1827 Women''s Interagency HIV Study participants, we measured CIMT and lipids (high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), non-HDL-c). A subset of 520 treated HIV-infected women had pre-1997 lipid measures. We used multivariable linear regression to examine associations between lipids and CIMT. Results: In HIV-uninfected women, higher TC, LDL-c and non-HDL-c were associated with increased CIMT. Among HIV-infected women, associations of lipids with CIMT were observed in treated but not untreated women. Among the HIV-infected women treated in 2003–4, CIMT was associated both with lipids measured a decade earlier in infection, and with late lipid measurements. Conclusion: Among HIV-infected women, hyperlipidemia is most strongly associated with subclinical atherosclerosis in treated women. Among treated women, the association appeared strongest early in the disease course. [Copyright &y& Elsevier]

Purpose: The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a multicenter, community-based cohort study of Hispanic/Latino adults in the United States. A diverse participant sample is required that is both representative of the target population and likely to remain engaged throughout follow-up. The choice of sample design, its rationale, and benefits and challenges of design decisions are described in this study. Methods: The study design calls for recruitment and follow-up of a cohort of 16,000 Hispanics/Latinos 18–74 years of age, with 62.5% (10,000) over 44 years of age and adequate subgroup sample sizes to support inference by Hispanic/Latino background. Participants are recruited in community areas surrounding four field centers in the Bronx, Chicago, Miami, and San Diego. A two-stage area probability sample of households is selected with stratification and oversampling incorporated at each stage to provide a broadly diverse sample, offer efficiencies in field operations, and ensure that the target age distribution is obtained. Conclusions: Embedding probability sampling within this traditional, multisite cohort study design enables competing research objectives to be met. However, the use of probability sampling requires developing solutions to some unique challenges in both sample selection and recruitment, as described here. [Copyright &y& Elsevier]

Purpose: The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a comprehensive multicenter community based cohort study of Hispanics/Latinos in the United States. Methods: The Study rationale, objectives, design, and implementation are described in this report. Results: The HCHS/SOL will recruit 16,000 men and women who self-identify as Hispanic or Latino, 18 to 74 years of age, from a random sample of households in defined communities in the Bronx, Chicago, Miami, and San Diego. The sites were selected so that the overall sample would consist of at least 2000 persons in each of the following origin designations: Mexican, Puerto Rican and Dominican, Cuban, and Central and South American. The study includes research in the prevalence of and risk factors for heart, lung, blood and sleep disorders, kidney and liver function, diabetes, cognitive function, dental conditions, and hearing disorders. Conclusions: The HCHS/SOL will (1) characterize the health status and disease burden in the largest minority population in the United States; (2) describe the positive and negative consequences of immigration and acculturation of Hispanics/Latinos to the mainstream United States life-styles, environment and health care opportunities; and (3) identify likely causal factors of many diseases in a population with diverse environmental exposures, genetic backgrounds, and early life experiences. [Copyright &y& Elsevier]

Abstract: Objective: To estimate the sensitivity of International Classification of Diseases (ICD-9-CM) coding for detecting hospitalized community-acquired pneumonia and to assess possible determinants for misclassification. Study Design and Setting: Based on microbiological analysis data, 293 patients with a principal diagnosis of community-acquired pneumonia at seven hospitals in the Netherlands were assigned to three categories (pneumococcal pneumonia, pneumonia with other organism, or pneumonia with no organism specified). For these patients, the assigned principal and secondary ICD-9-CM codes in the hospital discharge record were retrieved and the corresponding sensitivity was calculated. Furthermore, pneumonia-related patient characteristics were compared between correctly and incorrectly coded subjects. Results: The overall sensitivity was 72.4% for the principal code and 79.5% for combined principal and secondary codes. For pneumococcal pneumonia (ICD-9-CM code 481) and pneumonia with specified organism (ICD-9-CM code 482–483), the sensitivities were 35% and 18.3%, respectively. Patient characteristics were not significantly different between correctly and incorrectly coded subjects except for duration of hospital stay, which correlated negatively with coding sensitivity (P =0.01). Conclusion: ICD-9-CM codes showed modest sensitivity for detecting community-acquired pneumonia in hospital administrative databases, leaving at least one quarter of pneumonia cases undetected. Sensitivity decreased with longer duration of hospital stay. [Copyright &y& Elsevier]

: BackgroundThe association of physical inactivity and elevated body mass index (BMI) with cardiovascular disease (CVD) risk is well established. The relationship of dietary caloric intake and CVD risk is less certain.: MethodsThe epidemiologic follow-up of the First National Health and Nutrition Examination Survey (1971–1992) was examined to determine the relationship of caloric intake, BMI, and physical activity to CVD mortality. Of 14,407 participants, 9790 subjects aged 25 to 74 years met inclusion criteria. The CVD mortality rate was the outcome.: ResultsDuring the 17 years of follow-up, there were 3183 deaths, 1531 of which were due to CVD (9.11/1000 person-years). People with relatively less physical activity, lower caloric intake, and who were overweight (BMI 25 to 29.9 kg/m2) and obese (BMI ≥30 kg/m2) had a less favorable baseline CVD risk profile than did those who were more active and of normal weight and had greater caloric intake. Age- and race/ethnicity–adjusted CVD mortality rates were highest among those with the least physical activity and lowest caloric intake, and who were overweight or obese. Moreover, subjects of normal weight who exercised most were more likely to have high caloric intake and lower CVD mortality (5.9 vs 14.7 per 1000 person-years, p =0.01) than subjects who were obese and exercised least. In Cox regression analysis, controlling for relevant CVD risk factors, least physical activity was independently associated with increased CVD mortality (hazard ratio=1.32, 95% confidence interval [CI]=1.13–1.53); and obesity was associated with increased CVD mortality (hazard ratio=1.24, 95% CI=1.06–1.44). Although highest dietary caloric intake was associated with reduced CVD mortality (hazard ratio=0.83, 95% CI=0.74–0.93), after adjusting for physical activity and BMI, there was no significant association of highest caloric intake with CVD mortality (hazard ratio=0.91, 95% CI=0.81–1.01).: ConclusionsIn this large general population sample, lower levels of physical activity and obesity were independently associated with decreased CVD survival. Moreover, when BMI, physical activity, and other relevant characteristics were taken into account, caloric intake was not related to CVD mortality. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to investigate the association between undocumented immigration status and anxiety, depression, and use of anxiolytic or antidepressant medications in the Hispanic Community Health Study/Study of Latinos.Methods: Cross-sectional analysis of data collected between 2014 and 2017. Participants were categorized as U.S.-born citizens, naturalized citizens, documented noncitizens, or undocumented noncitizens. We calculated prevalence and prevalence ratios for anxiety, depression, and use of anxiolytic or antidepressant medication, by immigration status.Results: Of 9257 participants, 1403 (15%) were undocumented noncitizens, 2872 (31%) were documented noncitizens, 3766 (41%) were naturalized citizens, and 1216 (13%) were U.S.-born citizens. Prevalence of anxiety was lower among undocumented than documented noncitizens (9 vs. 15%, P < .0001) but not significantly different in adjusted analyses. Prevalence of depression was similar among undocumented and documented noncitizens (20 vs. 24%, P = .07) and not significantly different in adjusted analyses. Among participants with depression, 7% of undocumented and 27% of documented noncitizens reported use of antidepressants (adjusted prevalence ratio 0.49, 95% CI 0.27-0.87).Conclusions: Undocumented noncitizens had similar likelihood of anxiety and depression, but lower likelihood of antidepressant use, compared with documented noncitizens. These results may reflect the resilience of an undocumented population facing multiple stressors but suggest that this group may be undertreated for depression. [ABSTRACT FROM AUTHOR]

Abstract: Human longevity and healthy aging show moderate heritability (20%–50%). We conducted a meta-analysis of genome-wide association studies from 9 studies from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium for 2 outcomes: (1) all-cause mortality, and (2) survival free of major disease or death. No single nucleotide polymorphism (SNP) was a genome-wide significant predictor of either outcome (p < 5 × 10−8). We found 14 independent SNPs that predicted risk of death, and 8 SNPs that predicted event-free survival (p < 10−5). These SNPs are in or near genes that are highly expressed in the brain (HECW2, HIP1, BIN2, GRIA1), genes involved in neural development and function (KCNQ4, LMO4, GRIA1, NETO1) and autophagy (ATG4C), and genes that are associated with risk of various diseases including cancer and Alzheimer''s disease. In addition to considerable overlap between the traits, pathway and network analysis corroborated these findings. These findings indicate that variation in genes involved in neurological processes may be an important factor in regulating aging free of major disease and achieving longevity. [Copyright &y& Elsevier]