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To examine the association between sleep midpoint and inflammation in a population with a large proportion of individuals diagnosed with obstructive sleep apnea syndrome (OSAS), a group that is already prone to increased inflammation.Subjects from the Cleveland Family Study underwent overnight polysomnography and completed surveys on sleep habits. Morning and evening blood samples were collected and assayed for proinflammatory biomarkers interleukin (IL)-1, IL-6, and tumor necrosis factor α (TNF-α). Linear regression models were used, adjusting for potential confounders and sleep duration.The study population included 587 adults (52.3% with OSAS). Mean ± standard deviation weekday sleep midpoint was 3.52 ± 2.09 (3:31 am) and weekend sleep midpoint was 4.46 ± 1.69 (4:28 am). The Mean difference between weekday and weekend sleep midpoint (social jetlag) was 0.94 ± 2.08 hours. After adjusting for OSA severity, greater social jetlag was associated with higher levels of the inflammatory cytokine IL-1 (beta: 0.435 pg/mL, 95% confidence interval [CI]: 0.091 to 0.779). Additionally, later timing of sleep during both the weekdays and the weekends was associated with increased levels of IL-6 (weekday beta: 0.182 pg/mL; 95% CI: 0.013 to 0.350; and weekend beta: 0.188 pg/mL; 95% CI: 0.004 to 0.373). No trends were observed with TNF-α and any sleep exposure.Later sleep timing was associated with elevated levels of IL-6 while increased social jetlag was associated with elevated levels of IL-1. Our results indicate that later sleep schedules and increased social jetlag may lead to higher inflammation, even after controlling for OSA severity.Girtman KL, Baylin A, O'Brien LM, Jansen EC. Later sleep timing and social jetlag are related to increased inflammation in a population with a high proportion of OSA: findings from the Cleveland Family Study.

DNA methylation (DNAm) is a plausible mechanism underlying cardiometabolic abnormalities, but evidence is limited among youth. This analysis included 410 offspring of the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort followed up to two time points in late childhood/adolescence. At Time 1, DNAm was quantified in blood leukocytes at long interspersed nuclear elements (LINE-1), H19, and 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD-2), and at Time 2 in peroxisome proliferator-activated receptor alpha (PPAR-α). At each time point, cardiometabolic risk factors were assessed including lipid profiles, glucose, blood pressure, and anthropometry. Linear mixed effects models were used for LINE-1, H19, and 11β-HSD-2 to account for the repeated-measure outcomes. Linear regression models were conducted for the cross-sectional association between PPAR-α with the outcomes. DNAm at LINE-1 was associated with log glucose at site 1 [β = −0.029, p = 0.0006] and with log high-density lipoprotein cholesterol at site 3 [β = 0.063, p = 0.0072]. 11β-HSD-2 DNAm at site 4 was associated with log glucose (β = −0.018, p = 0.0018). DNAm at LINE-1 and 11β-HSD-2 was associated with few cardiometabolic risk factors among youth in a locus-specific manner. These findings underscore the potential for epigenetic biomarkers to increase our understanding of cardiometabolic risk earlier in life.

Examine cross-sectional and longitudinal relationships between organic food consumption, metabolic syndrome (MetS), and its components among older adults. Respondents of the 2012 Health and Retirement Study (HRS), and Health Care and Nutrition Study (HCNS) were included in this study. Organic food consumption was measured with a crude binary question asking about past-year consumption (yes/no). Cross-sectional analyses were conducted with 6,633 participants (mean (SE) age, 65.5 (0.3) years). Longitudinal analyses were conducted with a subset of 1,637 respondents who participated in the HRS Venous Blood Study (mean (SE) age, 63.8 (0.4) years). Hemoglobin A1C and high-density lipoprotein cholesterol were assessed using dried blood spots at baseline. Glucose, high-density lipoprotein cholesterol, and triglycerides were assessed using fasting blood samples collected 4 years after baseline. Waist circumference and blood pressure were measured at baseline and follow-up. Logistic and linear regressions were used to assess the associations between organic food consumption, MetS, and its components. Any organic food consumption over the previous year was reported among 47.4% of cross-sectional and 51.3% of longitudinal participants. Unadjusted models showed inverse cross-sectional associations between organic food consumption and waist circumference, blood pressure, and hemoglobin A1C, and positive longitudinal association with high-density lipoprotein cholesterol. No significant associations were detected in the fully adjusted models. No association was observed between organic food consumption and MetS among older adults after adjusting for confounders. Future studies with a precise definition, quantitative assessment of the consumption, and duration of organic food consumption, together with pesticides biomarkers, are warranted.

The current mixed-method study uses Food Frequency Questionnaires and 24-hour dietary recalls (n = 41) to assess the food/nutrient intake; and qualitative interviews to identify local perceptions of food among 41 early postpartum women in Belgaum, India. The results show that total energy, protein, and most micronutrient intake were significantly lower than the Recommended Dietary Allowance of India (p .05 individually); ninety percent of mothers restricted the consumption of some specific fruits, vegetables, and other foods during postpartum due to their perceptions of foods, folk medicines, and health beliefs. Culturally sensitive programs relevant to postpartum diet practices for women should be implemented.

Purpose Emerging evidence suggests that short sleep duration and delayed sleep timing may be independently related to insulin resistance (IR), although findings are mixed. Our aim was to investigate associations between sleep duration and timing with insulin resistance among adolescents. Methods The analytic sample included 384 Mexican adolescents from a birth cohort study who took part in a follow-up study beginning in 2015. Insulin and glucose were measured in fasting serum, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was calculated (marker of insulin resistance; [insulin x glucose]/22.5). Sleep duration and midpoint were measured by actigraphy for 7 days after the visit and for analysis were separated by weekdays and weekends. In full and sex-stratified regression analysis, sleep duration and midpoint were exposures, and the log HOMA-IR was the outcome, adjusting for age. Results The mean age of the sample was 13.8 ± 1.93 with 51% female. Shorter sleep duration on weekdays was associated with higher log HOMA-IR (β = −.049, 95% confidence interval [CI] −.097 to −.0009). Later midpoints on weekdays and the weekend were independently associated with higher log HOMA-IR (β = .0408, 95% CI −.0049 to .087, and β = .0486, 95% CI .0042 to .093, respectively). Girls showed stronger associations than boys for both sleep duration and timing with HOMA-IR. Conclusions Sleep duration and sleep timing were independently associated with insulin resistance, and associations were more pronounced among girls.

We examined maternal prenatal vitamin use or supplemental folic acid intake during month one of pregnancy for association with autism spectrum disorder (ASD) in the Early Autism Risk Longitudinal Investigation, an enriched-risk pregnancy cohort. Total folic acid intake was calculated from monthly prenatal vitamins, multivitamins, and other supplement reports. Clinical assessments through age 3 years classified children as ASD (n = 38) or non-ASD (n = 153). In pregnancy month one, prenatal vitamin use (59.7%) was not significantly associated with odds of ASD (OR = 0.70, 95%CI 0.32, 1.53). Sample size was limited and residual confounding was possible. Given the estimated effect sizes in this and previous work, prenatal vitamin intake during early pregnancy could be a clinically useful preventative measure for ASD.

Background: Intervention strategies to prevent childhood obesity in the Pacific Islands encourage eating a variety of local and traditional foods, but context-specific data to support this approach are limited. The objective was to assess the association between 2-year adherence to modern and neotraditional dietary patterns and body mass index z-scores (BMIz) among Samoan children. Methods: A convenience sample of 214 Samoan biological mother-child dyads who participated in the Ola Tuputupua'e “Growing Up” cohort study in 2015 and 2017 was included. At each time point, modern and neotraditional dietary patterns were identified using food frequency data and factor analysis. Children were assigned to categories based on diet pattern adherence: consistently high, high to low, low to high, and consistently low. Associations between 2-year adherence to dietary patterns, BMIz (in 2017 and 2015–2017), and weight and height z-scores were examined using linear models adjusted for potential confounders. Results: Consistently high adherence to the modern pattern was associated with a 0.36 standard deviation (SD)-adjusted change in BMIz between 2015 and 2017 (95% confidence interval [CI]: 0.04–0.69, p = 0.03). While the estimates for the individual components of BMI were imprecise, on average, children with consistently high adherence to the modern pattern had a 0.13 SD greater change in weight z-score (95% CI: −0.10 to 0.37) and 0.15 SD lower change in height z-score (95% CI: −0.43 to 0.13). The change in BMIz between 2015 and 2017 did not significantly differ by adherence to the neotraditional pattern. Conclusion: A neotraditional dietary pattern, comprising local produce, should be encouraged as a possible childhood obesity prevention strategy in Samoa.

Background Delayed sleep timing and short sleep duration represent a significant public health burden in adolescents. Whether intake of nutrients affects the pineal gland, where sleep/wake cycles are regulated, remains unclear. Objectives In a cross-sectional analysis, we investigated whether plasma concentrations of DHA and arachidonic acid (AA), long-chain fatty acids that can be obtained through diet, were related to sleep timing and duration in adolescents. Methods The study population included 405 Mexico City adolescents (mean age ± SD = 14.2 ± 2.1 y; 48% males) who took part in a 2015-2016 follow-up visit as a part of an ongoing cohort study. Fatty acid concentrations were measured in plasma using GLC, as a percentage of total fatty acids. Sleep midpoint and duration were assessed with 7-d wrist actigraphy. We categorized DHA and AA plasma concentrations into quartiles (Q1-Q4; Q4 = highest fatty acids). We conducted cross-sectional linear regression analysis with sleep characteristics as separate outcomes and quartiles of DHA and AA as exposures, adjusting for sex, age, and BMI z-scores. Results Mean ± SD plasma DHA (as percentage of total fatty acids) was 1.2 ± 0.4%, whereas mean ± SD plasma AA was 6.2 ± 1.5%. In adjusted analysis, higher plasma DHA was linearly associated with longer sleep duration on the weekends; to illustrate, those in Q4 compared with Q1 had 32 min longer duration (95% CI: 7, 57; P trend = 0.005). Higher DHA was also associated with earlier sleep timing during weekdays and weekends, although in a nonlinear fashion. The largest difference was a 0.75-h (45-min) later sleep midpoint in Q2 compared with Q4 (95% CI: 0.36, 1.14). Conclusions Plasma DHA was associated with earlier sleep timing and longer weekend sleep duration in Mexican adolescents. Whether DHA supplementation improves sleep in adolescent populations deserves consideration in randomized trials.

Maternal prenatal status, as encapsulated by that to which a mother is exposed through diet and environment, is a key determinant of offspring health and disease. Alterations in DNA methylation (DNAm) may be a mechanism through which suboptimal prenatal conditions confer disease risk later in life. One-carbon metabolism (OCM) is critical to both fetal development and in supplying methyl donors needed for DNAm. Plasma concentrations of one-carbon metabolites across maternal first trimester (M1), maternal term (M3), and infant cord blood (CB) at birth were tested for association with DNAm patterns in CB from the Michigan Mother and Infant Pairs (MMIP) pregnancy cohort. The Illumina Infinium MethylationEPIC BeadChip was used to quantitatively evaluate DNAm across the epigenome. Global and single-site DNAm and metabolite models were adjusted for infant sex, estimated cell type proportions, and batch as covariates. Change in mean metabolite concentration across pregnancy (M1 to M3) was significantly different for S-adenosylhomocysteine (SAH), S-adenosylmethionine (SAM), betaine, and choline. Both M1 SAH and CB SAH were significantly associated with the global distribution of DNAm in CB, with indications of a shift toward less methylation. M3 SAH and CB SAH also displayed significant associations with locus-specific DNAm in infant CB (FDR

Costa Rica, a middle-income country in Central America, has a life expectancy similar or even higher than richer countries. This survival advantage is more evident among the elderly, who have one of the lowest mortality rates in the world. Dietary factors may play a role in this extended longevity. We have shown that a traditional rural diet is associated with longer leukocyte telomere length—a biomarker of aging—among elderly Costa Ricans. In the present study, we used data from the Costa Rican Longevity and Healthy Aging Study (CRELES) to characterize further rural and urban diets of the elderly (60+ years). A validated food frequency questionnaire was used to assess usual diet. We used energy-adjusted regression models to compare the intake of micro- and macronutrients between rural and urban regions of the country. Elderly rural residents had a higher consumption of carbohydrates (but lower glycemic index), fiber, dietary iron, and used more palm oil for cooking than elderly urban dwellers. On the other hand, elderly subjects living in urban areas had a higher intake of total fat, mono and polyunsaturated fat, alcohol and dietary calcium compared to elderly rural residents. Our results are similar to earlier reports of middle-aged Costa Ricans and add to the characterization of diet differences in rural and urban regions of the country.

Both insufficient and excessive sleep duration have been associated with lower-quality diets in adult populations. However, investigations in Latin America, where different sleep norms may exist (e.g., daily napping), are scarce. Therefore, we examined whether weekday sleep duration and inconsistencies between weekday and weekend sleep duration were related to adherence to the Mediterranean diet among Costa Rican adults. The study population included 2169 controls (74% men) from a population-based case-control study. Usual sleep duration (weekday versus weekend) was self-reported and defined as short, recommended, and long (9 hours, respectively). Inconsistent weekday-weekend sleep duration was defined as >1-hour difference. Diet was assessed with a food frequency questionnaire, and adherence to the Mediterranean diet was calculated with the Alternative Mediterranean Diet Score (AMED). Sex-stratified linear regression models were conducted with AMED score as a continuous outcome and sleep variables as categorical or dichotomous exposures (in separate models). Models were adjusted for age, area of residence, education, napping category, caffeine intake, smoking status, type 2 diabetes mellitus, hypertension, and physical activity. Average (SD) hours of sleep per night reported were 7.0 (1.4) on weekdays and 7.3 (1.6) on weekends for men, and 7.0 (1.5) on weekdays and 7.2 (1.6) on weekends for women. Among women, sleep duration

Livestock can provide benefits to low-income households, yet may expose children to zoonotic enteropathogens that cause illness and negative long-term health outcomes. The aim of this cross-sectional study was to determine whether livestock-related risk factors, including animal ownership, exposure to animal feces, and consumption of animal-source foods, were associated with bacterial zoonotic enteropathogen infections in children 6–59 months old in Greater Accra, Ghana. Stool samples from 259 children and 156 household chickens were analyzed for atypical enteropathogenic Escherichia coli (aEPEC), Campylobacter jejuni/coli (C. jejuni/coli), Salmonella, and Shiga toxin–producing Escherichia coli (STEC) using quantitative polymerase chain reaction (qPCR). aEPEC, C. jejuni/coli, STEC, and Salmonella were detected in 45.6%, 11.6%, 4.3%, and 0.8% of children’s stool samples, respectively. In adjusted logistic regression models, household ownership of goats or sheep was associated with STEC detection in children (odds ratio [95% confidence interval]: 4.30 [1.32, 14.08]), as were positive detection of STEC in chicken feces (7.85 [2.54, 24.30]) and frequent consumption of fresh cow’s milk (3.03 [1.75, 5.24]). No livestock-related risk factors were associated with aEPEC or C. jejuni/coli infection in children. Our findings suggest that ruminant ownership in southern Ghana may expose children to STEC through household fecal contamination and foodborne routes. The lack of association between livestock risk factors and the more commonly detected pathogens, aEPEC and C. jejuni/coli, warrants further research, particularly to help explain how animal-keeping and sanitation practices affect transmission of fecal pathogens that were highly prevalent in chicken feces.

Objective:To examine the associations of trimester-specific maternal prenatal carbohydrate (CHO) intake with offspring adiposity and metabolic health during peripuberty.Design:Prospective cohort study in which maternal dietary intake was collected via validated FFQ during each trimester. Offspring adiposity and metabolic biomarkers were evaluated at age 8–14 years. We used multivariable linear regression to examine associations between total energy-adjusted maternal CHO intake and offspring BMI z-score, skinfold thickness and metabolic syndrome risk z-score calculated as the average of waist circumference, fasting glucose, fasting C-peptide, TAG:HDL and systolic blood pressure + diastolic blood pressure/2.Setting:Mexico City, MexicoParticipants:237 mother–child pairs in the Early Life Exposure in Mexico to Environmental Toxicants cohort.Results:We found non-linear associations of maternal CHO intake during pregnancy with offspring metabolic health during peripuberty. After adjusting for maternal age, and child age, sex and pubertal status, children whose mothers were in the fourth v. first quartile of total CHO intake during the third trimester had 0·42 (95 % CI –0·01, 0·08) ng/ml lower C-peptide and 0·10 (95 % CI –0·02, 0·22) units lower C-peptide insulin resistance (CP-IR). We found similar magnitude and direction of association with respect to net CHO intake during the first trimester and offspring C-peptide and CP-IR. Maternal CHO intake during pregnancy was not associated with offspring adiposity.Conclusions:In this study of mother–child pairs in Mexico City, children born to women in the highest quartile of CHO intake during pregnancy had lowest C-peptide and CP-IR during peripuberty. Additional research is warranted to replicate and identify mechanisms.

Introduction Irregular sleep duration may disrupt circadian rhythms necessary for optimal cardiovascular function. Yet, few studies have examined irregular sleep duration in relation to cardiovascular health, particularly among diverse cohorts of reproductive-age women. This study examined associations between sleep duration irregularities across the menstrual cycle and cardiovascular disease biomarkers in a cohort of healthy, premenopausal women. Methods We utilized the BioCycle micro-longitudinal cohort study of 259 regularly menstruating women aged 18–44 years. This measurement-intense study collected cardiovascular disease biomarkers at key reproductive time-points along the menstrual cycle (approximately days 2,7,12,13,14,18,22,27 of a 28-day cycle) across two cycles. Specifically, we assessed serum high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, triglycerides, and C-reactive protein (CRP). Women recorded sleep duration in daily diaries concurrently. We computed a system of four mathematical measures, the L-moments, robust versions of location, dispersion, skewness, and kurtosis for series of recorded sleep durations. Using linear mixed models with random intercepts and inverse probability weighting we estimated associations between irregular sleep duration and cardiovascular disease biomarkers in all women and within a subset of non-white women. Adjusted analysis accounted for baseline characteristics and time-varying hormonal changes across the menstrual cycle. Results Woman-specific mean sleep duration ranged from 4.4 to 10.6 hours. A one-hour increase in dispersion of sleep duration was associated with a lower mean LDL and higher mean HDL for non-white women (-19.4%, 95%CI -30.9,-6.0% and 24.7%, 95%CI 8.2,43.0, respectively). Unbalanced (skewed) sleep duration, frequent short or long hours, was associated with higher mean CRP for all women and non-white women (99.3%, 95%CI 17.2,238.9 and 126.7%, 95%CI 3.1,398.2, respectively), but lower total cholesterol (-10.9%, 95%CI -19.9,-1.0). Finally, irregular sleep durations, extreme short and long sleep bouts (kurtosis), were associated with reduced mean HDL for all women, and non-white women (-17.1%, 95%CI -31.1,-0.2 and -25.4%, 95%CI -39.5,-8.0, respectively). Conclusion This micro-longitudinal study of premenopausal women found associations between irregularities in sleep duration and differences in CRP, LDL, HDL and total cholesterol, but not with triglycerides. These data suggest that even in young and healthy women, irregularities in sleep duration could have a potential impact on cardiometabolic health. Support (If Any) Dr. Dunietz was supported by a Mentored Research Scientist Development Award from the National Heart, Lung, and Blood Institute (K01 HL144914). This work was supported in part by the Intramural Research Program of the NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development (authors KAM, JRF, EFS, SLM; The BioCycle Study was funded under the following intramural contracts: HHSN275200403394C HHSN275201100002I, and Task 1 HHSN27500001).

ObjectiveInitiatives to reduce neighborhood-based health disparities require access to meaningful, timely, and local information regarding health behavior and its determinants. We examined the validity of Twitter as a source of information for neighborhood-level analysis of dietary choices and attitudes.Materials and MethodsWe analyzed the “healthiness” quotient and sentiment in food-related tweets at the census tract level, and associated them with neighborhood characteristics and health outcomes. We analyzed keywords driving the differences in food healthiness between the most and least-affluent tracts, and qualitatively analyzed contents of a random sample of tweets.ResultsSignificant, albeit weak, correlations existed between healthiness and sentiment in food-related tweets and tract-level measures of affluence, disadvantage, race, age, U.S. density, and mortality from conditions associated with obesity. Analyses of keywords driving the differences in food healthiness revealed foods high in saturated fat (eg, pizza, bacon, fries) were mentioned more frequently in less-affluent tracts. Food-related discussion referred to activities (eating, drinking, cooking), locations where food was consumed, and positive (affection, cravings, enjoyment) and negative attitudes (dislike, personal struggles, complaints).DiscussionTweet-based healthiness scores largely correlated with offline phenomena in the expected directions. Social media offer less resource-intensive data collection methods than traditional surveys do. Twitter may assist in informing local health programs that focus on drivers of food consumption and could inform interventions focused on attitudes and the food environment.ConclusionsTwitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts.

Several epidemiologic investigations have found associations between the consumption of red meat and the metabolic syndrome (MetS). Very few studies have looked at populations undergoing the nutrition transition with smaller levels of red meat consumption than those in Westernized countries. In this population-based cross-sectional study, we examined the association between red meat consumption and MetS in Costa Rican adults, a population with comparably lower consumption of red meat. Prevalence ratios (PRs) of MetS across quintiles of total, unprocessed, and processed red meat consumption were estimated with log-binomial regression models among 2058 adults from the Costa Rican Heart Study. Least-squares mean values of individual components of MetS across quintiles of red meat consumption were estimated with linear regression models. We observed a significant positive association between total red meat consumption and MetS (PR for highest compared to lowest quintile: 1.21; 95% CI: 1.03, 1.42; P for trend = 0.0113) but not for unprocessed or processed red meat consumption when analyzed separately after mutual adjustments. We additionally observed a significant positive association between total, unprocessed, and processed red meat consumption and abdominal obesity. In this Hispanic population undergoing the nutrition transition, total red meat intake may have an impact on MetS. Based on the relatively low consumption of red meat in Costa Rica compared to other Westernized countries, we hypothesize that a “threshold effect” may exist for unprocessed and processed red meat.

We examined maternal prenatal vitamin use or supplemental folic acid intake during month one of pregnancy for association with autism spectrum disorder (ASD) in the Early Autism Risk Longitudinal Investigation, an enriched-risk pregnancy cohort. Total folic acid intake was calculated from monthly prenatal vitamins, multivitamins, and other supplement reports. Clinical assessments through age 3 years classified children as ASD (n = 38) or non-ASD (n = 153). In pregnancy month one, prenatal vitamin use (59.7%) was not significantly associated with odds of ASD (OR = 0.70, 95%CI 0.32, 1.53). Sample size was limited and residual confounding was possible. Given the estimated effect sizes in this and previous work, prenatal vitamin intake during early pregnancy could be a clinically useful preventative measure for ASD.

Examine cross-sectional and longitudinal relationships between organic food consumption, metabolic syndrome (MetS), and its components among older adults.Respondents of the 2012 Health and Retirement Study (HRS), and Health Care and Nutrition Study (HCNS) were included in this study. Organic food consumption was measured with a crude binary question asking about past-year consumption (yes/no). Cross-sectional analyses were conducted with 6,633 participants (mean (SE) age, 65.5 (0.3) years). Longitudinal analyses were conducted with a subset of 1,637 respondents who participated in the HRS Venous Blood Study (mean (SE) age, 63.8 (0.4) years). Hemoglobin A1C and high-density lipoprotein cholesterol were assessed using dried blood spots at baseline. Glucose, high-density lipoprotein cholesterol, and triglycerides were assessed using fasting blood samples collected 4 years after baseline. Waist circumference and blood pressure were measured at baseline and follow-up. Logistic and linear regressions were used to assess the associations between organic food consumption, MetS, and its components.Any organic food consumption over the previous year was reported among 47.4% of cross-sectional and 51.3% of longitudinal participants. Unadjusted models showed inverse cross-sectional associations between organic food consumption and waist circumference, blood pressure, and hemoglobin A1C, and positive longitudinal association with high-density lipoprotein cholesterol. No significant associations were detected in the fully adjusted models.No association was observed between organic food consumption and MetS among older adults after adjusting for confounders. Future studies with a precise definition, quantitative assessment of the consumption, and duration of organic food consumption, together with pesticides biomarkers, are warranted.

Allostatic load (AL), the concept of cumulative biological risk from chronic stressful exposures, may provide a framework with which to examine the links between diet, physiological stress, and disease.This study examined the associations between diet quality and AL.This cross-sectional study was conducted using the 2015 through 2018 cycles of the National Health and Nutrition Examination Survey. Dietary intake was assessed using two 24-hour diet recalls. Diet quality was measured using the Healthy Eating Index 2015. AL was measured by a composite score of nine biochemical markers, with three or more dysregulated values signaling elevated AL. All markers were collected during a physical examination.This study was conducted in a nationally representative population of 5,343 US adults aged 19 years or older who had no prior diagnosis of diabetes (except gestational diabetes), cancer (except skin cancer), or cardiovascular disease; were not pregnant; and had complete dietary intake and AL biomarker data.The outcome was odds of elevated AL.Accounting for the complex survey design of the National Health and Nutrition Examination Survey, multivariable logistic regression was used to examine the associations between Healthy Eating Index 2015 score and elevated AL, adjusting for sociodemographic variables.A significant inverse association between AL and diet quality was observed among adults aged 31 years and older but not among those aged 19 to 30 years. Among adults aged 31 years and older, those in higher quintiles of Healthy Eating Index 2015 score had significantly lower odds of elevated AL compared with the lowest quintile (P for trend0.05).These results suggest that, in adults older than age 30 years, consuming a more healthful diet is inversely associated with AL.

Elderly Costa Ricans have lower mortality rates compared to their counterparts from developed countries. Reasons for this survival advantage are not completely known. In the present study, we aimed to identify dietary factors associated with leukocyte telomere length (LTL), a marker of biologic aging, in the elderly population of Costa Rica. We conducted prospective analysis in 909 participants aged 60+ years from the Costa Rican Longevity and Healthy Aging Study (CRELES). We used a food frequency questionnaire to assess usual diet. We calculated dietary patterns using Principal Component Analysis (PCA). We used generalized linear models to examine the association of dietary patterns and food groups with leukocyte telomere length. We found two major dietary patterns explaining 9.15% and 7.18% of the total variation of food intake, respectively. The first dietary pattern, which represents a traditional Costa Rican rice and beans pattern, was more frequent in rural parts of the country and was positively associated with baseline LTL: (95% CI) = 42.0 base-pairs (bp) (9.9 bp, 74.1 bp) per one-unit increase of the traditional dietary pattern. In analysis of individual food groups, intake of grains was positively associated with baseline LTL: (95% CI) = 43.6 bp (13.9 bp, 73.3 bp) per one-serving/day increase of consumption of grains. Our results suggest that dietary factors, in particular a traditional food pattern, are associated with telomere length and may contribute to the extended longevity of elderly Costa Ricans. Universidad de Costa Rica/[]/UCR/Costa Rica National Institutes of Health/[P30 AG012839]/NIH/Estados Unidos National Institutes of Health/[R01 AG031716]/NIH/Estados Unidos UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP) UCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Biología

Objective:The association between organic food consumption and biomarkers of inflammation, C-reactive protein (CRP) and cystatin C (CysC) was explored in this cross-sectional analysis of older adults.Design:Dietary data and organic food consumption was collected in 2013 from a FFQ. Alternative Mediterranean diet score (A-MedDiet) was calculated as a measure of healthy eating. Biomarkers CRP and CysC were collected in serum or plasma in 2016. We used linear regression models to assess the associations between organic food consumption and CRP and CysC.Setting:This cross-sectional analysis uses data from the nationally representative, longitudinal panel study of Americans over 50, the Health and Retirement Study.Participants:The mean age of the analytic sample (n 3815) was 64·3 (se 0·3) years with 54·4 % being female.Results:Log CRP and log CysC were inversely associated with consuming organic food after adjusting for potential confounders (CRP: β = –0·096, 95 % CI 0·159, –0·033; CysC: β = –0·033, 95 % CI –0·051, –0·015). Log CRP maintained statistical significance (β = –0·080; 95 % CI –0·144, –0·016) after additional adjustments for the A-MedDiet, while log CysC lost statistical significance (β = –0·019; 95 % CI –0·039, 0·000). The association between organic food consumption and log CRP was driven primarily by milk, fruit, vegetables and cereals, while log CysC was primarily driven by milk, eggs and meat after adjustments for A-MedDiet.Conclusions:These findings support the hypothesis that organic food consumption is inversely associated with biomarkers of inflammation CRP and CysC, although residual confounding by healthy eating and socioeconomic status cannot be ruled out.

Objectives To identify dietary patterns associated with hepatic fat fraction (HFF), a measure of liver fat content and risk factor for non-alcoholic fatty liver disease, in a prospective study of 397 multi-ethnic youth. Methods We obtained information on habitual dietary intake via the Block Kids Food Frequency Questionnaire at age 6 to 15 years ('T1') and 12 to 19 years ('T2'), and measured HFF using magnetic resonance imaging at T2. We derived dietary patterns via principal components analysis and examined associations with ln-transformed HFF using linear regression models that accounted for maternal education, gestational diabetes exposure and smoking habits; and child pubertal status, BMI and physical activity. Results At T1, none of the dietary patterns identified were associated with HFF measured at T2. At T2, a Prudent dietary pattern characterized by high fruit and vegetable intake was inversely associated with HFF (-0.08 [95% CI: -0.16, -0.00]). Similarly, increased adherence to the Prudent pattern across T1 and T2 corresponded with lower ln-HFF (-0.11 [-0.18, -0.04] units). On the other hand, adherence to a Western pattern comprising fried foods and refined carbohydrates at T2 correlated with higher HFF among non-Hispanic White participants (0.16 [0.06, 0.26]). These findings persisted after accounting for child BMI. Conclusions Even in healthy youth, a diet high in fruits and vegetables is associated with lower HFF, whereas a diet high in fried foods and refined carbohydrates is related to higher HFF. Dietary changes may serve as an early preventive measure to mitigate liver fat accrual.

Adult studies show that healthy diet patterns relate to better sleep. However, evidence during adolescence, when sleep may change dramatically, is lacking. Within a cohort of 458 Mexican adolescents, we examined whether consumption of three dietary patterns was associated with sleep duration and timing measured 2 years later, as well as changes in sleep timing and duration. Dietary patterns (identified a posteriori in a prior analysis) were assessed with a baseline food frequency questionnaire, and sleep was measured with wrist actigraphy at baseline and follow-up. Linear regression analyses adjusting for sex, age, screen time, and smoking were conducted. Adolescents with higher consumption of a Plant-Based and Lean Proteins pattern had earlier sleep timing (&minus, 0.45 h with 95% Confidence Interval (CI) &minus, 0.81, &minus, 0.08 in the highest compared to lowest quartiles), less of a phase delay in sleep timing over follow-up (&minus, 0.39 h with 95% CI &minus, 0.80, 0.02), and shorter weekend sleep duration (0.5 h with 95% CI &minus, 0.88, &minus, 0.1). Higher consumption of an Eggs, Milk and Refined Grain pattern was associated with earlier sleep timing (&minus, 0.40 h with 95% CI &minus, 0.77, &minus, 0.04), while consumption of a Meat and Starchy pattern was related to higher social jetlag (weekend&ndash, weekday sleep timing difference). Healthier diet patterns may promote better sleep in adolescents.

OBJECTIVES: We aimed to assess the relationship between household livestock ownership and childhood anemia in Ghana and examine whether animal-source food (ASF) consumption or illness mediates this association. METHODS: We conducted a cross-sectional study of 470 children aged 6 to 59 months in two districts of the Greater Accra Region, Ghana. We measured hemoglobin (Hb) concentration, iron status biomarkers (serum ferritin and serum transferrin receptor), and inflammatory biomarkers (C-reactive protein and α-1-acid glycoprotein). Mothers were asked about the child's consumption of ASF in the past 3 months and symptoms of illness in the past 7 days. Household livestock ownership was defined as owning no livestock, some poultry, many poultry, small livestock and poultry, or cattle, small livestock and poultry. RESULTS: Overall, 47.9% of children were anemic (Hb

Background: Short and long sleep are risk factors for coronary artery disease. One of the mechanistic pathways is likely through diet. While many studies have examined associations between sleep and individual dietary components, few have examined diet patterns. We hypothesized that those with short sleep (< 7 hours/night) and long sleep (>9 hours/night) would have lower adherence to the Mediterranean diet. We also examined the effect of social jetlag, that is, a difference in the sleep duration between weekdays and weekends, on the Mediterranean diet. Methods: Participants in this study are population based-controls that were recruited for a case-control study on myocardial infarction and matched by sex, age and area of residence. Study participants (1600 men and 569 women) were recruited randomly using data from the National Census and Statistics Bureau of Costa Rica between 1994 and 2004 and therefore are representative of the Costa Rican population within matching strata. Sleep and napping patterns were self-reported by the participants. Social jetlag was defined as a ≥ 1-hour difference in sleep duration from weekdays to weekends. Validated food frequency questionnaires, detailed socio-demographic, medical history and physical activity questionnaires were administered. Alternative Mediterranean Diet (AMED) scores were calculated based on the consumption of vegetables, fruits, whole grains, nuts, legumes, fish, red and processed meat, alcohol and monounsaturated fat-to-saturated fat ratios. We used adjusted linear regression models stratified by sex to study the association between sleep duration, social jetlag and AMED score. Results: Men and women with short sleep tended to be younger, more educated, non-smokers, diabetic and have lower physical activity compared to those getting optimal hours (≥ 7 and ≤ 9 hours/night) of sleep. Among women, short sleep on weekdays was significantly associated with having a lower AMED score when compared to those with optimal hours of sleep. This association remained unchanged after adjusting for confounders including age, area of residence, education, napping frequency, caffeine intake, smoking status, physical activity and diagnosis of type 2 diabetes mellitus and hypertension (ß, -0.41 and CI, -0.69 to -0.13). Women with short sleep had a lower intake of vegetables, fruits, and legumes that contributed to their lower AMED score. There were about 20% of men and women with social jetlag. Social jetlag was associated with lower AMED scores, but it was not statistically significant amongst men (p=0.08) or women (p=0.15) after adjusting for confounders. Conclusions: Short sleep is associated with lower adherence to a Mediterranean diet amongst women in Costa Rica. The lack of an association amongst men might imply different biological pathways and residual confounding by lifestyle factors that drive food consumption in men as compared to women.

BACKGROUND: Excess sodium intake and insufficient potassium intake are risk factors for hypertension, but there is limited knowledge regarding genetic factors that influence intake. Twenty-hour or half-day urine samples provide robust estimates of sodium and potassium intake, outperforming other measures such as spot urine samples and dietary self-reporting. OBJECTIVE: The aim of this study was to investigate genomic regions associated with sodium intake, potassium intake, and sodium-to-potassium ratio measured from 24-h or half-day urine samples. METHODS: Using samples of European ancestry (mean age: 54.2 y; 52.3% women), we conducted a meta-analysis of genome-wide association studies in 4 cohorts with 24-h or half-day urine samples (n = 6,519), followed by gene-based analysis. Suggestive loci (P

Objective To assess whether adiposity measures differed according to joint categories of sleep duration and sleep variability in a sample of Mexican adolescents. Study design A sample of 528 Mexico City adolescents aged 9-17 years wore wrist actigraphs for 6-7 days. Average sleep duration was categorized as age-specific sufficient or insufficient. Sleep variability, the standard deviation of sleep duration, was split at the median into stable versus variable. Adiposity measures—body mass index (BMI)-for-age Z score (BMIz), triceps skinfolds, waist circumference, and percent body fat—were collected by trained assistants. We regressed adiposity measures on combined sleep duration and variability categories. Log binomial models were used to estimate prevalence ratios and 95% CI for obesity (>2 BMIz) by joint categories of sleep duration and variability, adjusting for sex, age, and maternal education. Results Approximately 40% of the adolescents had insufficient sleep and 13% were obese. Relative to sufficient-stable sleepers, adolescents with insufficient-stable sleep had higher adiposity across all 4 measures (eg, adjusted difference in BMIz was 0.68; 95% CI, 0.35-1.00) and higher obesity prevalence (prevalence ratio, 2.54; 95% CI, 1.36-4.75). Insufficient-variable sleepers had slightly higher BMIz than sufficient-stable sleepers (adjusted difference, 0.30; 95% CI, 0.00-0.59). Conclusions Adolescents with consistently insufficient sleep could be at greater risk for obesity. The finding that insufficient-variable sleepers had only slightly higher adiposity suggests that opportunities for “catch-up” sleep may be protective.

BACKGROUND AND AIMS: Animal models have shown that adipose-derived palmitoleic acid may act as a lipokine by conferring resistance to diet-induced obesity; however, human epidemiologic studies investigating this relationship thus far have not provided data in support of this hypothesis. Because metabolic syndrome and cardiovascular disease are intricately linked with the former being a major risk factor for the latter, we hypothesized that adipose-derived palmitoleic acid may be inversely associated with myocardial infarction. We examined whether adipose tissue palmitoleic acid was associated with nonfatal acute myocardial infarction in a representative population of Costa Rican adults. METHODS AND RESULTS: Odds ratios of nonfatal acute myocardial infarction by quintiles of adipose tissue palmitoleic acid were calculated using conditional logistic regression in a case-control study of 1,828 cases and 1,828 controls matched by age, sex, and area of residence. We observed an inverse relationship between nonfatal acute myocardial infarction and adipose tissue palmitoleic acid (OR for highest quintile compared to lowest quintile of palmitoleic acid: 0.55; 95% CI: 0.41, 0.75; P for trend

PURPOSE OF REVIEW: Poor sleep is a risk factor for cardiometabolic morbidity. The relationship of sleep and cardiometabolic health could be confounded, mediated, or modified by diet, yet the incorporation of diet in sleep-cardiometabolic health studies is inconsistent. This rapid systematic literature review evaluates the conceptualization of diet as a confounder, mediator, or effect modifier within sleep-cardiometabolic health investigations and the statistical approaches utilized. RECENT FINDINGS: Of 4,692 studies identified, 60 were retained (28 adult, 32 pediatric). Most studies included diet patterns, quality, or energy intake as a confounder, while a few examined these dietary variables as a mediator or an effect modifier. There was some evidence, mostly in pediatric studies, that inclusion of diet altered sleep-cardiometabolic health associations. SUMMARY: Diet plays a diverse role within sleep-cardiometabolic health associations. Investigators should carefully consider the conceptualization of diet variables in these relationships and utilize contemporary statistical approaches when applicable.

This study investigates relations of maternal N-3 and N-6 polyunsaturated fatty acids (PUFA) intake during pregnancy with offspring body mass index (BMI), height z-score and metabolic risk (fasting glucose, C-peptide, leptin, lipid profile) during peripuberty (8–14 years) among 236 mother–child pairs in Mexico. We used food frequency questionnaire data to quantify trimester-specific intake of N-3 alpha-linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); N-6 linoleic acid and arachidonic acid (AA); and N-6:N-3 (AA:EPA+DHA), which accounts for the fact that the two PUFA families have opposing effects on physiology. Next, we used multivariable linear regression models that accounted for maternal education and parity, and child’s age, sex and pubertal status, to examine associations of PUFA intake with the offspring outcomes. In models where BMI z-score was the outcome, we also adjusted for height z-score. We found that higher second trimester intake of EPA, DHA and AA were associated with lower offspring BMI and height z-score. For example, each 1-s.d.increment in second trimester EPA intake corresponded with 0.25 (95% CI: 0.03, 0.47) z-scores lower BMI and 0.20 (0.05, 0.36) z-scores lower height. Accounting for height z-score in models where BMI z-score was the outcome attenuated estimates [e.g., EPA: −0.16 (−0.37, 0.05)], suggesting that this relationship was driven by slower linear growth rather than excess adiposity. Maternal PUFA intake was not associated with the offspring metabolic biomarkers. Our findings suggest that higher PUFA intake during mid-pregnancy is associated with lower attained height in offspring during peripuberty. Additional research is needed to elucidate mechanisms and to confirm findings in other populations.

Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.

Background: Studies in Western nations have shown associations of certain dietary patterns with obesity and metabolic risk in youth. Little is known about these relations in newly industrialized countries where obesity prevalence is surpassing those of developed countries.Objective: We sought to characterize dietary patterns in a cross-sectional study in 224 adolescents aged 8-14 y in Mexico and to investigate associations of the dietary patterns with adiposity and metabolic risk.Methods: We used principal components analysis to derive dietary patterns from food-frequency questionnaire data. By using linear regression models that accounted for mother's marital status, education, and smoking habits and child's age and physical activity, we examined associations of the dietary patterns with adiposity [body mass index z score, waist circumference, the sum and ratio of the subscapular and triceps skinfold thicknesses, blood pressure, serum fasting glucose and a C-peptide-based measure of insulin resistance (CP-IR), lipid profile, and a metabolic syndrome risk z score (MetS z score)].Results: We identified a "prudent" dietary pattern characterized by high intakes of vegetables, fruit, fish, chicken, and legumes and a "transitioning" dietary pattern, which comprises processed meats, Mexican foods, and sweetened beverages. Each unit increase in the prudent pattern factor score corresponded with 0.33 ng/mL (95% CI: 0.09, 0.57 ng/mL) lower C-peptide, 0.08 units (95% CI: 0.02, 0.13 units) lower CP-IR, and a 0.14 unit (0.00, 0.27 unit) lower MetS z score in boys. In girls, the transitioning pattern corresponded with higher subscapular + triceps skinfold thickness (per 1-unit increase in the factor score: 2.46 mm; 95% CI: 0.10, 4.81 mm). These results did not change after accounting for pubertal status.Conclusions: A prudent dietary pattern was protective against metabolic risk in adolescent boys, whereas a transitioning dietary pattern corresponded with higher adiposity among adolescent girls. Given that adolescence is a key developmental period for long-term health, efforts to elucidate dietary determinants of metabolic risk during this life stage may have long-term benefits.

Background Alcohol and energy-dense beverages consumption have been implicated in cardiometabolic disease, albeit inconsistently. Objective This study tested prospective associations between intakes of alcohol, energy-dense beverages, and low-calorie beverages and cardiometabolic risk in midlife women. Design The Study of Women's Health Across the Nation is a 14-year, multisite prospective cohort study (1996-2011). Beverage intake and cardiometabolic risk factors that define the metabolic syndrome (hypertension, abdominal obesity, impaired fasting glucose, low high-density lipoprotein cholesterol level, and hypertriglyceridemia) were assessed throughout follow-up. Participants/setting Participants (N=1,448) were African American, Chinese, Japanese, and non-Hispanic white midlife women from six US cities. Main outcome measures The primary outcomes were incident metabolic syndrome and the individual metabolic syndrome components. Statistical analyses performed Generalized linear mixed models tested associations between intakes within each beverage category and odds of meeting criteria for metabolic syndrome and each of the metabolic syndrome components. Results Energy-dense beverage consumption was highest among African-American women and lowest among women with college degrees. Non-Hispanic white women consumed the largest quantities of alcohol. Independent of energy intake and potential confounders, each additional 355 mL energy-dense beverages consumed per day was associated with higher odds of developing metabolic syndrome in each successive year of follow-up (odds ratio [OR] 1.05, 95% CI 1.02 to 1.08). Greater energy-dense beverage intake was associated with more rapidly increasing odds of developing hypertension (OR 1.06, 95% CI 1.02 to 1.11) and abdominal obesity (OR 1.10, 95% CI 1.03 to 1.16) over time, but not with the other metabolic syndrome components. Intakes of alcohol and low-calorie coffees, teas, and diet cola were not associated with metabolic syndrome risk. Conclusions Over 14 years of follow-up, energy-dense nonalcoholic beverage consumption was associated with incident metabolic syndrome in midlife women. The observed differences in intakes by ethnicity/race and education suggest that consumption of these beverages may contribute to disparities in risk factors for diabetes and cardiovascular disease.

Chahal et al. (Am J Epidemiol. 2018;187(10):2073-2079) assessed the risk of placental abruption due to physical exertion using a case-crossover design. The authors found an increased risk of placental abruption following increased physical exertion in the hour prior to the abruption. The risk was greater among women who were primarily sedentary during pregnancy or prior to becoming pregnant compared with those who were more physically active. The authors used a case-crossover design to assess the association of an intermittent exposure on an acute event. Chahal et al. address the limitations of the study, including the inability to control for time-varying confounders as well as the potential for recall bias. The public health implications of the study must be carefully evaluated given that physical activity prior to and during pregnancy can lead to healthy outcomes and is likely recommended. While the current study is unable to determine the type of physical exertion associated with placental abruption, future studies are recommended to determine the type of activity that presents increased risk. Additionally, studies among larger samples and in other countries will help determine the generalizability of the results.