Effects of Persistent Undernutrition During Adolescence on Learning Skills: Findings From a Longitudinal Study of 16,000 Adolescents in India

Abstract Objectives Limited evidence exists on longitudinal impacts of undernutrition on learning skills as adolescents mature. This study aimed to examine the effect of undernutrition in early adolescence on learning skills in late adolescence. Methods We used longitudinal data from a project called UDAYA that surveyed 16,929 adolescents aged 10–19 years from Bihar and Uttar Pradesh, India in 2015–16 (wave 1) and again in 2018–19 (wave 2). Adolescents’ ability to read a story and solve division problems at age 19–22 years was assessed using the Annual Status of Education Report tools. We characterized adolescents’ nutrition status into 4 groups: never undernourished (e.g., not stunted in wave 1 and 2), recovered (e.g., stunted in in wave 1 but not stunted in wave 2), faltered (e.g., not stunted in wave 1 but stunted in wave 2), and persistent (e.g., stunted in both waves). These 4 groups were created for stunting, thinness, and anemia. We used multivariable logistic regression models adjusted for key demographics, environmental factors, and sampling design. Results Undernutriton was high (51% were anemic, 19% thin, and 36% stunted) in both survey rounds. Nearly one third of adolescents had persistent stunting or anemia, and 11% had persistent thinness. Compared to those who were never stunted, adolescents with persistent stunting had poorer reading (adjusted odds ratio: 0.66, 95% confidence interval: 0.53–0.83) and math (0.70, 0.56–0.89) skills. Reading ability was also poorer in adolescents who experienced growth faltering (0.61, 0.42–0.90) or who were stunted in wave 1 but not stunted in wave 2 (0.64, 0.44–0.93). Persistent thinness was negatively associated with reading (0.71, 0.54–0.93) but not math skills. Persistent anemia was also negatively associated with reading skills, but the association did not remain significant in the fully adjusted model. Conclusions In a high poverty sample of Indian adolescents, persistent undernutrition during adolescence was associated with poor learning skill. Promisingly, most of those who recovered from undernutrition in the 2–3 year period between surveys showed catch-up in learning. Ensuring appropriate nutrition during this period of rapid physical and cognitive maturation will yield long-term dividends for wellbeing. Funding Sources Bill & Melinda Gates Foundation.

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Complementary Feeding Practices and Associated Factors in Children 6–23 months in Uttar Pradesh, India: Program Implications

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_107 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 902-902

Author(s):

Deepa Sankaran ◽

Priyanshu Sharma ◽

Shajy Isac ◽

Manish Kumar ◽

James Blanchard ◽

...

Keyword(s):

Fruits And Vegetables ◽

Complementary Feeding ◽

Dietary Diversity ◽

Uttar Pradesh ◽

Meal Frequency ◽

Food Groups ◽

Funding Sources ◽

Age Appropriate ◽

Gates Foundation

Abstract Objectives Optimal complementary feeding (CF) practices among children 6–23 months can prevent childhood malnutrition and can improve long term development and health. Our study aimed to understand CF practices in children 6–23 months, as part of an ongoing nutrition program (with a focus on improving dietary diversity) in UP, India. Methods Mothers of children 6–23 months old were interviewed in 125 blocks across 25 districts of UP (N = 34,290). We assessed dietary intake using 24-hour dietary recalls and calculated minimum dietary diversity (MDD, 4 + food groups) and age-appropriate minimum meal frequency (MMF). We used multivariate logistic regression to test for associations between MDD and program exposure variables, such as frontline worker (FLW) CF knowledge, home visits by FLWs, and FLW counseling on age-appropriate CF practices, controlling for age, caste, religion, mother's education level, birth order and sex of the child. Results Merely 22% of children 6–8 months old received any semisolid/solid food the previous day, and even at 1 year of age, only 60% children received any CF. Fourteen % of all children and 5% of children 9–11 months received age-appropriate MMF. Children 6–23 months old had poor diets with only 11% reaching MDD. Only 3% of younger children (6–11 months) and 18% of children 12–23 months reached MDD. In children 12–23 months, starchy staples, pulses, other fruits and vegetables (F&V) and dairy products were consumed in higher proportions (65%, 52%, 36% and 36% respectively) while Vitamin-A rich F&V, eggs and flesh foods were rarely consumed (11%, 2% and 3.1% respectively). Higher odds of achieving MDD were associated with FLWs CF knowledge (OR: 3.2; 95% CI: 2.2–4.5), home visit by FLWs in the past month (OR: 1.2; 95% CI: 1.1–1.4) and counselling by FLWs on age-appropriate CF practices (OR: 1.4; 95% CI: 1.2–1.7) were positively associated with MDD. Conclusions CF practices in children 6–23 months old in these 25 districts in UP are suboptimal. Dietary diversity in this age group can be improved by improving FLW knowledge and quantity and quality of FLW interactions with families. Results suggest a need for targeted age-specific counselling to increase meal frequency and to introduce a greater variety of foods to younger children. Funding Sources Bill and Melinda Gates Foundation.

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Growth Faltering Among Pre-School Aged Children in the Plains of Nepal (P10-009-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-009-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Swetha Manohar ◽

Andrew Thorne-Lyman ◽

Angela KC ◽

Binod Shrestha ◽

Elizabeth Colantuoni ◽

...

Keyword(s):

Linear Growth ◽

Age Groups ◽

Incidence Rates ◽

Paired Data ◽

Biologically Relevant ◽

Funding Sources ◽

Growth Faltering ◽

Feed The Future ◽

Gates Foundation ◽

Definition Of

Abstract Objectives Growth faltering in relation to the WHO reference is common in the first 2 years of life in South Asia. Stunting, defined as an attained height/length-for-age (H/LA) < -2 Z, is limited in its ability to capture this dynamic process. Our aims were to (1) reveal distributions of growth faltering by age in a cohort of preschool Nepali children, and (2) propose a definition of growth faltering that represents early or continued deviated growth that precedes a child reaching < -2 H/LAZ. Methods We conducted a mixed longitudinal study in 21 wards of 7 randomly selected sub-districts across the Tarai (plains) of Nepal. Mid-year anthropometry was measured annually from 2013–2016 in children < 71 months (mo) of age. Children with paired data over a ∼1-year interval contributed to any of 6 age groups: < 6 mo [n = 645], 6–11 mo [n = 998], 12–23 mo [n = 744], 24–35 mo [n = 691], 36–47 mo [n = 730] and 48–59 mo [n = 637], reflecting age at the outset of the interval. Sex-specific, annualized growth velocities and incidence rates of growth faltering were calculated for each age. Growth faltering was provisionally defined as an annualized decrement (-△) in H/LA of >0.5 Z, corresponding to a ∼ >1 cm/year slower rate of linear growth than an estimated median velocity on the WHO referent growth curve for children < 6 months at the outset. A -0.5 △H/LAZ cutoff was applied to all ages. Results Annualized △H/LAZ [mean (SD)] was -1.3 (1.2), -0.8 (1.2), -0.3(0.8), 0.0 (0.7), 0.1(0.6), 0.1 (0.5) at each age specified above. Incidence of growth faltering was 79.8%, 66.3%, 40.4%, 11.7%, 4.9%, 2.1% at each respective age. Among infants < 6 mo whose initial LAZ was -1 < x < + 1 (excluding extrema), a △LAZ of < -0.5 or >0 (acceleration) was observed in 85.8% and 3.6%, respectively. Conclusions Growth faltering, expressed as an annualized decrement in HAZ >0.5 likely reflects biologically relevant deceleration before children reach < -2 H/LAZ. Two-thirds to 80% of infants in the Tarai of Nepal exhibit growth faltering the year after assessment. By 36 months and older, linear growth, parallels the WHO median attained HA on average, with < 5% appearing to falter, an age at which WHO growth velocity standard curves are lacking. Funding Sources The study was funded by USAID via a subaward from Tufts University under the Feed the Future Innovation Lab for Nutrition. Additional assistance was received from Sight and Life and the Gates Foundation.

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Developmental Dyslexia, Reading Acquisition, and Statistical Learning: A Sceptic’s Guide

Brain Sciences ◽

10.3390/brainsci11091143 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1143

Author(s):

Xenia Schmalz ◽

Barbara Treccani ◽

Claudio Mulatti

Keyword(s):

Statistical Learning ◽

Developmental Dyslexia ◽

Individual Variation ◽

Reading Ability ◽

Causal Chain ◽

Learning Ability ◽

Learning Skills ◽

Low Level ◽

Underlying Processes ◽

Theoretical Issues

Many theories have been put forward that propose that developmental dyslexia is caused by low-level neural, cognitive, or perceptual deficits. For example, statistical learning is a cognitive mechanism that allows the learner to detect a probabilistic pattern in a stream of stimuli and to generalise the knowledge of this pattern to similar stimuli. The link between statistical learning and reading ability is indirect, with intermediate skills, such as knowledge of frequently co-occurring letters, likely being causally dependent on statistical learning skills and, in turn, causing individual variation in reading ability. We discuss theoretical issues regarding what a link between statistical learning and reading ability actually means and review the evidence for such a deficit. We then describe and simulate the “noisy chain hypothesis”, where each intermediary link between a proposed cause and the end-state of reading ability reduces the correlation coefficient between the low-level deficit and the end-state outcome of reading. We draw the following conclusions: (1) Empirically, there is evidence for a correlation between statistical learning ability and reading ability, but there is no evidence to suggest that this relationship is causal, (2) theoretically, focussing on a complete causal chain between a distal cause and developmental dyslexia, rather than the two endpoints of the distal cause and reading ability only, is necessary for understanding the underlying processes, (3) statistically, the indirect nature of the link between statistical learning and reading ability means that the magnitude of the correlation is diluted by other influencing variables, yielding most studies to date underpowered, and (4) practically, it is unclear what can be gained from invoking the concept of statistical learning in teaching children to read.

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Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.44 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Lars W Andersen ◽

Katherine Berg ◽

Brian Z Saindon ◽

Joseph M Massaro ◽

Tia T Raymond ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

National Registry ◽

Epinephrine Administration ◽

Negatively Associated ◽

Logistic Regression Models ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age < 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

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Maternal Malnutrition, Breastfeeding, and Child Inflammation in India (P11-025-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-025-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Peter Rockers ◽

Anish Sharda ◽

Arun Shet

Keyword(s):

Breast Milk ◽

Maternal Nutrition ◽

Household Wealth ◽

Maternal Malnutrition ◽

Logistic Regression Models ◽

Reactive Protein ◽

Funding Sources ◽

Mothers And Children ◽

Mother And Child ◽

Mother’S Age

Abstract Objectives Previous research has demonstrated a relationship between maternal nutrition and inflammatory mediators in breast milk which may stimulate an immune response in breastfed children. The objective of this study is to explore the relationship between maternal malnutrition, breastfeeding, and child inflammation in a sample of children in India. Methods Data were collected from a cross-section of 401 mothers and children 12 to 23 months of age in India. Anthropometric information was collected from mothers and used to compute body mass index (BMI). Household demographics and information on breastfeeding practices were collected as part of a survey. Blood samples were drawn from mothers and children and tested for hemoglobin (mother and child) and C-reactive protein (CRP; child only). Anthropometric measurements were performed on children and used to compute length-for-age z-scores (LAZ). Logistic regression models were fit to estimate unadjusted and adjusted associations between current breastfeeding status (yes or no) and child inflammation (CRP > 3 mg/L), stratified by maternal underweight status (BMI < 18.5). The adjusted model included controls for child's age, mother's age, household wealth, a food insecurity index, and mother and child hemoglobin level. Additional models were fit to estimate associations between child inflammation and stunting (LAZ < -2). Results Among children of underweight mothers, those who were breastfed at the time of the assessment were significantly more likely to have inflammation (adjusted odds ratio (aOR) 4.08 [95% CI: 2.71, 6.16]; P < 0.001). There was no relationship between current breastfeeding and inflammation in children whose mothers were not underweight (aOR 1.18 [0.94, 1.49]; P = 0.152). Child inflammation was significant associated with stunting (aOR 1.95 [1.88, 2.01]; P < 0.001). Conclusions Our findings suggest that breast milk from malnourished mothers may stimulate inflammation in breastfed children. Consistent with previous research, we find that inflammation is significantly associated with stunted growth in children under two years old. Funding Sources This study was supported by grant funding from the Allen Foundation. Supporting Tables, Images and/or Graphs

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Biomarkers in the Hypothalamus-pituitary-adrenal Axis Were Associated with Maternal Psychosocial Stress and Choline Intake and Status During Pregnancy (P11-011-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-011-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Chauntelle Jack-Roberts ◽

Patricia Maples ◽

Anjana Saxena ◽

Mudar Dalloul ◽

John Kral ◽

...

Keyword(s):

Hpa Axis ◽

Psychosocial Stress ◽

Healthy Eating Index ◽

Dietary Quality ◽

Nutrition Status ◽

Dietary Intakes ◽

Omega 3 ◽

Gestational Length ◽

Negatively Associated ◽

Neighborhood Stress

Abstract Objectives Maternal psychosocial stress during pregnancy can lead to heightened activity of the hypothalamus-pituitary-adrenal (HPA) axis, increasing the risk of pre-term birth, intrauterine restriction, and preeclampsia. Maternal dietary intakes and nutrition status modify epigenetic marks in the placental and fetal HPA axis, which may then counter the negative influence of maternal stress. This study aims to determine the correlation of maternal psychosocial stress and nutrient intakes with biomarkers of HPA axis activity in human pregnancies. Methods Pregnant women (n = 60) were recruited to this observational study. Psychosocial stress survey, dietary recalls and blood samples were obtained in the 3rd trimester. Placentas and cord blood were retrieved at delivery. Results Maternal financial stress, neighborhood stress, and anxiety were positively or tended to be positively associated with maternal blood cortisol levels (P = 0.01-0.08), although none of the psychosocial stress measurements were correlated with placental corticotropin-releasing hormone (CRH), glucocorticoid receptor (NR3C1), or 11β-hydroxysteroid dehydrogenase (11BHSD) expression. Placental NR3C1 expression was positively associated with birth weight (r = 0.42, P = 0.02) while placental CRH was negatively associated with gestational length (r = –0.45, P = 0.01). Overall dietary quality as measured by the Healthy Eating Index (HEI) was not associated with psychosocial stress or related biomarkers, while intakes of the methyl donor choline (r = 0.46, P = 0.04) and omega-3 fatty acids (r = 0.47, P = 0.03) were positively associated with placental NR3C1 expression. Placental choline content was also positively associated with NR3C1 expression (r = 0.39, P = 0.04) and negatively associated with maternal neighborhood stress (r = –0.72, P = 0.02). Conclusions In summary, these data suggest that maternal psychosocial stress may adversely affect HPA axis functioning during pregnancy, whereas choline and other nutrients have the potential to counteract some of the impacts of psychosocial stress. Funding Sources CUNY Interdisciplinary Research Grant.

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Harmonization of Maternal Nutrition Trials – Finding and Creating Similarities in Protocols and Outcomes

Current Developments in Nutrition ◽

10.1093/cdn/nzaa065_003 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1738-1738

Author(s):

Alison Gernand ◽

Yemane Berhane ◽

Nita Bhandari ◽

Ranadip Chowdhury ◽

Fyezah Jehan ◽

...

Keyword(s):

Data Analysis ◽

Gestational Age ◽

Maternal Nutrition ◽

Time Frame ◽

Protein Supplementation ◽

Fetal Biometry ◽

Funding Sources ◽

Biospecimen Collection ◽

Gates Foundation ◽

Meta Analyses

Abstract Objectives Public health and clinical recommendations should be based on results from multiple studies, however trials often have outcomes that are not defined in the same way. This project aims to harmonize selected protocols, outcome definitions, and data analysis across five randomized trials of antenatal balanced energy-protein supplementation being conducted in Burkina Faso, Ethiopia, India, Nepal, and Pakistan. Methods Harmonization efforts include a range of activities from reviewing detailed protocols, biospecimen collection plans, data dictionaries, and data analysis plans to proposing best practices and acceptable practices based on field limitations. Most studies have not begun or are early in enrollment, an ideal time frame to make changes. A two-day workshop of lead investigators, content experts and advisors will be held in late February, and harmonization activities will continue thereafter. Results All studies are examining anthropometry at birth as a primary outcome, however the timing of birth measurements (hours since birth) and types of measurements taken differ across trials. All studies are estimating gestational age by ultrasound measurements, but the gestational age at ultrasound differs (in part due to differences in timing of antenatal care by country) as well as the number of fetal biometry measures. Finally, stillbirth is a key outcome across trials, but initial definitions had slight differences that will now be harmonized. We are also able to add new, important maternal and child health outcomes to each trial that will have the same protocols from inception (e.g., microbiome). Conclusions Efforts thus far have resulted in communication between study investigators, consideration of improved protocols, and addition of new outcomes to collect across all sites. Further results are forthcoming after the February workshop, which will include documentation of how much definitions vary across studies and the challenges of standardization. We expect the harmonization process to improve overall reporting within each study and provide opportunities for better meta-analyses. Funding Sources The Bill and Melinda Gates Foundation.

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Nutritional Iron Deficiency and Malaria: Impact of a Public-Private Partnership

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_042 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 837-837

Author(s):

Patricia Haggerty ◽

Daniel Raiten

Keyword(s):

Iron Deficiency ◽

Public Private Partnership ◽

Lessons Learned ◽

The Novel ◽

Private Partnership ◽

Funding Sources ◽

Novel Approach ◽

Research Track ◽

Gates Foundation ◽

The Impact

Abstract Objectives Background: In 2007 the Bill and Melinda Gates Foundation (BMGF) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) collaborated to address concerns about the safety and efficacy of interventions to prevent and treat nutritional iron deficiency (NID) particularly in the context of malaria. The “Iron and Malaria Project” (IMP) addressed how iron might not be safe, iron assessment, and the value of interventions to address NID. This presentation will: Describe the novel approach used to achieve the IMP goals, describe the IMP accomplishments and impacts, and summarize lessons learned. Methods The IMP had: 1) Research Track: NICHD initiated 2 funding opportunity announcements resulting in 10 funded projects; 2) Translation Track: a) consultations with global stakeholders; b) risk: benefit analyses on the use of interventions to prevent and treat NID; c) a collaboration with the CDC to develop standards for a sTfR assay; d) the BOND project to harmonize the process for discovery, development and deployment of nutrient biomarkers; e) the INSPIRE project, a review of extant evidence on reciprocal relationships between nutrition and inflammation; and f) the BRINDA project, a collaboration with the CDC, GAIN, and WHO to study the impact of inflammation on interpretation of biomarkers of iron and other determinants of anemia and develop approaches to account for this interaction. Results Funded grants included 4 basic science projects exploring mechanisms to explain iron and malaria interactions and 6 clinical studies addressing various aspects of the iron malaria relationship. To date, 72 journal publications have resulted. Using the NIH Relative Citation Ratio metric, 2/3 have scientific influence scores ≥the 50th percentile of all NIH-funded research publications and 15 have scores ≥ the 90th percentile. Conclusions The IMP leveraged the attributes of this public-private partnership between BMGF and NICHD/NIH to accomplish its goals. The partnership's complementarity and synergy resulted in broad traction and collaboration with a global community invested in solving the challenges of iron and malaria. Funding Sources BMGF $9.3 million, NIH Office of Dietary Supplements $1.3 million.

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Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda

Current Developments in Nutrition ◽

10.1093/cdn/nzaa067_060 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1833-1833

Author(s):

Nicolai Petry ◽

James Wirth ◽

Valerie Friesen ◽

Fabian Rohner ◽

Arcade Nkundineza ◽

...

Keyword(s):

Urban Areas ◽

Large Scale ◽

Household Survey ◽

Test Methods ◽

Food Fortification ◽

Program Performance ◽

Sweet Potatoes ◽

Cross Sectional ◽

Funding Sources ◽

Gates Foundation

Abstract Objectives Biofortification is a promising approach to increase micronutrient intakes, especially among populations that are hard to reach with other interventions. Information on the coverage of biofortified foods is needed to ascertain potential for impact, understand program performance, and identify bottlenecks. In this study, we aimed to develop and test methods and indicators for assessing household coverage of biofortified foods. Methods We developed five recall-based indicators of household coverage to assess biofortification programs building on approaches previously used to assess targeted and large-scale food fortification programs. These were: 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). We tested these indicators in a cross-sectional, cluster, household survey in 20 rural and five peri-urban areas in Musanze, Rwanda where two biofortification programs, i.e., biofortified beans and orange fleshed sweet potatoes (OFSP), were implemented. Results Among the 242 households surveyed, consumption of beans and sweet potatoes was high (99% and 96%, respectively) while awareness of biofortified beans or OFSP was 66% and 49%, respectively, and availability was 24% and 11%, respectively. Overall, 15% and 11% of households had ever consumed biofortified beans and OFSP, respectively, and 10% and 2% of households were currently consuming them, respectively. The major bottlenecks to coverage were awareness and availability of the biofortified foods. Conclusions The proposed methods and indicators fill a gap in the availability of tools to assess biofortification program coverage and the results of the survey highlight their utility for assessing program performance and identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different contexts. Funding Sources Bill & Melinda Gates Foundation.

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Adherence to DASH Dietary Pattern Is Inversely Associated with Osteoarthritis in Americans (P18-012-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-012-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ellen Francis ◽

Karen Kemper ◽

Joel Williams ◽

Liwei Chen

Keyword(s):

Dietary Pattern ◽

Survey Design ◽

Dietary Factors ◽

Common Disease ◽

Dash Score ◽

Complex Survey ◽

Logistic Regression Models ◽

Funding Sources ◽

Lower Likelihood ◽

Complex Survey Design

Abstract Objectives Osteoarthritis (OA) is a common disease which significantly contributes to disability among older adults. Dietary factors are suggested to play a role in preventing OA, however, studies in this area spare. The objective of this study was to assess the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) and OA in American adults. Methods This study included United States (US) adults (≥aged 20 years) who participated NHANES cycles 2007–2016. The Dietary Approaches to Stop Hypertension (DASH) score was calculated from nine food items with a higher DASH score indicating better adherence to the DASH dietary pattern. Multivariable logistic regression models adjusted for age, education, race/ethnicity, household income, smoking, alcohol consumption, and total energy intake were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of DASH with OA. All analyses accounted for the complex survey design. Results Among the 17,349 participants included in this study, 9.05% reported OA. The DASH score was inversely associated with OA. The aOR (95% CI) were 1.00 (ref), 0.09 (0.70, 1.16), and 0.74 (0.58, 0.94) (Ptrend = 0.01) across the DASH score tertiles. When analyses were stratified by BMI categories (normal, overweight, obese) the magnitude of the association was stronger and remained significant only among obese participants (i.e., BMI ≥ 30 kg/m2). Among participants with an obese BMI, participants with a DASH score in the highest tertile compared to participants with a DASH score in the lowest tertile had a 17% lower likelihood of having OA (P = 0.009). Conclusions In a representative sample of American adults, higher adherence to the DASH dietary pattern was associated with lower likelihood of having OA and this association was particularly evident among obese individuals. Funding Sources N/A. Supporting Tables, Images and/or Graphs

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