Abstract P380: Steps Per Day and Step Intensity are Associated With a Lower Risk of Diabetes. The Hispanic Community Health Study / Study of Latinos (HCHS/SOL)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Carmen Cuthbertson ◽  
Christopher Moore ◽  
Daniela Sotres-Alvarez ◽  
Gerardo M HEISS ◽  
Olga Garcia-Bedoya ◽  
...  

Introduction: Physical activity has been associated with a lower risk of diabetes but less is known about the association of steps per day (steps/d) and step intensity with incident diabetes. Hypothesis: We hypothesized an inverse association between both number of steps/d and time spent at a stepping rate corresponding to purposeful steps ( > 40 steps/min) with the risk of incident diabetes. Methods: We included 7247 participants free of diabetes at baseline in the prospective HCHS/SOL cohort of Latinos sampled from four communities in the United States. Steps/d and minutes per day (min/d) at a stepping rate > 40 steps/min were assessed at baseline with the Actical accelerometer (2008-2011), and incident diabetes was ascertained at a follow-up visit (2014-2017). The association of steps with incidence rates (per 1,000 person-years) of diabetes and incidence rate ratios (IRR) was estimated using Poisson regression, accounting for the sampling design and adjusted for age, ethnicity, gender, education, smoking status, alcohol intake, and accelerometer wear time. Results: The average age at baseline was 38 years (range 18 - 74 years) and 52% were female. Over a median of 5.9 years, 850 participants (9%) developed diabetes. The median step count was 7360 steps/d and the median minutes per day at a stepping rate of > 40 steps/min was 55 minutes. For each 1,000 step/d increment, the risk of diabetes was 5% lower (Table, IRR= 0.95(95% confidence interval (CI) 0.88, 1.02)). Compared to adults who engaged in 2,000 steps/d, those who engaged in 5,000 and 10,000 steps/d had a 13% and 26% lower risk of diabetes. The risk of diabetes was 5% lower (IRR=0.95 (95% CI 0.89, 1.00)) per 10 minute increase in time spent at a stepping rate > 40 steps/min. Compared to adults who spent 10 min/d at > 40 step/min, those who spent 30, 60, and 120 min/d had a 10%, 20%, and 32% lower risk of diabetes. Conclusion: The number of steps per day and time spent at a stepping rate that corresponds to purposeful steps are inversely associated with the risk of developing diabetes among adults.

2020 ◽  
Vol 31 (6) ◽  
pp. 1315-1324
Author(s):  
Ana C. Ricardo ◽  
Matthew Shane Loop ◽  
Franklyn Gonzalez ◽  
Claudia M. Lora ◽  
Jinsong Chen ◽  
...  

BackgroundAlthough Hispanics/Latinos in the United States are often considered a single ethnic group, they represent a heterogenous mixture of ancestries who can self-identify as any race defined by the U.S. Census. They have higher ESKD incidence compared with non-Hispanics, but little is known about the CKD incidence in this population.MethodsWe examined rates and risk factors of new-onset CKD using data from 8774 adults in the Hispanic Community Health Study/Study of Latinos. Incident CKD was defined as eGFR <60 ml/min per 1.73 m2 with eGFR decline ≥1 ml/min per 1.73 m2 per year, or urine albumin/creatinine ratio ≥30 mg/g. Rates and incidence rate ratios were estimated using Poisson regression with robust variance while accounting for the study’s complex design.ResultsMean age was 40.3 years at baseline and 51.6% were women. In 5.9 years of follow-up, 648 participants developed CKD (10.6 per 1000 person-years). The age- and sex-adjusted incidence rates ranged from 6.6 (other Hispanic/mixed background) to 15.0 (Puerto Ricans) per 1000 person-years. Compared with Mexican background, Puerto Rican background was associated with 79% increased risk for incident CKD (incidence rate ratios, 1.79; 95% confidence interval, 1.33 to 2.40), which was accounted for by differences in sociodemographics, acculturation, and clinical characteristics. In multivariable regression analysis, predictors of incident CKD included BP >140/90 mm Hg, higher glycated hemoglobin, lower baseline eGFR, and higher baseline urine albumin/creatinine ratio.ConclusionsCKD incidence varies by Hispanic/Latino heritage and this disparity may be in part attributed to differences in sociodemographic characteristics. Culturally tailored public heath interventions focusing on the prevention and control of risk factors might ameliorate the CKD burden in this population.


Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Nicola P Bondonno ◽  
Frederik Dalgaard ◽  
Kevin Murray ◽  
Raymond J Davey ◽  
Catherine P Bondonno ◽  
...  

Introduction: The promotion of evidence-based diets is an important s trategy to mitigate the global health and economic burden of diabetes. Higher flavonoid intakes are associated with a lower risk of obesity and diabetes. Less clear are associations of the flavonoid subclasses with diabetes, the mediating impact of body fat, and the identification of subpopulations that may receive the greatest benefit. Hypothesis: Higher flavonoid intakes will be associated with lower body fat at baseline and a lower risk of diabetes during follow-up. Methods: Incident diabetes was assessed in 54,787 participants of the Danish Diet, Cancer, and Health Study followed-up for 23 years. Dietary intake and objective measures of body fat were assessed at baseline; habitual flavonoid intake was calculated using the Phenol-Explorer database and body fat was objectively assessed using bioelectrical impedance. Incidence of diabetes was obtained using Danish National Patient and Prescription Registries. Cross-sectional associations between flavonoid intakes and body fat were assessed using multivariable-adjusted linear regression models. Non-linear associations between flavonoid intake and incident diabetes were examined using restricted cubic splines based on multivariable-adjusted Cox proportional hazards models. Results: Among 54,787 participants without diabetes at baseline (median [IQR] age of 56 [52 - 60] years; (47.3%) men), 6,700 individuals were diagnosed with diabetes. Participants in the highest total flavonoid intake quintile (median, 1,202 mg/d) had a 1.52 kg lower body fat (95% CI: -1.74, -1.30) and a 19% lower risk of diabetes [HR (95% CI): 0.81 (0.75, 0.87)] after multivariable adjustments and compared to participants in the lowest intake quintile (median, 174 mg/d). Body fat mediated 51.6% of the association between flavonoid intake and incident diabetes. Neither smoking status, BMI, nor sex appeared to modify the association between total flavonoid intake and incident diabetes. However, the difference (flavonoid intake quintile 5 - quintile 1) in the 20-year estimated absolute risk of diabetes was greatest for current smokers (males: 2.19%, females: 1.65%) and those with a BMI ≥30 kg/m 2 (males: 5.56%, females: 4.59%), likely owing to the higher prevalence of diabetes in these “at risk” subgroups. Moderate to high intakes of flavonols, flavanol monomers, flavanol oligo+polymers, and anthocyanins, and the individual compounds within these subclasses, were associated with a lower risk of diabetes. Conclusion: In this Danish prospective cohort study, we observed that higher flavonoid intakes were cross-sectionally associated with lower body fat, and longitudinally associated with a lower risk of diabetes. Our results suggest that promoting a diet abundant in flavonoid-rich foods may help to ameliorate diabetes risk, in part through a reduction in body fat.


2020 ◽  
Vol 112 (5) ◽  
pp. 1318-1327
Author(s):  
Guo-Chong Chen ◽  
Qibin Qi ◽  
Simin Hua ◽  
Jee-Young Moon ◽  
Nicole L Spartano ◽  
...  

ABSTRACT 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 (&lt;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 &lt; 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 &lt; 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.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Bondonno ◽  
K Murray ◽  
C P Bondonno ◽  
J R Lewis ◽  
K D Croft ◽  
...  

Abstract Background Our understanding of how diet affects future risk of atrial fibrillation (AF) is limited. Evidence suggests that higher habitual intakes of flavonoids, bio-active compounds found in plant-based foods and beverages, lower cardiovascular disease risk, attenuate inflammation, and may have anti-arrhythmic properties. Purpose To investigate the association between flavonoid intake and clinically apparent AF in a large cohort of Danish men and women. Methods Baseline data from 55 634 participants without AF of the Danish Diet, Cancer and Health Study, recruited from 1993 to 1997, were cross-linked with Danish nationwide registries. Flavonoid intake was calculated from validated food frequency questionnaires using the Phenol-Explorer database. Associations between flavonoid intake and AF hospitalisation were examined using restricted cubic splines based on Cox proportional hazards models with adjustments for age, sex, BMI, smoking status, physical activity, alcohol intake, income, and hyperthyroidism. Results After a median [IQR] follow-up of 21 [18–22] years, 6 301 participants were hospitalised with AF. Non-linear associations were observed for total flavonoid intake and for all flavonoid sub-classes. For total flavonoid intake, after adjusting for potential lifestyle confounders and compared to participants in quintile 1 (median intake: 173 mg/day), those in quintile 3 (median intake: 320 mg/day) and quintile 4 (median intake: 494 mg/day) had a significantly lower risk of AF, with hazard ratios (95% CI) of 0.93 (0.87, 0.99) and 0.92 (0.86, 0.98), respectively. Compared to median intake in the lowest quintile, a total flavonoid intake of 1000 mg/day was associated with a lower risk of AF in smokers [0.86 (0.77, 0.96)] but not in non-smokers [0.96 (0.88, 1.05)], a lower risk of AF in high alcohol consumers [>20 g/d: 0.84 (0.75, 0.94)] but not in low-to-moderate alcohol consumers [<20 g/d: 0.97 (0.89, 1.06], a trending lower risk of AF in diabetics [0.76 (0.51, 1.14)] but not in non-diabetics [0.95 (0.89, 1.02)], and a trending lower risk of AF in those with ischaemic heart disease [0.84 (0.65, 1.09)] but not in those without [0.96 (0.89, 1.03), Figure 1]. Figure 1 Conclusion We observed an inverse association between total flavonoid intake and AF, most notably in sub-populations with known lifestyle and disease risk factors for AF. This finding warrants investigation in randomised controlled trials. If confirmed, ensuring the adequate consumption of flavonoid-rich foods, particularly in individuals “at risk”, may be an important strategy to mitigate AF risk. Acknowledgement/Funding The Danish Diet, Cancer, and Health Study was funded by the Danish Cancer Society.


Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Masaki Ohsawa ◽  
Kuniaki Ogasawara ◽  
Shinichi Omama ◽  
Kozo Tanno ◽  
Kazuyoshi Itai ◽  
...  

Background: Smoking is an important risk factor for cardiovascular disease, however, to what extent smoking increases excessive deaths and strokes in a general population has not been sufficiently examined especially in women. Methods: A total of 10,382 female and male participants aged 65 years or older were divided into two groups according to smoking status (current smoker; never smoker). Past smokers were excluded. Main outcomes were all-cause death and incident stroke. Age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis. Age-adjusted rate ratios (RR) and excess events (EE per 1000 person-years) attributable to smoking were determined using the rate in never smokers as a reference. Results: There were 1410 deaths and 735 strokes during the 9.0-year observation period (90,099 person-years). Smoking contributed to a 2.3-fold higher risk of death in women and 1.8-fold higher risk in men. It contributed to 12 excess deaths per 1000 person-years in both men and women. The rate ratio and excessive events of stroke were likely to be higher in women than those in men (RR: 2.6 vs. 1.6; EE: 9.3 vs 5.0, see table). Conclusion: Smoking significantly increases risks of death and stroke not only in men but also in women. Absolute risk difference of stroke attributable to smoking is likely to be larger in women than in men.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Stephanie E Chiuve ◽  
Kathryn M Rexrode ◽  
Qi Sun ◽  
Eric N Taylor ◽  
Gary C Curhan ◽  
...  

Background: Plasma magnesium (Mg) has been strongly associated with lower risk of fatal coronary heart disease (CHD) and sudden cardiac death, which may be due to its anti-arrhythmic properties. Mg also affects endothelial function, inflammation, blood pressure and diabetes and thus may impact atherosclerosis in general. We examined the association between magnesium, measured in diet and plasma, and risk of fatal, nonfatal and total CHD among women in the Nurses’ Health Study. Design: The association for Mg intake was examined prospectively among 86,361 women free of disease in 1980. Mg intake and other covariates were ascertained updated every 2-4 years through questionnaires and 3661 cases of CHD (1214 fatal/2447 nonfatal) were documented through 2008. For plasma Mg, we conducted a nested case-control analysis with 405 CHD (63 fatal/342 nonfatal) cases, matched to controls (1:1) on age, smoking, fasting status, and date of blood sampling. Results: Dietary magnesium was inversely associated with risk of CHD, even after controlling for diet and CHD risk factors (RR comparing extreme quintiles: 0.75; 95%CI: 0.64, 0.89; P trend=0.002) (Table 1). The relationship with plasma Mg was less linear ( P trend=0.09) with a potential threshold effect at the 2 nd quintile. The RR of CHD comparing plasma Mg >2.0 v. ≤2.0 mg/dl was 0.49 (95%CI: 0.32, 0.74). The associations for dietary and plasma Mg appeared stronger for fatal versus nonfatal CHD. The RR (95%CI; P trend) comparing the highest to lowest quintile of dietary Mg was 0.60 (0.45, 0.79; p <0.001) for fatal and 0.85 (0.70, 1.04; p = 0.14) for nonfatal CHD. The RR (95%CI) comparing plasma Mg >2.0 v. ≤2.0 mg/dl was 0.23 (0.07, 0.81) for fatal and 0.55 (0.35, 0.86) for nonfatal CHD. Conclusions: Higher levels of Mg, in diet and plasma, were associated with lower risk of total CHD among women. The consistent inverse association found between two measures of Mg and CHD risk supports the hypothesis that Mg might lower CHD risk through multiple mechanisms, and may be most strongly protective for fatal events.


Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Matthew J O'Brien ◽  
Mercedes R Carnethon ◽  
Frank J Penedo ◽  
Karen M Tabb ◽  
Sylvia Wassertheil-Smoller ◽  
...  

Background: Among Hispanics/Latinos, there is substantial heterogeneity in the prevalence of depressive symptoms and diabetes by background. This study aimed to examine the association between depressive symptoms and incident diabetes among Hispanic/Latino adults of diverse backgrounds. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective, community-based study of 16,415 self-identified Hispanic/Latino adults aged 18-74 years at Visit 1 (2008-2011) and 10,914 who have also completed the Visit 2 examination by August 2017. This analysis includes 8,804 participants who were free from diabetes at baseline and attended both Visits. Baseline depressive symptoms were assessed using the CES-D 10-item depression scale and divided into quartiles. Incident diabetes was defined by fasting glucose ≥126mg/dL, 2-hour postload glucose 140-199mg/dL, HbA1c ≥6.5%, or self-report. Accounting for HCHS/SOL complex survey design, we used Poisson regression models to estimate diabetes incidence density ratios (Table). Results: Baseline BMI was associated with both depressive symptoms and incident diabetes. Overall, 876 participants developed diabetes. In analyses stratified by Hispanic/Latino background, the association between baseline depressive symptoms and incident diabetes was significant for South Americans, Central Americans, and Mexicans. No significant associations between depressive symptoms and diabetes were seen among Hispanics/Latinos of Dominican, Cuban, or Puerto Rican backgrounds. Conclusions: These findings suggest that the association between depressive symptoms and incident diabetes in Hispanics/Latinos may differ by their background, with South and Central Americans at the highest risk. This difference may be partly explained by variation in participants’ understanding of CES-D questions by Hispanic/Latino background. Future research is needed to understand these novel findings fully and explore their implications for practice and policy.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Catherine Rahilly-Tierney ◽  
Howard D Sesso ◽  
J. Michael Gaziano ◽  
Luc Djousse

BACKGROUND: Few studies have examined prospectively the relationship between baseline high-density lipoprotein (HDL) cholesterol and longevity. OBJECTIVES: We sought to examine whether higher HDL levels were associated with lower risk of all-cause, cardiovascular (CVD), and non-CVD mortality prior to age 90 in the Physicians’ Health Study (PHS). METHODS: We considered a baseline cohort of 1351 PHS participants who provided bloods between 1997 and 2001 and were old enough to reach age 90 by March 4, 2009. Included subjects had complete baseline data on HDL and total cholesterol; lifestyle factors including smoking, exercise, alcohol consumption, and BMI; and comorbidities including hypertension, diabetes mellitus, congestive heart failure, cancer, and stroke. We used Cox proportional hazards to determine the HRs and 95% CIs for all-cause, CVD, and non-CVD mortality prior to age 90, adjusting for baseline age, co-morbidities, and non-HDL cholesterol. RESULTS: At baseline, the cohort had a mean (SD) age of 81.9 (2.9) years and a mean (SD) HDL cholesterol of 44.8(16.5) mg/dL. After a mean follow-up of 6.8 years (maximum 12.3 years), 501 (37.1%) of men died prior to age 90. In multi-variable adjusted analyses, men in the highest HDL-C quartile (≥54.1 mg/dL) had a 28% lower risk (HR 0.72, 95% CI 0.55-0.95) of all-cause mortality prior to age 90 compared to men in the lowest HDL-C quartile (<32.8 mg/dL). From the lowest to highest HDL quartile, age-adjusted HR(95%CI) for CVD mortality prior to age 90 were 0.66 (0.44-0.99), 0.58 (0.38-0.90), and 0.53 (0.34-0.82) (p for trend 0.004). There was no significant association between baseline HDL cholesterol and non-CVD death. CONCLUSION: In a cohort of older male physicians with long-term follow-up, baseline HDL cholesterol was inversely associated with the risk of dying prior to age 90, largely explained by an inverse association between HDL and CVD mortality.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S884-S884
Author(s):  
Fadi Youkhana ◽  
Yanyan Wu ◽  
Catherine M Pirkle ◽  
Eric Hurwitz ◽  
Andrew Grandinetti ◽  
...  

Abstract Parkinson’s disease (PD) is the second most common neurodegenerative disease in the United States with more than 50,000 new cases annually. Studies have reported an inverse relationship between smoking status and the risk for PD. Current smoking status, the number of pack-years smoked, and the lifetime duration of smoking have all been shown to have a lower risk for PD compared to non-smokers. However, studies exploring smoking behaviors in a multiethnic cohort with an ample sample size of PD cases to analyze smoking differences between men and women are rare. Using the Multiethnic Cohort (MEC), our study included 680 self-reported cases of PD from total sample of 98,191 Blacks, Latinos, Japanese, Native Hawaiians, and Whites from Hawaii and Los Angeles surveyed in 2003-2007. Stratified by sex, we conducted a cross-sectional logistic regression analysis to examine the odds of developing PD by various smoking indicators. Overall, current smokers had the lowest risk for PD (OR=0.46, 95%CI 0.27-0.76) compared to non-smokers. The odds of developing PD gradually decreased as the number of years of smoking increased with participants that smoked for 50 years or more having the lowest odds of developing PD (OR= 0.41, 95%CI 0.22-0.78) compared to non-smokers. Using a multiethnic cohort, our analyses further supported the inverse association between PD and smoking status, as well as the number of years of smoking. Future studies are necessary to investigate the possible genetic modulation on the relationship between tobacco and PD.


2020 ◽  
Vol 150 (10) ◽  
pp. 2825-2834
Author(s):  
Briana J K Stephenson ◽  
Daniela Sotres-Alvarez ◽  
Anna-Maria Siega-Riz ◽  
Yasmin Mossavar-Rahmani ◽  
Martha L Daviglus ◽  
...  

ABSTRACT Background Latent class models (LCMs) have been used in exploring dietary behaviors over a wide set of foods and beverages in a given population, but are prone to overgeneralize these habits in the presence of variation by subpopulations. Objectives This study aimed to highlight unique dietary consumption differences by both study site and ethnic background of Hispanic/Latino populations in the United States, that otherwise might be missed in a traditional LCM of the overall population. This was achieved using a new model-based clustering method, referred to as robust profile clustering (RPC). Methods A total of 11,320 individuals aged 18–74 y from the Hispanic Community Health Study/Study of Latinos (2008–2011) with complete diet data were classified into 9 subpopulations, defined by study site (Bronx, Chicago, Miami, San Diego) and ethnic background. At baseline, dietary intake was ascertained using a food propensity questionnaire. Dietary patterns were derived from 132 food groups using the RPC method to identify patterns of the general Hispanic/Latino population and those specific to an identified subpopulation. Dietary patterns derived from the RPC were compared to those identified from an LCM. Results The LCM identified 48 shared consumption behaviors of foods and beverages across the entire cohort, whereas significant consumption differences in subpopulations were identified in the RPC model for these same foods. Several foods were common within study site (e.g., chicken, orange juice, milk), ethnic background (e.g., papayas, plantain, coffee), or both (e.g., rice, tomatoes, seafood). Post hoc testing revealed an improved model fit in the RPC model [Deviance Information Criterion DICRPC = 2.3 × 104, DICLCM  = 9.5 × 106]. Conclusions Dietary pattern behaviors of Hispanics/Latinos in the United States tend to align by ethnic background for some foods and by location for other foods. Consideration of both factors is imperative to better understand their contributions to population health and developing targeted nutrition intervention studies.


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