Development Of Diet Score For Reflecting Diet Patterns and Dietary Guidelines: A Case Of Singapore

Foods and dietary patterns substantially affect health outcomes. The overall dietary assessment score associated with dietary guidelines in Singapore has not been assessed previously. This study aimed to develop and evaluate diet score for identifying the relationship between dietary patterns and dietary guidelines in Singapore. Using a localised diet score survey collaborated with the Commonwealth Scientific and Industrial Research Organisation (CSIRO), we conducted a cross-sectional study of 600 Singapore persons in two-generational cohorts (40-64: 300 and > 65 years: 300). The proposed local diet score was calculated to reflect their overall compliance with the Dietary Guidelines in Singapore. ANOVA analysis was used to identify the significant difference among socio-demographic variables associated with diet score and comparison analysis was performed to compare the diet patterns and diet score. There are significant differences among age, education, housing, residency associated with diet score. Diet score of older cohort (M= 67.71, SD= 13.38) is significantly higher than young cohort (M= 60.73, SD= 14.71). The highest education level (University or tertiary) obtain the lowest diet score (M= 58.58, SD= 14.41). The participants who live in the landed property (M= 69.45, SD= 14.43) are higher than those who live in Condominium and Public House. And the participants who live alone (M= 67.26, SD= 14.66) have a higher average diet score. Two-generational cohorts are not compliant with recommendations about dietary guideline well in Singapore. The present findings suggest that dietary patterns need improvement in aspects such as vegetables and extra food components.

Association of endothelial dysfunction with sarcopenia and muscle function in a relatively young cohort of kidney transplant recipients

Background Sarcopenia and endothelial dysfunction are both common among kidney transplant (KT) recipients. We aimed to evaluate the association between endothelial dysfunction and sarcopenia, as well as its individual components. Methods Vascular reactivity index (VRI), skeletal muscle index (SMI = skeletal muscle mass/height2), handgrip strength (HGS), and 6-meter usual gait speed (GS) were measured in 95 KT recipients. Low SMI was defined as SMI less than 10% of the sex-specific reference values from Chinese adults; low HGS as HGS < 28 kg for men and < 18 kg for women; slow GS as GS below 1.0 m/s. Sarcopenia was diagnosed based on the presence of low SMI as an essential criterion, accompanied by either low HGS or slow GS. Vascular reactivity was classified as being indicative of poor (VRI < 1.0), intermediate (1.0 ≤ VRI < 2.0), or good (VRI ≥ 2.0) vascular reactivity. Results Of the 95 patients, aged 45.2 ± 10.9 years, 11.6% had sarcopenia and 13.7% had poor vascular reactivity. Patients with sarcopenia were lower in body mass index (p = 0.001) and VRI (p = 0.041), and have a higher proportion of low muscle mass (p < 0.001), low HGS (p < 0.001), and slow GS (p = 0.001). Patients with poor vascular reactivity have a higher proportion of sarcopenia (p = 0.005), low HGS (p = 0.006), and slow GS (p = 0.029). Multivariate logistic regression analysis showed that patients in the poor VRI group were significantly associated with sarcopenia (odds ratio, OR = 6.17; 95% confidence interval [1.06–36.04]; p = 0.043), comparing to those with good VRI. We further analysed the effects of VRI on individual components of sarcopenia and found that VRI predicted slow GS significantly (OR = 0.41; 95% CI = [0.21–0.79]; p = 0.007), but not low SMI (OR = 1.15; 95% CI [0.53–2.49]; p = 0.718) and HGS (OR = 0.59; 95% CI [0.31–1.16]; p = 0.125). Conclusions We concluded that endothelial dysfunction is a key determinant of sarcopenia in KT recipients. Furthermore, endothelial dysfunction is more closely related to gait speed than muscle mass and strength.

909. Treating Hepatitis C Virus (HCV) in Young Adult Active Drug Users Is Possible

Background Successful treatment of HCV in persons who inject drugs (PWIDS), has been reported for patients who were older or who had used drugs more than 6 months prior. The young, &lt; 35 year of age (yoa), active user has not been well studied or reported. We performed a pilot treatment study in a young cohort of PWIDS to evaluate cure rates of HCV in this population. Methods Young, active PWIDS using &lt; 6months earlier, &lt; 35 yoa were identified. Treatment for HCV with glecaprevir/pibrentasvir (G/P) and concurrent treatment for opiate use disorder with XR Naletrexone (XR-NTX) was provided. Two patients chose methadone. Patients were followed up to 12 months after enrollment. Patients were evaluated for adherence, side effects, alanine aminotransferase (ALT) levels, urine drug screens (UDS) and opioid craving scores using a visual analog scale (VAS) while on XR-NTX to assess management of their addiction. Rates of treatment completion, SVR 4 & 12 were determined. Results 30 patients were recruited: 18 were women. Average age was 28 with a range of 23-35. Recent injection drug use was common with 22 (73%) having injected within the 30 days and all having injected within 3 months of recruitment. The average ALT on enrollment was 106. Genotypes were 1 (15), 3a (11), and unknown (4). Of the 30 patients, 15 failed to come for the required 2 visits prior to starting G/P. Lost to follow up occurred due to relapse of addiction (9), overdose death (1), lost communication and suspected relapse (4). 15 began and completed G/P. 15 were cured of their HCV infection. 17 patients receive one or more doses of XR-NTX. On average patients were on XR-NTX for 4.8 months. Sobriety was measured for patients on XR-NTX using Opiate Craving Scores using the Visual Analogue Scale (VAS) and UDS (Figure 1) demonstrating excellent control of craving and significant declines positive UDS. Toxicities were uncommon with no treatment limiting adverse events. Adverse effects of XR-NTX included mild injection site irritation. No ALT abnormalities were noted. Conclusion Young active PWIDS can successfully be cured of HCV. Their addiction can be concurrently managed with XR-NXT. Our findings suggest it is safe to treatment active users with active HCV with XR-NXT improving elimination goals. Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau) Ruth A. Homer, MSW, Abbvie (Grant/Research Support)Alkermes (Grant/Research Support)

Combining Navigator and Optical Prospective Motion Correction for High-Quality 500 μm Resolution Quantitative Multi-Parameter Mapping at 7T

PURPOSEHigh-resolution quantitative multi-parameter mapping shows promise for non-invasively characterizing human brain microstructure but is limited by physiological artifacts. We implemented corrections for rigid head movement and respiration-related B0-fluctuations and evaluated them in healthy volunteers and dementia patients.METHODSCamera-based optical prospective motion correction (PMC) and free-induction decay (FID) navigator correction were implemented in a gradient and RF-spoiled multi-echo 3D gradient echo sequence for mapping proton density (PD), longitudinal relaxation rate (R1) and effective transverse relaxation rate (R2*). We studied their effectiveness separately and in concert in young volunteers and then evaluated the navigator correction (NAVcor) with PMC in a group of elderly volunteers and dementia patients. We used spatial homogeneity within white matter (WM) and gray matter (GM) and scan-rescan measures as quality metrics.RESULTSNAVcor and PMC reduced artifacts and improved the homogeneity and reproducibility of parameter maps. In elderly participants, NAVcor improved scan-rescan reproducibility of parameter maps (coefficient of variation decreased by 14.7% and 11.9% within WM and GM respectively). Spurious inhomogeneities within WM were reduced more in the elderly than in the young cohort (by 9% vs 2%). PMC increased regional GM/WM contrast and was especially important in the elderly cohort, which moved twice as much as the young cohort. We did not find a significant interaction between the two corrections.CONCLUSIONNavigator correction and PMC significantly improved the quality of PD, R1 and R2* maps, particularly in less compliant elderly volunteers and dementia patients.

Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients

Introduction While surgery is the primary treatment choice for intracranial meningiomas in young patients, surgery in elderly patients, especially those with pre-existing comorbidities, has been the subject of repeated discussion. This study investigated the postoperative risks and neurological benefits of meningioma surgery in elderly patients compared to young patients. Methods In total, 768 patients were included and divided into two main groups: group I (age: ≤ 64 years; 484 young patients) and group II (age: ≥ 65 years; 284 elderly patients). Group II was subdivided into: IIa (age: 65–69 years), IIb (age: 70–79 years); and IIc (age: ≥ 80 years). Results The total tumor resection rate was higher in the elderly cohort than in the young cohort (84.5 and 76.2%, respectively). 154 young patients (31.8%) and 132 elderly patients (46.5%) developed postoperative morbidities, with the three most common being bleeding (12.9%), cranial nerve disorder (10%) and CSF fistula (8.1%). Postoperative bleeding, palsy, speech disorder, pneumonia and renal insufficiency were dependent on age (r = 0.123, p = 0.001; r = 0.089, p = 0.014; r = 0.100, p = 0.006; r = 0.098, p = 0.007 and r = 0.084, p = 0.020) and presented more often in elderly patients. 6 young and 15 elderly patients died during the 17.4-year observation period. Most patients showed a significant improvement in postoperative KPS (p < 0.001), except those over 80 years old (p = 0.753). The KPS at the last follow-up was significantly improved in all patients (p < 0.001). Conclusion Meningioma surgery is associated with a higher rate of postoperative complications in elderly patients than in young patients. Most elderly patients, similar to young patients, show a significant improvement in neurological status postoperatively.

Ultrasonic diagnosis of skin, facial, neck and hand soft tissue in women of different age: a non-randomised observational cross-sectional study

Background. A dynamic cross-layer visualisation of skin, its vascular structure in various anatomical facets during treatment in different age cohorts holds both scientific and practical value.Objectives. A semiotic study of skin, facial, neck and hand soft tissues using high-resolution ultrasound in women of different age cohorts.Methods. A total of 63 women aged between 22 and 59 years were enrolled. The study was designed with two comparison cohorts. The inclusion criteria were: women aged 22-59 years with no evident somatic or acute dermatological pathology not having aesthetic procedures for at least one month prior to the ultrasound examination of skin, facial, neck and hand soft tissues. The cohorts separated by age. Cohort 1 included 32 women aged 22-44 years (young), and cohort 2 — 31 women aged 45-59 years (middle-aged). High-resolution ultrasound (US) was performed in B-mode, colour Doppler and microV imaging.Results. A maximal dermal thickness was facial middle-third in both cohorts, averaging to 1.87 ± 0.35 mm in the young and 1.57 ± 0.23 — in middle-aged cohort (p <0.0001). A minimal dermal thickness in both cohorts was periorbital (1.16 ± 0.15 mm in the 22-44-year and 0.95 ± 0.12 — in 45-59-year cohort) and in dorsal hand surface (0.89 ± 0.13 and 0.9 ± 0.16 mm, respectively, p <0.0001). The dermal thickness in face and neck diminished with age due to a thinning papillary layer. An adequate dermal vascularisation rate was greater in the young cohort (p = 0.038).Conclusion. Ultrasound is effective in the diagnosis of skin, facial, neck and hand soft tissues at the planning and further control of safe injection and hardware aesthetic procedures, allowing a real-time thickness assessment of epidermis, dermis and its layers, vessels, subcutaneous fat and mimic muscles in norm and during complications.

Child Growth and Adolescent Pregnancy: A Longitudinal Sibling Comparison in Peru

Objectives We aim to quantify the longitudinal growth differences during childhood and early adolescence between siblings born at different maternal ages at delivery (adult vs. adolescent/young). Methods We analyzed data from siblings of the same biological parents of the young cohort from the Young Lives Study in Peru, over 14 of follow-up. Elder siblings were enrolled at one year of age (2002), while younger siblings were enrolled in the third cohort visit (2009). We include elder siblings who were firstborn only and younger siblings who were second-born children. We performed three-level hierarchical models using Gaussian and Poisson families for height for age Z-score (HAZ) and stunting prevalence, respectively, to estimate predicted values at age 2, 5, 8, and 12. We report absolute marginal average contrasts (Φ) between a younger sibling and elder sibling born to adult (25–34 years) and adolescent/young mothers (15–24 years), respectively. Moreover, we adjust the estimate of interest with expected differences between siblings born to mothers in the same maternal age at delivery group. Results The total eligible sample included 310 pairs of siblings, where 85% of index children and 65% of younger siblings were born to adolescent/young women. Contrasts between a sibling from an adult mother and a firstborn index were positive up to age 12 for HAZ (Φ: 0.20 95% CI 0.01, 0.39) and negative for stunting (Φ: −5.09% 95% CI −12.28, 2.10). Expected differences between siblings born to adult mothers in the same delivery age group did not substantially change the findings for HAZ (ΦA: 0.29 95% CI 0.04, 0.53) but increase the magnitude of stunting differences (ΦA: −9.70% 95% CI −15.40, −4.01). Expected differences between siblings born to adolescent mothers decrease the magnitude of both estimates but remain their direction. Conclusions Younger siblings born to adult mothers outperformed older siblings born to adolescent mothers in growth throughout childhood and early adolescence. The long-lasting effects of adolescent pregnancy on their offspring's nutrition ought to be addressed with social policies focused on preventing adolescent pregnancy. Funding Sources None.

Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients: A regional perspective.

e18604 Background: In developing countries, breast cancer treatment outcomes may be uniquely affected by the tendency of breast cancer patients to develop the disease at a much younger age than the worldwide average. Contrarily, older patients tend to present with multiple comorbidities that complicate their outcomes and influence their treatment options and decisions. This study will be the first to investigate the dichotomies between older and young breast cancer patients in our region. Methods: The study was based on data collected from the cancer registry of our institution for breast cancer patients 65 years or older (n = 553), and patients 40 years or younger (n = 417) at time of diagnosis. Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Results: A total of 970 patients were included in the final analysis. Compared to younger patients, older ones were more frequently diagnosed with distal metastasis; 20.6% compared to 15.1%, p =0.028. However, among patients with non-metastatic disease, younger ones tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p< 0.001), T-3/4 (28.2% vs. 13.8%, p< 0.001) and HER2-positive disease (29.3% vs. 16.3%, p< 0.001). A higher percentage of patients from the young cohort underwent surgery (85.4%) when compared to the older group (74.9%), p< 0.001. More patients in the older group had mastectomy than did younger patients (67.5% versus 40.2%, p< 0.001), while breast conserving surgery (BCS) was performed on almost a third in each cohort, p= 0.245. Skin-sparing, with or without, nipple-sparing mastectomies (SSMs) along with breast reconstruction surgery were more frequently performed on younger patients than they were on the older patients. After a median follow-up of 59 months for the younger patients and 45 months for the older ones, the 5-year OS rate of the older patients was 67.6% compared to 72.1% for the younger patients, p= 0.035. However, the 5-year DFS rates of the two cohorts were not statistically different at 63.9% for the older group and 60.7% for the young patients, p= 0.31. The survival of patients with non-metastatic disease was also compared among both groups; the 5-year OS among the younger patients was significantly higher (83.6% compared to 78.8% among the older patients, p= 0.046). Survival was better among the younger patients across many clinical and pathological characteristics. Conclusions: Younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was insignificant, suggesting that older women were more likely to die from non-cancer related causes.

Associations between 20-year lipid variability throughout young adulthood and midlife cognitive function and brain integrity

Background Little is known about long-term lipid variability in young adulthood in relation to cognitive function and brain integrity in midlife. Methods We studied 3,328 adults from the Coronary Artery Risk Development in Young Adults. We defined low- and high- density lipoprotein (LDL, HDL) variability as the intra-individual standard deviation of lipid measurements over 20 years of young adulthood (1985–2005). Cognitive tests were administered in 2010. Brain scans were performed in 2010 on 714 participants. To facilitate comparison, cognitive tests and brain metrics were z-scored. Results Mean age at baseline was 25.4 years. Higher 20-year LDL variability was associated with worse verbal memory in midlife (β=-0.25, 95% CI [-0.42, -0.08]), adjusted for important covariates. Higher 20-year HDL variability was associated with worse processing speed in midlife (β=-0.80, 95% CI [-1.18, -0.41]) and brain integrity, e.g. smaller total brain volume (β=-0.58, 95% CI [-0.82, -0.34]) and worse total brain fractional anisotropy (β=-1.13, 95% CI [-1.87, -0.39]). Conclusions Higher long-term lipid variability in adulthood was associated with worse cognition and brain integrity in midlife, in a relatively young cohort.