Infusing Representativeness and Cultivating Harmonization in Alzheimer’s Trials: World Wide FINGERS

World Wide Fingers is a network involving over 30 countries organized to conduct randomized controlled clinical trials to slow the progression of cognitive decline and reduce dementia risks. Trials are designed to parallel the successful Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial of a multidomain lifestyle intervention featuring increased physical activity, improved diet, cognitive training, and metabolic risk factor monitoring. While FINGER found that its intervention significantly benefited cognitive function, it is not clear whether this approach might be successfully tailored to other cultures and environments to yield similar results. This is the goal of World Wide FINGERS. It infuses representativeness by enrolling cohorts that reflect the communities in which it is conducted. For findings across the many trials to be integrated, it is necessary for protocols to be harmonized as much as possible. The COVID-19 pandemic presents special challenges towards harmonization as its disruptions of trial protocols and conduct vary among countries and over time. This symposium is organized to provide the scientific background and framework for the World Wide FINGERS. Novel grassroots efforts towards enrolling representative cohorts in the US will be described. Plans for harmonization and federated data analyses spanning international boundaries and regulations will be outlined. Integrated approaches to challenges of COVID-19 pandemic across trials will be presented. The conclusion of this session will be a discussion of how World Wide FINGERS may serve as a model for collaborative approaches to identify effective, translatable approaches to reduce risks for Alzheimer’s disease.

ASSOCIATIONS BETWEEN MATERNAL METABOLIC RISK FACTORS AND BIRTH OF OVERWEIGHT PREMATURE BABY

The relative contribution of individual metabolic risk factors and their clusters in pregnant women to the birth of premature infants, who are too large for their gestational age, is not fully understood. The aim of this study is to find the correlation between individual metabolic risk factors and their clusters in pregnant women and the birth of premature newborns, which are too large for their gestational age. This retrospective study included 84 preterm infants. The following metabolic risk factors were assessed in mothers of the children: the presence of overweight / obesity before pregnancy, weight gain during pregnancy, high blood pressure during pregnancy, as well as the growing level of triglycerides immediately after childbirth, high-density lipoproteins, cholesterol, and hyperglycemia. Adverse effects in children included delivery route, neonatal asphyxia, respiratory failure syndrome, and jaundice. The odds ratios were calculated for both an individual metabolic risk factor and their combination using logistic regression analysis. Metabolic risk factors such as hypertension, diabetes and dyslipidemia were significantly associated with the birth of premature babies, who are too large for their gestational age after adjustment for other factors. In a cohort of premature babies, no reliable relationship was found between obesity and the birth of children, who are too large for their gestational age. Children whose mothers have three metabolic risk factors at the same time, as a rule, are more likely (OR = 7.39, 95% CI 2.72-20.11) to be born too large for their gestational age. Pregnant women with a combination of metabolic risk factors for preterm birth are more likely to give birth to babies, who are large for their gestational age.

Analysis of renal calcular disease among children: our tertiary care experience

Background: Renal calcular disease is a common disorder that affects patients of all age groups. Paediatric age group is no exception and due to lack of timely intervention it can prove disastrous in the years to come. This study is aimed to assess and evaluate the clinical and metabolic profile of paediatric patients presenting with renal calculi. The research was conducted in a cross-sectional manner. Methods: The research enrolled a total of 254 urolithiasis patients aged 14 or less who presented to G. B. Panth hospital Srinagar. Structured history and relevant investigations were collected from all the patients. The physical exam, blood chemistry, and metabolite excretion in the urine (urinary calcium, citrate, magnesium, and oxalate) were all recorded.Results: There were 65 percent males and 35 percent females (2:1) among the 254 patients, with an average age of 8.15±5.04 years at presentation. In 54% of the patients, hypertension was discovered. Urea and creatinine levels were respectively 73.01, 59 mg/dl and 4.45, 4.01 mg/dl. The amount of PTH in the blood was 51.2931 pg/l. The calcium and phosphorus levels in the blood were 8.44±1.14 and 5.0234±0.895, respectively. Metabolic irregularities were discovered in 95 percent of the patients. Hypercalciuria was the most prevalent (54%), followed by hyperoxaluria (28%). In 21% of the patients, hypocitraturia was observed. In 7.8% of children, distal renal tubular acidosis was discovered. Just 4.7% of the children had a magnesium deficiency in their urine.Conclusions: The majority of children with stone disease have a metabolic risk factor, with hypercalciuria being the most frequent in our environment.

The Healthy Eating and Living Against Noncommunicable Diseases Study: An Innovative Family-Based Intervention

Objective Inadequate nutrition literacy within families is a barrier for healthy dietary choices and influences chronic disease risk. This pilot study examined the feasibility of providing an in-person nutrition intervention for families at high risk of developing prediabetes or type 2 diabetes and cardiovascular risk-factors. Methods Eligible families had at least one member with a non-communicable disease (NCD) or metabolic risk factor, fluency in English, willingness to attend all three educational sessions and complete questionnaires as a family unit. Sessions included didactic and experiential activities on food label reading, portion sizing, physical activity and modifiable lifestyle factors to reduce NCD risk. Demographics and fruit and vegetable screeners were collected from all participants at baseline and after completion of sessions. Families participated in focus groups to evaluate the program. Results Twelve families (n=35;17 adults;18 children) were recruited from New York City. Participants self-identified as Asian, Hispanic or Black. Adults had a mean age of 40y, BMI of 32.29kg/m2, household income of $35,000-$49,000y, and 13 of 17 adult participants had college degrees. Children ranged from 1-17y. Based on focus group feedback, three sessions were acceptable, families reported enjoying interactive activities and group learning and requested child-friendly activities. They reported improved knowledge of food labels, strategies for grocery shopping, portion-sizing, and increased awareness of the links between diet quality and NCDs. Conclusions and Implications The study met recruitment goals within 4 months. The educational intervention was acceptable and may be scaled-up for future studies on NCD prevention, particularly prediabetes and type 2 diabetes.

Prevalence of Cardio-metabolic Risk Factors among Young Saudi Women with Vitamin D Deficiency

Aims: The aim of this study was to determine the prevalence of cardio-metabolic risk factors in apparently healthy Saudi women with vitamin D deficiency. Study Design: A retrospective chart review. Place and Duration of Study: This study was conducted in the Center of Excellence for Osteoporosis Research (CEOR), King Abdulaziz University, Jeddah, Saudi Arabia, between June 2015 to October 2015. Methodology: Healthy women 20–40 years old, with no history of previous illnesses and not on any medications were included in this study. Data on anthropometric measurements as well as blood pressure (BP) were obtained. Body mass index (BMI) was calculated. Laboratory results including fasting blood glucose (FBG), fasting lipid profile, 25-hydroxyvitamin D3 (25(OH)D3) and parathyroid hormone (PTH) were also obtained. Vitamin D deficiency was defined as 25(OH)D3 concentration <50 nmol/l. Modified NCEP:ATPIII criteria were used to define cardio-metabolic risk factor cutoff points. Results: A total of 305 women were included in the current analysis. Mean (± S.D.) age of the study group was 28.4±6.1 years and median (IQR) 25(OH)D3 was 17.8 (11.9–28.2) nmol/l. Almost 97% of the study participants were vitamin D deficient and 70% had values below 25 nmol/l. 25(OH)D3 was significantly inversely associated with waist circumference, systolic and diastolic BP and PTH (P=0.011, <0.0001, <0.0001, <0.0001, respectively). Prevalence of cardio-metabolic risk factors were higher among participants who fell in the lowest tertile of 25(OH)D3 except total cholesterol and low density lipoprotein cholesterol, however only higher PTH was statistically significant (P=0.022). Conclusion: The results of the present study confirm the high prevalence of vitamin D deficiency among otherwise healthy Saudi women. The results also suggest that the prevalence of selected cardio-metabolic risk factors is higher among those with low vitamin D status. Prospective studies are needed to determine whether such deficiency will be of clinical significance with advancing age in this population, and whether vitamin D supplementation has beneficial effects.

Sex-Specific Association between Serum 25-Hydroxyvitamin D and Metabolic Risk Factors in T2DM Patients

Objective. To evaluate the relationship between serum 25-hydroxyvitamin (25(OH)D) levels and metabolic risk factor levels in patients with type 2 diabetes mellitus (T2DM) on a sex-specific basis. Methods. Our study comprised 507 patients with T2DM (321 men, 186 women; median age, 59 years). The metabolic risk factors examined included lipoprotein(a), glycated albumin (GA-L), and random blood glucose (RBG); the levels of these parameters were determined enzymatically. Serum 25(OH)D levels were measured by commercial ELISA kits. Participants were divided into low and high 25(OH)D groups according to the median 25(OH)D concentration (13.2 ng/mL). Two-way analysis of covariance and multiple linear regression analysis were performed. Results. The median 25(OH)D concentration was 13.9 ng/mL in men and 12.2 ng/mL in women. 25(OH)D levels inversely correlated with levels of three metabolic risk factors in a sex-dependent manner after adjusting for several confounding factors. These were lipoprotein(a) in men (141.3 ± 137.9 and 195.3 ± 204.8 mg/L in high and low 25(OH)D groups, respectively; P<0.05); GA-L in women (22.2 ± 8.8 vs. 23.3 ± 7.3% in high and low 25(OH)D groups, respectively; P<0.05). In a subgroup analysis, serum 25(OH)D levels inversely correlated with lipoprotein(a) levels in men (β = −0.185, P=0.002) and RBG levels in women (β = −0.176, P=0.028). Conclusion. Higher serum 25(OH)D levels indicate a more favorable lipid profile in men and a more favorable glucose profile in women.

Cardio-metabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal

Background The co-morbidity of cardio-metabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardio-metabolic risk factors among patients with Tuberculosis. Methods This was a cross-sectional study conducted in 12 tuberculosis centers from eight districts of Nepal between May and July 2017. A total of 238 patients with tuberculosis who visited Tuberculosis centers for Directly Observed Treatment Short-course therapy participated in this study. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on site blood glucose tests. Data were analyzed using descriptive and inferential statistics. Results Among 221 study participants, 138 (62.4%) had new smear positive pulmonary tuberculosis, 24 (10.9%) had new smear negative pulmonary tuberculosis and 34 (15.4%) had new extra pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardio-metabolic risk factor. The prevalence of at least one cardio-metabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR=0.47; CI: 0.23-0.94), those from Gandaki Province (AOR=0.32; CI: 0.13-0.79) and literate (AOR=0.49; CI: 0.25-0.96) had reduced risk of cardio-metabolic disease risk factors. Conclusions This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardio-metabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.

Nutrition as risk factor for development of chronic non-communicable diseases

Chronic non-communicable diseases are diseases that arise as a response of the human body to a number of factors, the most important of which are ecological and socio-economic factors. According to the World Health Organization, their classification is based on mortality and morbidity statistics. The top four leading causes of death are as follows: cardiovascular diseases, malignancies, chronic respiratory diseases and diabetes. Non-communicable diseases (NCDs) present a global public health problem, leading to over 40 million deaths a year, whereby the population aged 30 to 69 years account for one third of the total number of deaths. Risk factors for the development of chronic NCDs can be divided into metabolic and environmental ones. Metabolic risk factors include hypertension, hyperglycemia, hyperlipidemia and obesity. Environmental risk factors include: alcohol and tobacco consumption, followed by physical inactivity and unhealthy diet. Unhealthy diet, apart from posing a risk for the development of NCDs, is also the cause of metabolic risk factor development, namely hypertension and obesity. The world nutritional authorities are focused on making dietary recommendations to prevent the rising trend and subsequently reduce morbidity from NCDs.