Adverse Childhood Experiences and Health Care Utilization in a Low-Income Population.

OBJECTIVE: To determine associations of adverse childhood experiences (ACE) with adult health care utilization in an underserved, low-income population. METHODS: Questionnaires on ACE were completed by 38,200 adults (mean age 54), two-thirds African American, recruited from community health centers (CHCs) across 12 Southeastern states. Odds ratios (ORs) and accompanying 95% confidence intervals (CIs) were computed. RESULTS: The percentages reporting emergency room visits and doctor's office visits, with high chronic disease index scores, rose monotonically (ptrend<.001) with rising ACE score. Odds ratios (CIs) for those with four or more vs. zero ACEs were 1.37 (95% CI 1.27-1.47) for 1-10 times and 1.80 (95% CI 1.29-2.52) for more than 10 times ER visits, 1.37 (95% CI 1.18-1.59) for over 10 doctor's visits, and 2.29 (95% CI 2.06-2.54) for three or more chronic diseases. CONCLUSIONS: High ACE levels were associated with greater chronic disease burden and greater health care utilization in adulthood. Long-lasting effects from ACE on the health care of underserved populations are indicated. There is an urgent need to train health care providers, patients, and their families on ACE effects and treatments for better health care outcomes.

Physical Activity Levels and Cardiometabolic Risks in Obese African American Adults: A Pilot Intervention Study.

Limited information is available regarding the effects of physical activity on risks of cardiometabolic diseases among obese African American adults. We conducted a church-based 12-week weight control and cardiometabolic risk reduction intervention (n=30, 22 females, 56.7±11.4 years old, BMI 37.4±6.7 kg/m2), after which body weight was slightly reduced (98.3±18.4 and 97.3±19 kg, p=.052); body fat percentage was significantly decreased among males (34.7±8.9 to 28.5±8.4 %; p=.049); and walking steps were increased, but not significantly. Among measured cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) was decreased significantly (6.8±1.1 to 6.1±1.1%; p=.0004) while time spent in sedentary behaviors was associated with less favorable change in total cholesterol (ß=11.49, SE=3.55, p=.003) and tumor necrosis factor (TNF-α, ß=0.3, SE=0.13, p=.038). Our study shows that adiposity reduction was feasible through a short-term healthy lifestyle program for obese African American adults, and suggests that reducing sedentary behaviors through light physical activity might lead to a decrease in cardiovascular risks.

Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study.

OBJECTIVE: The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. METHODS: Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. RESULTS: Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, ß = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. CONCLUSIONS: This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.

Plasma Lycopene Is Associated with Pizza and Pasta Consumption in Middle-Aged and Older African American and White Adults in the Southeastern USA in a Cross-Sectional Study.

BACKGROUND: The role of dietary lycopene in chronic disease prevention is not well known. METHODS: This study examined intake of lycopene and other antioxidants from lycopene-rich foods (e.g., pizza and pasta) simultaneously with plasma levels of lycopene and other antioxidants in a representative cross-sectional sample (187 Blacks, 182 Whites, 40-79 years old) from the Southern Community Cohort Study (SCCS). The SCCS is an ongoing study conducted in populations at high risk for chronic diseases living in Southeastern United States. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and plasma levels of lycopene and other antioxidants were measured at baseline (2002-2005). The participants were classified into tertiles according to consumption of pizza and pasta food groups. RESULTS: Lycopene dietary intake and plasma lycopene concentrations were significantly higher in the highest (tertile 3) compared to tertiles 1 and 2 (both P < 0.01). Total energy intake ranged from 1964.3 ± 117.1 kcal/day (tertile 1) to 3277.7 ± 115.8 kcal/day (tertile 3) (P<0.0001). After adjusting for age and energy intake, total dietary fat, saturated fatty acids, trans-fatty acids, and sodium intakes were significantly higher in tertile 3 than tertiles 2 and 1 (all P <0.01). Vitamin C intake was significantly lower in tertile 3 than tertiles 1 and 2 (P = 0.003). Except for γ-tocopherol being higher in tertile 3 than tertiles 1 and 2 (P = 0.015), the plasma concentrations of antioxidants were lower in tertile 3 than tertiles 1 and 2 (ß-carotene, α-carotene, lutein and zeaxanthin, all P<0.05). CONCLUSIONS: In the SCCS population, pizza and pasta were the main sources of dietary lycopene and their intake was associated with plasma lycopene concentration. Diets with frequent pizza and pasta consumption were high in energy, saturated fatty acids, trans-fatty acids, sodium and low in other antioxidants. Future studies of lycopene as a protective dietary factor against chronic disease should consider the overall nutritional quality of lycopene-containing foods.

Association of infant feeding with adiposity in early childhood in a WIC sample.

OBJECTIVES: To evaluate the association of different infant feeding practices with adiposity in early childhood. METHODS: Survey was conducted among 150 White, Black, and Hispanic low-income families with children ages 2­4. RESULTS: History of supplementing breast milk with formula (mixed feeding) was more prevalent among Hispanic children (67.4%) than either White (8.5%) or Black children (22.7%) (p<.001). African American children had the highest BMI percentile of the three groups (p=.043), although Hispanic children had slightly higher birth weight than the other two groups (p=.06). Among Hispanic children, after adjusting for confounding variables including maternal BMI, the mixed feeding group and the exclusive formula-feeding group had significantly higher BMI percentile (b=3.068 and b=2.936, respectively) than the exclusive breastfeeding group. These associations were not observed among Blacks and Whites. CONCLUSION: Further research is warranted on the impact of different feeding practices during infancy on subsequent adiposity during pre-school years

Childhood obesity prevention interventions in childcare settings: systematic review of randomized and nonrandomized controlled trials.

OBJECTIVE: Childcare settings are an opportune location for early intervention programs seeking to prevent childhood obesity. This article reports on a systematic review of controlled trials of obesity prevention interventions in childcare settings. DATA SOURCE: The review was limited to English language articles published in PubMed, Web of Science, and Education Resources Information Center (ERIC) between January 2000 and April 2012. INCLUSION CRITERIA: childhood obesity prevention interventions in childcare settings using controlled designs that reported adiposity and behavior outcomes. EXCLUSION CRITERIA: no interventions, non-childcare settings, clinical weight loss programs, non-English publications. DATA EXTRACTION: Publications were identified by key word search. Two authors reviewed eligible studies to extract study information and study results. DATA SYNTHESIS: Qualitative synthesis was conducted, including tabulation of information and a narrative summary. RESULTS: Fifteen studies met the eligibility criteria. Seven studies reported improvements in adiposity. Six of the 13 interventions with dietary components reported improved intake or eating behaviors. Eight of the 12 interventions with physical activity components reported improved activity levels or physical fitness. CONCLUSION: Evidence was mixed for all outcomes. Results should be interpreted cautiously given the high variability in study designs and interventions. Further research needs long-term follow-up, multistrategy interventions that include changes in the nutrition and physical activity environment, reporting of cost data, and consideration of sustainability.

Highly unsaturated n-3 fatty acids status of Canadian Inuit: International Polar Year Inuit Health Survey, 2007-2008.

OBJECTIVES: Previous studies suggest that dietary patterns and the extent of reliance upon traditional food vary among Inuit communities. Inuit traditional foods are an important source of nutrients such as highly unsaturated n-3 fatty acids (HUFA n-3), whose beneficial effects include protection against ischemic heart disease. Dietary transition is occurring with younger generations consuming less traditional foods and more market foods with low nutrient density. Utilizing erythrocyte membrane fatty acid composition as an indicator of body HUFA n-3 status, which reflects dietary intake levels of traditional Inuit foods, we explored the regional and age variability of highly unsaturated n-3 fatty acids (HUFA n-3) in the International Polar Year Inuit Health Survey. STUDY DESIGN: Cross-sectional health survey. METHODS: Participants were recruited through random sampling of households. Fatty acid data were available among 2,200 adults (≥18 yr). RESULTS: HUFA n-3 levels in the Eastern Arctic were significantly higher than in the Western Arctic, with Nunatsiavut (northern Labrador) and Baffin showing the highest HUFA n-3 status compared to Kivalliq, Kitikmeot and Inuvialuit Settlement Region (ISR) (p<0.0001). Fatty acid proportion in erythrocyte membranes showed pronounced differences between coastal communities and inland communities, including a higher HUFA n-3 status among the coastal communities (p<0.0001). Additionally, the HUFA n-3 status showed a strong positive association with age, particularly in Baffin and Kivalliq. HUFA n-3 were inversely associated with saturated (ß=-0.98 [SE=0.03], R2=0.36, p<0.0001) and trans fatty acids (ß=-0.06 [SE=0.004], R2=0.07, p<0.0001). CONCLUSIONS: The present study results provided biochemical support for varying dietary patterns and dietary transition among Inuit across the Canadian Arctic. The analyses also suggested multifactorial determinants of HUFA n-3 status among Canadian Arctic Inuit. A nutritional intervention strategy with multiple approaches may be needed to improve and maintain their HUFA n-3 status.

Is iron status associated with highly unsaturated fatty acid status among Canadian Arctic Inuit?

Impaired fatty acid synthesis was noted in iron deficient animal models. Human data, however, are scarce. Although Canadian Inuit have a traditional diet rich in heme iron and long chain n-3 fatty acids, recent literature has also indicated the presence of prevalent iron deficiency. We aimed to explore whether the presence of iron deficiency would affect fatty acid status and an estimate of the activity of desaturase 5 (Δ5), which is crucial in the biosynthesis of highly unsaturated n-3 fatty acids among Canadian Inuit. Erythrocyte membrane fatty acid composition was utilized as an indicator of fatty acid status and serum ferritin and circulating hemoglobin level were measured as the indicators of iron status. Data analyzed were collected among 1511 Canadian Inuit adult participants in the International Polar Year Inuit Health Survey, 2007-2008. Only 13.7% of survey participants had iron deficiency; however, serum ferritin showed a moderate positive association with highly unsaturated n-3 fatty acids after adjusting for age, waist and C-reactive protein (r = 0.172, P < .0001). Serum ferritin correlated significantly with Δ5 after further adjusting for highly unsaturated n-3 fatty acids (r = 0.126, P < .0001). Although the current study only demonstrated a weak link between ferritin and Δ5, the latter association underscores a possible health risk caused by a nutrient interaction related to reduced iron intake and decreased highly unsaturated n-3 fatty acid biosynthesis. Future studies are recommended to evaluate iron status in relation to highly unsaturated n-3 fatty acid biosynthesis and status among indigenous people undergoing rapid dietary transitions.

Decreased activity of desaturase 5 in association with obesity and insulin resistance aggravates declining long-chain n-3 fatty acid status in Cree undergoing dietary transition.

Emerging evidence shows that desaturase 5 (Delta5), the key regulator in the synthesis of highly unsaturated long-chain fatty acids (HUFA), is modulated by factors including adiposity, diet and insulin resistance. We explored the association of these factors in a cross-sectional study within a high-risk Cree population. Anthropometric measures and fasting blood glucose and insulin were analysed. Delta5 was estimated as the 20 : 4n-6:20 : 3n-6 ratio in erythrocyte membranes. The setting of the present study was the Mistissini community in the Cree Territory of Québec, Canada with ninety-eight female and sixty-eight male subjects aged 20-88 years. Obesity (BMI > or = 30 kg/m2) was prevalent across age groups. Delta5 was inversely associated with BMI (Spearman's correlation coefficient (rs) - 0.175; P = 0.03) and positively associated with age (rs 0.593; P < 0.0001), which was driven by age-related increases in dietary intake of n-3 fatty acids and decreases in 20 : 3n-6. Homeostasis model assessment of insulin resistance (HOMA-IR) was significantly inversely associated with Delta5 in age-adjusted linear regression analyses in normoglycaemic individuals (beta - 2.110 (SE 0.566); P < 0.001), whereas no association was observed among glucose-intolerant individuals (interaction term P = 0.03). In contrast, there were no significant interactions indicating differences in the slope for each of the adiposity measures in their associations with Delta5. The present study indicates that the dietary transition of reduced consumption of fish among younger Cree may compound the effects of obesity and emerging insulin resistance which, in turn, could reduce bioavailability of HUFA n-3 (through reduced Delta5 activity). Also, the study suggests that disease progression is an important consideration when evaluating correlates of Delta5 activity in observational studies.

The association of desaturase 9 and plasma fatty acid composition with insulin resistance-associated factors in female adolescents.

Desaturase 9 (Delta 9), which converts saturated fatty acids (SFAs) into monounsaturated fatty acids, is an important component in leptin-mediated energy homeostasis in rodent models. Few human studies, however, have been performed regarding the clinical relevance of Delta 9, particularly whether Delta 9 is involved in the relationship between blood fatty acid profiles and insulin resistance-associated factors. The aim of the present study was to examine fatty acid data from 178 apparently healthy female adolescents and determine whether (a) Delta 9 has independent associations with adiposity, insulin resistance level, and fasting plasma polyunsaturated fatty acids (PUFAs); (b) Delta 9 is a predictor of fasting blood lipid profile; and (c) the associations between fasting plasma fatty acid component and insulin resistance level are independent of abdominal obesity level. Desaturase 9-16 (surrogate of Delta 9 as calculated by plasma ratio C16:1 n-7/C16:0) correlated with waist girth (r = .160, P < .05), homeostasis model assessment of insulin resistance (HOMA-IR) (r = .201, P < .01), plasma PUFAs (eg, C20:4 n-6 [r = -.269, P < .001], C22:6 n-3 [r = -.274, P < .001]). After adjustment for dietary SFAs, Delta 9-16 had stronger correlation with waist (r = .227, P < .01) and significant correlation with PUFAs, whereas it had a nonsignificant correlation with HOMA-IR. The same pattern was observed with Delta 9-18 (surrogate of Delta 9 as calculated by plasma ratio C18:1 n-9/C18:0). After adjustment for dietary SFAs, waist, and HOMA-IR, Delta 9-16 and Delta 9-18 were still positive predictors of triglyceride (both P < .001) and apolipoprotein B (Delta 9-18, P < .001; Delta 9-16, P = .052). After adjustment for waist, HOMA-IR only remained a positive determinant of medium-chain SFAs (C14:0, P < .001; C16:0, P < .05); but it emerged to be inversely related to C20:4 n-6 (P < 0.1). The positive and independent associations of medium-chain SFAs with insulin resistance level suggest their vital roles in diabetes pathogenesis, whereas certain PUFAs such as C20:4 n-6 appear to be protective. The observed associations of Delta 9 with adiposity and plasma lipid profile in these apparently healthy female adolescents support the concept derived from rodent models that Delta 9 activity is independently reflective of higher body mass index and higher circulatory triglyceride levels.