Diet quality predicts hypertensive disorders of pregnancy in Asian and Pacific Islander Cohort.

Background: There is limited data on diet quality during pregnancy and its impact on hypertensive disorders of pregnancy (HDP). Aim: Examine the association with diet quality and development of HDP in an Asian and Pacific Islander Cohort Methods: Pregnant women from the 4 largest ethnic groups in Hawai'i were recruited for participation. Participants completed a food frequency questionnaire during each trimester. Adherence to three diet quality indices (DQIs) were scored-The Healthy Eating Index (HEI), The Alternate Mediterranean Diet score (aMED), and the Dietary approaches to Stop Hypertension (DASH) score. Mean scores were compared among those who did and did not develop HDP. Logistic Regression models were used to examine the association between diet quality and HDP accounting for confounders (age, parity, obesity, ethnicity, gestational weight gain). Results: Among 55 participants with complete follow-up, there was a high incidence of HDP (23%). There was no significant change of DQIs over time. Non-Hispanic White participants had higher DQIs than Filipinas, Japanese, or Native Hawaiians (not statistically significant). Across gestation, participants who did not have HDP had better diet quality than those who did. Logistic regression showed that HEI and DASH indices are predictive of HDP development, with the high DASH diet score having the greatest reduced odds. Every point higher of DASH diet score portended approximately 30% reduced odds of developing HDP. Conclusions: The DASH diet had the strongest association with reduced odds of HDP, but better diet quality in any of the indices was also predictive.

The Importance of Echocardiogram during the Second Week of Illness in Children with Kawasaki Disease.

OBJECTIVE: To determine the timing of peak coronary artery dilation and the characteristics of patients who present with new-onset coronary artery dilation during the acute phase of Kawasaki disease with an initial normal echocardiogram. STUDY DESIGN: This retrospective study analyzed 231 children hospitalized for Kawasaki disease in Hawai'i over a period of 7 years. Clinical and echocardiographic data were collected to calculate the timing of peak z score, and study subjects were compared based on the timing of coronary dilation. RESULTS: Peak coronary artery dilation was observed on average at 11.5 days from the onset of fever (median 8, IQR 7-13 days). Among study subjects with normal z scores in both coronary arteries during the initial encounter and echocardiogram (n = 164), 16 (10%) developed coronary artery dilation or aneurysm at the second echocardiogram, and 5 (3%) continued to have coronary artery dilation or aneurysm at the convalescent phase. CONCLUSIONS: A repeat echocardiogram during the second week of illness (day 7-14 from fever onset) in patients with normal initial echocardiogram could identify new-onset coronary artery dilation or aneurysm and could be useful in the timely adjustment of antithrombotic or anti-inflammatory therapies.

Mapping the Trends of Kawasaki Disease in Hawai'i from 1996 to 2018.

Kawasaki disease is a systemic vasculitis of unknown etiology and is the leading cause of acquired heart disease in children in the developed world. Historically, Hawai'i has had the highest incidence of Kawasaki disease in the United States, likely due to the population's unique ancestral composition. To analyze the epidemiology, demographics and spatiotemporal distribution of Kawasaki disease in Hawai'i, a retrospective chart review was conducted utilizing data from Kapi'olani Medical Center for Women and Children encompassing the period of 1996-2018. A total of 858 patients were analyzed with 877 episodes of Kawasaki disease. On average, 37 episodes of Kawasaki disease were diagnosed annually over the 23-year period. The annual incidence was 32 per 100 000 children <5 years of age. Asian children (66.1%) accounted for the majority of cases, followed by Native Hawaiians and Other Pacific Islanders (16.6%). Unlike Japan and the continental United States, there was no characteristic seasonal pattern in the distribution of Kawasaki disease in Hawai'i, which may be attributed to its tropical climate or the recent changes in global weather patterns. Local geographical differences in the incidence of Kawasaki disease demonstrated that the Windward (Eastern) coast of O'ahu had a higher rate, while the Leeward (Western) coast displayed a lower incidence rate. This could be explained by variations in ethnic composition and weather patterns of certain areas. Future studies could provide geographical weather data and statistical analysis to determine what environmental triggers are correlated with Kawasaki disease trends in the State of Hawai'i.