Influential Periods in Longitudinal Clinical Cardiovascular Health Scores.

The prevalence of ideal cardiovascular health (CVH) among adults in the United States is low and decreases with age. Our objective was to identify specific age windows when the loss of CVH accelerates, to ascertain preventive opportunities for intervention. Data were pooled from 5 longitudinal cohorts (Project Heartbeat!, Cardiovascular Risk in Young Finns Study, The Bogalusa Heart Study, Coronary Artery Risk Development in Young Adults, Special Turku Coronary Risk Factor Intervention Project) from the United States and Finland from 1973 to 2012. Individuals with clinical CVH factors (i.e., body mass index, blood pressure, cholesterol, blood glucose) measured from ages 8 to 55 years were included. These factors were categorized and summed into a clinical CVH score ranging from 0 (worst) to 8 (best). Adjusted, segmented, linear mixed models were used to estimate the change in CVH over time. Among the 18,343 participants, 9,461 (52%) were female and 12,346 (67%) were White. The baseline mean (standard deviation) clinical CVH score was 6.9 (1.2) at an average age of 17.6 (8.1) years. Two inflection points were estimated: at 16.9 years (95% confidence interval: 16.4, 17.4) and at 37.2 years (95% confidence interval: 32.4, 41.9). Late adolescence and early middle age appear to be influential periods during which the loss of CVH accelerates.

Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women.

This article explores cross-sectional associations between depressive symptoms and body mass index (BMI) in women working in schools in the Greater New Orleans area. Self-efficacy for eating and exercise, eating styles, and exercise are examined as potential pathways. This is a secondary data analysis of 743 women who were participating in a workplace wellness randomized controlled trial to address environmental factors influencing eating and exercise behaviors using baseline data prior to the intervention. BMI was the primary outcome examined. Path analysis suggested that increased depressive symptoms were associated with increased BMI in women. Indirect effects of depressive symptoms on BMI were found for increased healthy eating self-efficacy, increased emotional eating, and decreased exercise self-efficacy. The association between greater healthy eating self efficacy and BMI was unexpected, and may indicate a suppressor effect of eating self-efficacy in the relationship between depressive symptoms and BMI in women. The findings suggest the importance of depressive symptoms to BMI in women. Targets for interventions to reduce BMI include targeting depressive symptoms and related sequelae including self-efficacy for exercise, and emotional eating. Further investigation of eating self-efficacy and BMI are recommended with particular attention to both efficacy for health eating and avoidance of unhealthy foods.

Life events, coping, and antihypertensive medication adherence among older adults: the cohort study of medication adherence among older adults.

The authors examined the association between life events and antihypertensive medication adherence in older adults and the moderating role of coping. A cross-sectional analysis was conducted by using data (n = 1,817) from the Cohort Study of Medication Adherence among Older Adults (recruitment conducted from August 2006 through September 2007). Life events occurring in the 12 months preceding the study interview were assessed via the Holmes Rahe Social Readjustment Rating Scale (SRRS), and coping levels were assessed via an adapted version of the John Henry Active Coping Scale. Low adherence to antihypertensive medication was defined as scores less than 6 on the 8-item Morisky Medication Adherence Scale (known as "MMAS-8"). Of study participants, 13.2% had low adherence, and 27.2% and 5.0% had medium (150-299) and high (≥300) SRRS scores, respectively. After multivariable adjustment, the odds ratios for low adherence associated with medium and high, versus low, SRRS were 1.50 (95% confidence interval: 1.11, 2.02) and 2.11 (95% confidence interval: 1.24, 3.58), respectively. When multivariable models were stratified by coping level, the association between life events and adherence was evident only among participants with low coping levels.

Serum homocysteine and folate concentrations among a US cohort of adolescents before and after folic acid fortification.

OBJECTIVE: We assessed serum homocysteine (tHcy) and folate concentrations among US adolescents before and after fortification of cereal-grain products with folic acid, and associations with demographic, behavioural and physiological factors. DESIGN: Observational study conducted among participants of a randomized trial. SETTING: The Child and Adolescent Trial for Cardiovascular Health (CATCH) study. SUBJECTS: Adolescents (n 2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years). RESULTS: Average serum concentrations of tHcy, folate and vitamin B6 increased by 17 %, 16 % and 14 %, respectively, while serum concentrations of vitamin B12 decreased by 11 % post-fortification. Folic acid fortification provided, on average, an additional intake of 118 µg folate/d. Male sex (P < 0.0001) and white race (P = 0.0008) were associated with significantly greater increases in tHcy concentration, while increases in BMI (P = 0.006) and serum folate concentration (P < 0.0001) were associated with significant decreases in tHcy concentration. Female sex (P < 0.0001), non-smoking (P < 0.0001), use of multivitamins (P < 0.0001) and higher dietary intake of folate (P = 0.001) were associated with significantly greater increases in serum folate concentrations. From grade 8 to grade 12, the upward age trend in serum tHcy concentration was uninterrupted in its course (P > 0.50); whereas serum folic acid concentration showed a downward trend that incurred a discrete jump upward (17 % higher; P < 0.0001) with fortification. These trends differed significantly for males v. females (P < 0.001 for interaction). CONCLUSIONS: Fortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.

Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale.

BACKGROUND: Self-report scales are used to assess medication adherence. Data on how to discriminate change in self-reported adherence over time from random variability are limited. OBJECTIVE: To determine the minimal detectable change for scores on the 8-item Morisky Medication Adherence Scale (MMAS-8). METHODS: The MMAS-8 was administered twice, using a standard telephone script, with administration separated by 14-22 days, to 210 participants taking antihypertensive medication in the CoSMO (Cohort Study of Medication Adherence among Older Adults). MMAS-8 scores were calculated and participants were grouped into previously defined categories (<6, 6 to <8, and 8 for low, medium, and high adherence). RESULTS: The mean (SD) age of participants was 78.1 (5.8) years, 43.8% were black, and 68.1% were women. Overall, 8.1% (17/210), 16.2% (34/210), and 51.0% (107/210) of participants had low, medium, and high MMAS-8 scores, respectively, at both survey administrations (overall agreement 75.2%; 158/210). The weighted κ statistic was 0.63 (95% CI 0.53 to 0.72). The intraclass correlation coefficient was 0.78. The within-person standard error of the mean for change in MMAS-8 scores was 0.81, which equated to a minimal detectable change of 1.98 points. Only 4.3% (9/210) of the participants had a change in MMAS-8 of 2 or more points between survey administrations. CONCLUSIONS: Within-person changes in MMAS-8 scores of 2 or more points over time may represent a real change in antihypertensive medication adherence.

Performance of estimated glomerular filtration rate prediction equations in preeclamptic patients.

Accurate estimation of the glomerular filtration rate (GFR) in patients with preeclampsia requires the collection of a 24-hour urine and can have important therapeutic and diagnostic implications. This procedure is often difficult or impossible to accomplish in this patient group. In this study, the Cockcroft-Gault, the Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia. The estimated GFRs calculated from the above formulas were compared with the creatinine clearance values obtained from a 24-hour urine collections in 543 preeclamptic patients recruited from several large hospitals. Additionally, a set of new equations, preeclampsia GFR (PGFR), based on ethnicity, was created. The Cockcroft-Gault, MDRD, and CKD-EPI formulas were inaccurate in predicting GFR and both were significantly less accurate than PGFR. The latter formula provided an estimated GFR that was much closer to the creatinine clearance. Current GFR estimation equations based on serum creatinine values in nonpregnant patients are not reliable measures of renal function in patients with preeclampsia. The use of a new formula (PGFR) is recommended.

The Timing and Sequence of Cardiovascular Health Decline.

INTRODUCTION: Childhood declines in cardiovascular health have been linked to the development of subclinical atherosclerosis; however, less is known about the timing and sequence of the decline of the specific cardiovascular health components. The study objective is to identify the patterns of decline and associations with adulthood subclinical atherosclerosis. METHODS: Data were pooled from 5 cardiovascular cohorts. Clinical components of cardiovascular health (BMI, blood pressure, cholesterol, and blood glucose) were categorized as ideal or nonideal using American Heart Association definitions. Multitrajectory models simultaneously fitted the probability ideal for each factor. Adjusted associations between trajectory groups and carotid intima-media thickness were modeled. Data were pooled from December 1, 2015 to June 1, 2019; statistical analysis occurred between June 1, 2019 and June 1, 2020. RESULTS: This study included 9,388 individuals (55% female, 66% White). A total of 5 distinct trajectory groups were created: 1 maintained the ideal levels of all the 4 health factors, 2 had risk onset of a single factor in childhood, 1 had risk onset of multiple factors in childhood, and 1 had risk onset in adulthood. Those with childhood multiple risk onset had 8.1% higher carotid intima-media thickness (95% CI=0.067, 0.095) than those in the ideal group, childhood cholesterol risk onset had 5.9% higher carotid intima-media thickness (95% CI=0.045, 0.072), childhood BMI risk onset had 5.5% higher carotid intima-media thickness (95% CI=0.041, 0.069), and early adulthood multiple risk onset had 2.7% higher carotid intima-media thickness (95% CI=0.013, 0.041). CONCLUSIONS: Those who lost the ideal status of cardiovascular health in childhood and early adulthood had more subclinical atherosclerosis than those who retained the ideal cardiovascular health across the life course, underscoring the importance of preserving the ideal cardiovascular health beginning in childhood and continued into adulthood.

Association of depression with antihypertensive medication adherence in older adults: cross-sectional and longitudinal findings from CoSMO.

BACKGROUND: Little is known about the associations between depressive symptoms, social support and antihypertensive medication adherence in older adults. PURPOSE: We evaluated the cross-sectional and longitudinal associations between depressive symptoms, social support and antihypertensive medication adherence in a large cohort of older adults. METHODS: A cohort of 2,180 older adults with hypertension was administered questionnaires, which included the Center for Epidemiologic Studies-Depression Scale, the Medical Outcomes Study Social Support Index, and the hypertension-specific Morisky Medication Adherence Scale at baseline and 1 year later. RESULTS: Overall, 14.1% of participants had low medication adherence, 13.0% had depressive symptoms, and 33.9% had low social support. After multivariable adjustment, the odds ratios that participants with depressive symptoms and low social support would have low medication adherence were 1.96 (95% confidence interval (CI) 1.43, 2.70) and 1.27 (95% CI 0.98, 1.65), respectively, at baseline and 1.87 (95% CI 1.32, 2.66) and 1.30 (95% CI 0.98, 1.72), respectively, at 1 year follow-up. CONCLUSION: Depressive symptoms may be an important modifiable barrier to antihypertensive medication adherence in older adults.

Cardiovascular Health Trajectories From Childhood Through Middle Age and Their Association With Subclinical Atherosclerosis.

Importance: Cross-sectional measures of cardiovascular health (CVH) have been associated with cardiovascular disease in older age, but little is known about longitudinal trajectories in CVH and their association with subclinical atherosclerosis in middle age. Objectives: To model long-term patterns in CVH starting in childhood and to assess their association with subclinical atherosclerosis in middle age. Design, Setting, and Participants: This cohort study used data from 5 prospective cardiovascular cohort studies from the United States and Finland from 1973 to 2015. A total of 9388 participants aged 8 to 55 years had at least 3 examinations and were eligible for this study. Statistical analysis was performed from December 1, 2015, to June 1, 2019. Exposures: Clinical CVH factors (body mass index, total cholesterol level, blood pressure, and glucose level) were classified as ideal, intermediate, or poor, and were summed as a clinical CVH score. Group-based latent class modeling identified trajectories in this score over time. Main Outcomes and Measures: Carotid intima-media thickness (cIMT) was measured for participants in 3 cohorts, and high cIMT was defined as a value at or above the 90th percentile. The association between CVH trajectory and cIMT was modeled using both linear and logistic regression adjusted for demographics, baseline health behaviors, and baseline (or proximal) CVH score. Results: Among 9388 participants (5146 [55%] female; 6228 [66%] white; baseline mean [SD] age, 17.5 [7.5] years), 5 distinct trajectory groups were identified: high-late decline (1518 participants [16%]), high-moderate decline (2403 [26%]), high-early decline (3066 [32%]), intermediate-late decline (1475 [16%]), and intermediate-early decline (926 [10%]). The high-late decline group had significantly lower adjusted cIMT vs other trajectory groups (high-late decline: 0.64 mm [95% CI, 0.63-0.65 mm] vs intermediate-early decline: 0.72 mm [95% CI, 0.69-0.75 mm] when adjusted for demographics and baseline smoking, diet, and physical activity; P < .01). The intermediate-early declining group had higher odds of high cIMT (odds ratio, 2.4; 95% CI, 1.3-4.5) compared with the high-late decline group, even after adjustment for baseline or proximal CVH score. Conclusions and Relevance: In this study, CVH declined from childhood into adulthood. Promoting and preserving ideal CVH from early life onward may be associated with reduced CVD risk later in life.

Co-use of alcohol and tobacco among ninth-graders in Louisiana.

INTRODUCTION: The co-use of alcohol and tobacco by adolescents is a public health problem that continues well into adulthood and results in negative behavioral, social, and health consequences. The purpose of this study was to examine the co-use of alcohol and tobacco among ninth-graders in south-central Louisiana. METHODS: We created a health habits survey to collect data from 4,750 ninth-grade students, mean age 15.4 years. Cross-sectional analysis used chi2, 1-way analysis of variance, and logistic regression methods. RESULTS: Almost 20% of students were co-users. Students who were white, performed poorly in school, did not expect to graduate high school, and had more discretionary money to spend were more likely to be co-users. Co-users had friends who got drunk weekly and were more likely to approve of alcohol use among friends than among adults. Significant differences in attitudes toward drinking and smoking were observed between co-users and nonusers. For adolescent drinkers, including girls, hard liquor was the preferred beverage. CONCLUSION: These data for high school students are applicable for prevention strategies at a critical age when harmful health behaviors can mark the start of lifelong habits. Intervention efforts will be successful only if they account for multiple levels of influence.

Targeting school tobacco policy: lessons from the Acadiana Coalition of Teens Against Tobacco (ACTT).

This case study examines the comparative effect of no-use school tobacco policies and restricted-use tobacco policies on teacher and student smoking behaviors and attitudes. Data from teachers (n = 1,041) and ninth-grade students (n = 4,763) at 20 schools in five districts in southern Louisiana were available. No significant difference was observed between teacher smoking (11% vs. 13%, p = .42) or student smoking (24.6% vs. 25.2%, p = .75) at no-use versus restricted-use policy schools. The proportion of teachers smoking on campus at no-use or restricted-use schools was not significantly different. Teachers at restricted-use schools were however less concerned about students seeing teachers smoke and less supportive of a no-use policy than teachers at no-use schools. Tobacco use policies are often not promoted, and enforcement of policies impacting teachers is complex. Changing social norms for smoking at high schools through policy promotion and enforcement is understudied.

Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls.

BACKGROUND: Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. DESIGN: Group randomized controlled trial. SETTING/PARTICIPANTS: Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). INTERVENTION: A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. MAIN OUTCOME MEASURES: The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. RESULTS: After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. CONCLUSION: A school-based, community-linked intervention modestly improved physical activity in girls.

Relationships among fitness, body composition, and physical activity.

PURPOSE: This study was designed to examine the associations of physical activity and body composition with cardiorespiratory fitness in eighth grade girls. METHODS: A random sample of 1440 eighth grade girls at 36 schools participated in this cross-sectional investigation, which represented an ethnically and geographically diverse group. Cardiorespiratory fitness was assessed using a modified physical work capacity test on a cycle ergometer that predicted workload at a heart rate of 170 beats.min. Physical activity was assessed over 6 d in each girl using an accelerometer and body composition was estimated from body mass index and triceps skinfolds using a previously validated equation. Pearson correlations and multiple regression analyses were used to determine the relationships among fitness, physical activity, and body composition. RESULTS: Significant linear relationships among cardiorespiratory fitness, body composition, and physical activity were found. The combination of fat and fat-free mass along with racial group and a race by fat-free-mass interaction accounted for 18% (R) of the variation in physical fitness. Adding moderate-to-vigorous physical activity to the regression model increased the R to 22%. Black girls had somewhat lower fitness levels (P < 0.05) especially at higher levels of fat and fat-free mass than other racial/ethnic groups. CONCLUSIONS: Physical activity, fat-free mass, and the interaction between fat-free mass and racial group are significantly associated with cardiorespiratory fitness in adolescent girls.

Cohort study of medication adherence in older adults (CoSMO): extended effects of Hurricane Katrina on medication adherence among older adults.

BACKGROUND: Previous research indicates that many patients with hypertension ran out of medications and had difficulties getting refills immediately after Hurricane Katrina. The extended effect of Hurricane Katrina on antihypertensive medication adherence is not well characterized. METHODS: Data were analyzed for 2194 participants who completed the baseline survey for the Cohort Study of Medication Adherence among Older Adults between August 2006 and September 2007. Based on pre-Katrina zip codes, the study population was categorized into high- and low-affected areas. Low medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale. RESULTS: Prevalence of low adherence was similar among participants living in high and low affected areas. Low medication adherence was similar for participants with greater than or less than 25% of the residence damaged by Hurricane Katrina and for participants with and without symptoms of post-traumatic stress disorder. In high affected areas, nonsignificant associations were present for those who had moved since the storm and those with a friend or immediate family member who had died in the month after the storm. These factors were not associated with low medication adherence in low affected areas. In both high- and low-affected areas, lower scores on the hurricane coping self-efficacy scale were associated with low medication adherence (P < 0.05). CONCLUSIONS: The effect of Hurricane Katrina on patient adherence to antihypertensive medication was limited in the second year after the storm. Intrinsic patient factors, such as low coping self-efficacy, remain important factors associated with low adherence.

Medication adherence in older clinic patients with hypertension after Hurricane Katrina: implications for clinical practice and disaster management.

BACKGROUND: In post-disaster situations, additional barriers may reduce antihypertensive medication adherence. METHODS: Between November 2005 and August 2006, 210 hypertensive patients receiving care at a multispecialty group practice in New Orleans completed a structured questionnaire. Antihypertensive medication adherence was measured with the Hill-Bone medication compliance subscale. In a subset of patients, data on difficulties patients encountered with blood pressure medications in the aftermath of Hurricane Katrina were collected. RESULTS: : Seventy-six percent of patients reported damage to their residence and 46% of patients had less-than-perfect medication adherence. After multivariate adjustment, less than perfect medication adherence postdisaster was more common among people aged <65 years (prevalence ratio = 1.37; 95% confidence interval: 1.03-1.82) and non-whites (1.32; 95% confidence interval: 1.02-1.71). Uncontrolled blood pressure (systolic/diastolic > or =140/> or =90 mm Hg) was more common in those with less-than-perfect adherence than their counterparts with perfect adherence (51% versus 42%, respectively). In addition, 7% of patients reported not bringing their blood pressure medications when they evacuated, 28% ran out of blood pressure medications, 16% reported difficulties getting medications filled, and 28% reported a blood pressure medication change postdisaster. CONCLUSIONS: Opportunities exist to improve disaster planning and prescription refill processes and increase medication adherence and hypertension control postdisasters.

Process evaluation of an in-school anti-tobacco media campaign in Louisiana.

OBJECTIVES: In light of challenges imposed by the changing media landscape and decreasing classroom time available for health interventions, new approaches are needed to disseminate anti-tobacco messages to adolescents. This study reported process evaluation of an in-school three-year anti-tobacco media campaign conducted in 10 schools in Louisiana. METHODS: Over three years, 10 schools received an in-school anti-tobacco media campaign. The media campaign was one intervention component of the Acadiana Coalition of Teens against Tobacco. Campaign measures were tracked over the campaign's three-year duration. The campaign and evaluation were designed to target the students as they progressed through high school. The number of students who completed the surveys were 1,823 in Year 1, 1,552 in Year 2, and 1,390 in Year 3. Schools eligible for participation were publicly funded schools with no magnet or special populations and within a two-hour driving distance of the New Orleans study office. RESULTS: In a self-report survey (Year 1, n = 1,823; Year 2, n = 1,552; Year 3, n = 1,390), more than 75% and 50% of students reported being exposed to posters and public service announcements, respectively. Recognition of campaign theme was more than 80%. Almost half of respondents reported that the posters were interesting, one-third reported that the posters prevented them from smoking, and 10% reported that the posters encouraged them to cease smoking. Stock media posters had a significantly higher affective reaction than the customized media posters. CONCLUSION: Findings suggest that in-school media programs are useful and should be considered as a viable approach to health education for adolescents.

Objectively assessed associations between physical activity and body composition in middle-school girls: the Trial of Activity for Adolescent Girls.

Declining levels of physical activity probably contribute to the increasing prevalence of overweight in US youth. In this study, the authors examined cross-sectional and longitudinal associations between physical activity and body composition in sixth- and eighth-grade girls. In 2003, girls were recruited from six US states as part of the Trial of Activity for Adolescent Girls. Physical activity was measured using 6 days of accelerometry, and percentage of body fat was calculated using an age- and ethnicity-specific prediction equation. Sixth-grade girls with an average of 12.8 minutes of moderate-to-vigorous physical activity (MVPA) per day (15th percentile) were 2.3 times (95% confidence interval: 1.52, 3.44) more likely to be overweight than girls with 34.7 minutes of MVPA per day (85th percentile), and their percent body fat was 2.64 percentage points greater (95% confidence interval: 1.79, 3.50). Longitudinal analyses showed that percent body fat increased 0.28 percentage points less in girls with a 6.2-minute increase in MVPA than in girls with a 4.5-minute decrease (85th and 15th percentiles of change). Associations between MVPA in sixth grade and incidence of overweight in eighth grade were not detected. More population-based research using objective physical activity and body composition measurements is needed to make evidence-based physical activity recommendations for US youth.

Safe play spaces to promote physical activity in inner-city children: results from a pilot study of an environmental intervention.

OBJECTIVES: We evaluated the effect of providing a safe play space on the physical activity level of inner-city schoolchildren. METHODS: In 1 of 2 matched neighborhoods, we opened a schoolyard and provided attendants to ensure children's safety. Over the next 2 years we directly observed the number of children and their physical activity levels in the school-yard, as well as in the surrounding intervention and comparison neighborhoods. We also surveyed children in the schools in the intervention and comparison neighborhoods regarding sedentary activities. RESULTS: After the schoolyard was opened, a mean of 71.4 children used it on weekdays and 25.8 used it on weekends during the school year. When observed, 66% of these children were physically active. The number of children who were outdoors and physically active was 84% higher in the intervention neighborhood than the comparison neighborhood. Survey results showed that children in the intervention school reported declines relative to the children in the comparison school in watching television, watching movies and DVDs, and playing video games on weekdays. CONCLUSION: When children were provided with a safe play space, we observed a relative increase in their physical activity. Provision of safe play spaces holds promise as a simple replicable intervention.

Utility of existing diabetes risk prediction tools for young black and white adults: Evidence from the Bogalusa Heart Study.

AIMS: To evaluate several adult diabetes risk calculation tools for predicting the development of incident diabetes and pre-diabetes in a bi-racial, young adult population. METHODS: Surveys beginning in young adulthood (baseline age ≥18) and continuing across multiple decades for 2122 participants of the Bogalusa Heart Study were used to test the associations of five well-known adult diabetes risk scores with incident diabetes and pre-diabetes using separate Cox models for each risk score. Racial differences were tested within each model. Predictive utility and discrimination were determined for each risk score using the Net Reclassification Index (NRI) and Harrell's c-statistic. RESULTS: All risk scores were strongly associated (p<.0001) with incident diabetes and pre-diabetes. The Wilson model indicated greater risk of diabetes for blacks versus whites with equivalent risk scores (HR=1.59; 95% CI 1.11-2.28; p=.01). C-statistics for the diabetes risk models ranged from 0.79 to 0.83. Non-event NRIs indicated high specificity (non-event NRIs: 76%-88%), but poor sensitivity (event NRIs: -23% to -3%). CONCLUSIONS: Five diabetes risk scores established in middle-aged, racially homogenous adult populations are generally applicable to younger adults with good specificity but poor sensitivity. The addition of race to these models did not result in greater predictive capabilities. A more sensitive risk score to predict diabetes in younger adults is needed.

Serum homocysteine is related to food intake in adolescents: the Child and Adolescent Trial for Cardiovascular Health.

BACKGROUND: An understanding of the relation in adolescents between serum homocysteine and foods rich in vitamin B-6, vitamin B-12, and folate is important because high homocysteine concentrations in childhood and adolescence may be a risk factor for later cardiovascular disease. However, little is known about the relation between food intake and homocysteine in adolescents. OBJECTIVE: Five years after national folic acid fortification of enriched grain products, cross-sectional relations between food intake and serum homocysteine concentrations were examined in 2695 adolescents [x age: 18.3 (range: 15-20) y] enrolled in the Child and Adolescent Trial for Cardiovascular Health. DESIGN: A nonfasting blood specimen was analyzed for serum homocysteine, folate, and vitamins B-6 and B-12. Dietary intake was assessed by using a food-frequency questionnaire. Multiple regression analyses were used to evaluate the relation of intakes of whole grains, refined grains, fruit, vegetables, dairy products, red and processed meats, and poultry with serum homocysteine concentrations after adjustment for demographic characteristics, lifestyle factors, and food intake. RESULTS: Serum homocysteine concentrations were lower with greater intakes of whole grains (P for trend = 0.002), refined grains (P for trend = 0.02), and dairy foods (P for trend <0.001); were higher with greater intake of poultry (P for trend = 0.004); and were not related to intakes of fruit, vegetables, or red or processed meat. After additional adjustment for serum B vitamins, the relations of serum homocysteine with most food groups were attenuated. CONCLUSION: These observational findings suggest a beneficial effect of whole-grain, refined-grain, and dairy products on serum homocysteine concentrations in an adolescent population.