Body mass index trajectories during the first year of life and their determining factors.

OBJECTIVE: The purpose of this study was to examine the trajectories of body mass index (BMI) in the first year of life and their determining factors. METHODS: We used data from the Infant Feeding Practices Survey II restricted to children with 2 or more time points of BMI data during follow-up visits within the first year of life (n = 2320). Latent class growth analysis was used to identify distinct BMI trajectories. Using multinomial logistic regression, we examined the prenatal and early life determinants of the identified trajectories. RESULTS: Three BMI trajectories were identified during the first year of life: "low-stable" (81.6%), "high-stable" (15.6%), and "rising" (2.8%) trajectories. Boys, preterm infants, infants born to overweight mothers, Hispanic mothers, non-Hispanic Black mothers, and mothers who smoked during pregnancy were significantly more likely to have high-stable versus low-stable trajectories. Infants born to non-Hispanic Black mothers were more likely to have a rising versus a low-stable trajectory. Household income ≥350% of the federal poverty level and full adherence to the guidelines of the American Academy of Pediatrics for both breastfeeding exclusivity and duration reduced the likelihood of infants being in the rising versus the low-stable trajectory. CONCLUSION: Distinct BMI trajectories were evident as early as infancy. The predictors of these trajectories offer information about high-risk groups, and important and preventable prenatal and postnatal risk factors for future intervention programs.

Obesity Mediates the Association between Mediterranean Diet Consumption and Insulin Resistance and Inflammation in US Adults.

Background: The inverse association between Mediterranean diet (Med-diet) consumption and insulin resistance or inflammatory markers is well known. However, the extent to which obesity may act directly on or mediate this association is unclear.Objective: We aimed to investigate whether the associations between Med-diet consumption and markers of insulin resistance and inflammation are mediated by body mass index (BMI) or waist circumference (WC) in a representative US population.Methods: We used cross-sectional data from 4700 adults aged 20-90 y without any previous diagnosis of cancer, cardiovascular disease, diabetes, or hypertension based on the NHANES III, 1988-1994. A Med-diet score (MDS) was created to assess adherence to the Med-diet. Linear regression models were fitted in conventional and causal mediation analyses comparing extreme MDS tertiles.Results: Compared with the lowest MDS tertile, the highest tertile of MDS was associated with a 0.77 lower BMI (in kg/m2; P = 0.004) and a 2.7 cm lower WC (P < 0.001) after multivariable adjustment. WC mediated the association of MDS with insulin resistance and glucose intolerance markers (log insulin, log homoeostasis model assessment of insulin resistance, fasting glucose, and glycated hemoglobin) and inflammatory markers (white blood cell count and fibrinogen), whereas BMI mediated the association between MDS and insulin resistance and glucose intolerance markers only (all P < 0.05). The mediated effects of WC were consistently greater than those of BMI for all markers in both conventional and causal mediation analyses. Furthermore, the association between MDS and fasting glucose was fully mediated by adiposity, especially by WC in men aged <45 y and in premenopausal women.Conclusion: Our results suggest that reducing abdominal obesity may play an important role in the pathway through which Med-diet consumption reduces insulin resistance and inflammation.

Factors related to coronary heart disease risk among men: validation of the Framingham Risk Score.

INTRODUCTION: Coronary heart disease (CHD) remains a leading cause of death in the United States. The Framingham Risk Score (FRS) was developed to help clinicians in determining their patients' CHD risk. We hypothesize that the FRS will be significantly predictive of CHD events among men in the Aerobics Center Longitudinal Study (ACLS) population. METHODS: Our study consisted of 34,557 men who attended the Cooper Clinic in Dallas, Texas, for a baseline clinical examination from 1972 through 2002. CHD events included self-reported myocardial infarction or revascularization or death due to CHD. During the 12-year follow-up 587 CHD events occurred. Multivariable-adjusted hazard ratios generated from ACLS analysis were compared with the application of FRS to the Framingham Heart Study (FHS). RESULTS: The ACLS cohort produced similar hazard ratios to the FHS. The adjusted Cox proportional hazard model revealed that men with total cholesterol of 280 mg/dL or greater were 2.21 (95% confidence interval (CI), 1.59-3.09) times more likely to have a CHD event than men with total cholesterol from 160 through 199mg/dL; men with diabetes were 1.63 (95% CI, 1.35-1.98) times more likely to experience a CHD event than men without diabetes. CONCLUSION: The FRS significantly predicts CHD events in the ACLS cohort. To the best of our knowledge, this is the first report of a large, single-center cohort study to validate the FRS by using extensive laboratory and clinical measurements.

Connecting to the future: telepsychiatry in postgraduate medical education.

OBJECTIVE: This study characterized and examined factors influencing psychiatry residents' and fellows' interest, exposure, and future plans to use telepsychiatry. SUBJECTS AND METHODS: A 17-item electronic survey was distributed to 485 psychiatry residency and fellowship programs in the United States. Each program director or administrator was asked to voluntarily distribute the survey to his or her trainees. Chi-squared tests were performed to test differences in proportions. Stepwise multivariate logistic regression was used to model outcomes of interest. RESULTS: In total, 283 respondents completed the survey. A majority of respondents were interested in telepsychiatry and felt that it was an important part of training. Of the 50 respondents who had clinical exposure to telepsychiatry and completed the survey, most reported that their experience increased their interest level, and two-thirds reported having either a one-time encounter or less than 6 h of multiple patient experiences via telepsychiatry. Clinical exposure to telepsychiatry was significantly related to level of training (p=0.001) and program location (p=0.005). Residents in their postgraduate year (PGY) 4 or fellowship were 2.6 times more likely to be exposed to clinical telepsychiatry than PGY 1-3 residents (95% confidence interval [CI] 1.41-4.95). Residents and fellows in rural programs were 4.3 times more likely to be exposed than those in urban or suburban settings (95% CI 1.07-17.28). Factors affecting trainees' plans to use telepsychiatry in their future practice include program location (p=0.013) and interest level (p<0.001). Residents and fellows in rural locations were 9.3 times more likely to report future plans to use telepsychiatry (95% CI 1.88-45.71). CONCLUSIONS: There is a practice gap between resident interest and resident exposure to telepsychiatry. Training programs should consider incorporating a brief telepsychiatry experience to fulfill both resident interest and the growing demand for psychiatrists.

Associations of maternal gestational weight gain with the risk of offspring obesity and body mass index Z scores beyond the mean.

PURPOSE: We examined the association of meeting the 2009 Institute of Medicine gestational weight gain (GWG) guidelines with offspring obesity and body mass index Z score (BMIZ) at age six overall and by maternal weight status. METHODS: Data were from the Infant Feeding Practices Survey II Study (2005-2007) and their Year Six Follow-Up Study (2012). Logistic regression and quantile regression models were used. RESULTS: Eleven percent of children were obese. Children born to mothers who gained excessive weight during pregnancy had an increased risk of obesity as compared with those born to mothers who gained adequate weight (adjusted odds ratio: 1.67). The association was stronger among normal-weight mothers (adjusted odds ratio: 3.50). Inadequate GWG was not associated with offspring obesity overall or in subsamples by maternal prepregnancy BMI. Children born to mothers who gained excessive weight had higher BMIZ. This distributional association was more pronounced among normal-weight mothers. Children born to obese mothers who gained inadequate weight had lower BMIZ at some percentiles of the BMIZ distribution. CONCLUSIONS: Excessive GWG was associated with increased risk of offspring obesity and higher BMIZ at age six, whereas inadequate GWG was protective of high BMIZ among children born to obese mothers.

Body mass index trajectories during infancy and pediatric obesity at 6 years.

PURPOSE: The purpose of the article was to examine the relationship between body mass index (BMI) trajectories during infancy and risk of obesity at the age of 6 years. METHODS: We used data on 1169 children with at least two BMI measures during their first year of life from the Infant Feeding Practices Survey II and its Year 6 Follow-Up. Latent class growth analysis was used to identify distinct trajectories of BMI, and multiple logistic regression analyses were used to assess the association of the identified trajectories with obesity at the age of 6 years. RESULTS: Three trajectories of BMI were identified during the first year of life: low stable (80.2%), high stable (16.9%), and rising (2.8%). Obesity at the age of 6 years was highest among children with a high-stable trajectory (17.2%), followed by the low-stable (9.6%) and rising (9.1%) groups. Compared with those in the low-stable trajectory, the adjusted odds ratio for obesity at the age of 6 years was 1.79 (95% confidence interval 1.13-2.84) in children with the high-stable growth trajectory and 0.84 (0.26-2.72) in children with the rising growth trajectory. CONCLUSIONS: High-stable BMI trajectory in infancy resulted in a higher risk for obesity at the age of 6 years, but had low accuracy for identifying obese children at the age of 6 years.

Addition of estimated cardiorespiratory fitness to the clinical assessment of 10-year coronary heart disease risk in asymptomatic men.

The Framingham Risk Score (FRS) was developed to quantify a patient's coronary heart disease (CHD) risk. Non-exercise estimated CRF (e-CRF) may provide a clinically practical method for describing cardiorespiratory fitness. We computed e-CRF and tested its association with the FRS and CHD. Male participants (n = 29,854) in the Aerobics Center Longitudinal Study (ACLS) who completed a baseline examination between 1979-2002 were followed for 12 years to determine incident CHD defined by self-report of myocardial infarction, revascularization, or CHD mortality. e-CRF was defined from a 7-item scale and categorized using age-specific tertiles. Multivariable survival analysis determined associations between FRS, e-CRF, and CHD. Interaction between e-CRF and FRS was tested by stratified analysis by 'low' and 'moderate or high' 10-year CHD risk. Men with high e-CRF were significantly (p-value < 0.0001) younger, and less likely to be smokers, compared to men with low e-CRF. Multivariable survival analysis reported men with high e-CRF were 29% (HR = 0.71; 95% 0.56, 0.88) less likely to experience a CHD event compared to men with low e-CRF. Stratified analyses showed men with 'low' 10-year FRS predicted CHD risk and high e-CRF had a 28% (HR = 0.72; 95% CI 0.57, 0.91) lower CHD-mortality risk compared to men with low e-CRF, no association was found in this group and men with moderate e-CRF. Men who were more fit had a decreased risk for CHD compared to men in the lowest third of fitness. Estimated CRF may add clinical value to the FRS and help clinicians better predict long-term CHD risk.

Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults.

BACKGROUND & AIMS: There is sparse evidence on the relationship between the Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health, especially comparing cardiometabolic phenotypes among in normal weight and obese populations. We aimed to investigate the association of the Mediterranean diet scores (MDS) and DASH index with metabolically healthy obese (MHO) and metabolically obese normal weight (MONW) phenotypes in a representative U.S. METHODS: MDS and DASH index were calculated using dietary data from 2767 adults aged 20-90 years without any prior diagnosis of cancer or cardiovascular disease from the National Health and Nutrition Examination Survey III, 1988-1994. MHO and MONW individuals were identified using fasting glucose, insulin resistance, blood pressure, triglycerides, C-reactive protein, and high-density lipoprotein-cholesterol. RESULTS: Higher MDS was associated with higher odds of MHO phenotype (odds ratio (OR)T3 vs T1, 2.57 [95% confidence interval (CI), 1.04-6.35]; P trend = 0.04), and higher DASH index was associated with lower odds of MONW phenotype (ORT3 vs T1, 0.59 [95% CI, 0.38-0.93]; P trend = 0.03) only in the younger age group (<45 years for men or premenopausal women). No significant associations of MDS and DASH index with MHO and MONW phenotypes were observed in the older age group (≥45 years for men or postmenopausal women). CONCLUSIONS: Adherence to Mediterranean diet or DASH style diet was favorably associated with MHO and MONW phenotypes only in the younger age group, suggesting that potential dietary intervention to prevent cardiometabolic disease differ by age group.

Diet Quality and Mortality Risk in Metabolically Obese Normal-Weight Adults.

OBJECTIVE: To examine the associations among the Dietary Approaches to Stop Hypertension (DASH)-style diet, the Healthy Eating Index (HEI), and mortality risk in metabolically obese normal-weight (MONW) adults. PATIENTS AND METHODS: Data were from normal-weight (body mass index of 18.5 to <25) adults aged 30 to 90 years at baseline in the Third National Health and Nutrition Examination Survey, October 18, 1988, through October 15, 1994, followed up for deaths (all-cause, cardiovascular, and cancer related) until December 31, 2011. A total of 2103 participants without known cardiovascular disease and cancer at baseline were included in this prospective cohort study. Metabolic obesity was defined as having 2 or more of the following: high glucose, blood pressure, triglyceride, C-reactive protein, and insulin resistance values and low high-density lipoprotein cholesterol levels; metabolic healthy status was defined as having 0 or 1 of these metabolic derangements. RESULTS: During median follow-up of 18.6 years, there were 344 and 296 deaths in the MONW and metabolically healthy normal-weight (MHNW) phenotypes, respectively. In MONW individuals, a 1-SD increment in adherence to a DASH diet (2 points) or HEI (14 points) was significantly associated with reductions (17% [hazard ratio (HR), 0.83; 95% CI, 0.72-0.97] and 22% [HR, 0.78; 95% CI, 0.68-0.90], respectively) in the risk of all-cause mortality, after adjustment for potential confounders. The corresponding HRs for cardiovascular disease mortality were 0.72 (95% CI, 0.55-0.94) and 0.79 (95% CI, 0.65-0.97), respectively. In addition, reduction of cancer mortality was observed with 1-SD increment of HEI (HR, 0.63; 95% CI, 0.46-0.88). However, no association was observed in the MHNW phenotype. Sensitivity analyses suggested relationships robust to different definitions of MONW and also dose responses with the number of metabolic derangements. CONCLUSION: Higher diet quality scores were associated with lower risk of mortality in normal-weight individuals with metabolic abnormalities.

Relationship between serologic markers of periodontal bacteria and metabolic syndrome and its components.

BACKGROUND: Periodontitis is a result of a complex biologic alteration of the periodontal microenvironment and a distributional shift of key periodontal pathogens. Metabolic syndrome (MetS), a complex cluster of cardiovascular risk factors, has been linked to periodontal diseases; however, the contribution of periodontal bacteria to systemic conditions remains unclear. METHODS: The study population comprised 7,848 United States adults who participated in an interview, underwent a clinical oral-health examination, and had serum immunoglobulin G titers measured against 19 periodontal bacteria as part of the third National Health and Nutritional Examination Survey. The z-score antibody titers were clustered into four mutually exclusive groups and named after Socransky's classification of periodontal bacteria (Orange-Red, Red-Green, Yellow-Orange, and Orange-Blue). Survey logistic regression was used to investigate the independent associations between the cluster scores, and MetS and each component, including hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, central obesity, and elevated fasting glucose. RESULTS: The Orange-Red cluster score (that included Porphyromonas gingivalis and Prevotella spp.) was positively associated (odds ratio [OR] = 1.067, 95% confidence interval [CI] = 1.02 to 1.12) and the Orange-Blue cluster score (which included Actinomyces naeslundii and Eubacterium nodatum) was inversely associated (OR = 0.93, 95% CI = 0.88 to 0.97) with elevated fasting glucose (≥ 110 mg/dL) after adjustment for clusters and potential confounders. Neither MetS nor its other remaining MetS components were associated with a particular cluster score. CONCLUSIONS: The associations between specific antibody clusters (Orange-Red and Orange-Blue) against periodontal bacteria and elevated plasma glucose were in qualitatively opposite directions after multivariable adjustment in a large, adult population. The periodontal bacterial profile was not found to be associated with metabolic control other than a very moderate association with elevated plasma glucose.

Association of Cardiorespiratory Fitness With Coronary Heart Disease in Asymptomatic Men.

OBJECTIVE: To examine the association of cardiorespiratory fitness (CRF) with risk of coronary heart disease (CHD) while controlling for an individual's Framingham Risk Score (FRS)-predicted CHD risk. PATIENTS AND METHODS: The study included 29,854 men from the Aerobics Center Longitudinal Study, who received a baseline examination from January 1, 1979, to December 31, 2002. Coronary heart disease events included self-reported myocardial infarction or revascularization or CHD death. Multivariable survival analysis investigated the association between CRF, FRS, and CHD. Cardiorespiratory fitness was analyzed as both a continuous and a categorical variable. The population was stratified by "low" and "moderate or high" risk of CHD to test for differences in the FRS stratified by CRF. RESULTS: Compared with men without incident CHD, men with incident CHD were older (mean age, 51.6 years vs 44.6 years), had lower average maximally achieved fitness (10.9 metabolic equivalent of tasks vs 12.0 metabolic equivalent of tasks [METs]), and were more likely to have moderate or high 10-year CHD risk (P<.001). Cardiorespiratory fitness, defined as maximal METs, exhibited a 20% lower risk of CHD (hazard ratio, 0.80; 95% CI, 0.77-0.83) for each 1-unit MET increase. Among men in the low CRF strata, individuals with moderate or high 10-year CHD risk, according to the FRS, had a higher CHD risk (hazard ratio, 6.55; 95% CI, 3.64-11.82) than men with low CHD risk according to the FRS. CONCLUSION: Clinicians should promote physical activity to improve CRF so as to reduce CHD risk, even to patients with otherwise low CHD risk.

Antecedents and mediators of community connection in African American women with breast cancer.

OBJECTIVE: To describe the theory of community connection defined as close relationships with women and men who are members of a neighborhood, a church, a work group, or an organization. Antecedent and mediator variables related to community connection are identified. DESIGN/METHODS: A cross-sectional design was used to assess for relationships among theorized antecedents and mediators of community connection in a sample of 144 African American women aged 21 years and older (mean = 54.9) who had been diagnosed with invasive/infiltrating ductal carcinoma. MEASUREMENT AND ANALYSES: Community connection was measured with the relational health indices-community subscale. Mediator analysis was conducted to assess significance of the indirect effects of the mediator variables, which were fear, breast cancer knowledge, and isolation. RESULTS: Community connection was found to be associated with three of the four antecedents, cancer stigma, stress, and spirituality, but not associated with fatalism. Effects were mediated primarily through fear and isolation with isolation as was more dominant of the two mediators. Surprisingly, breast cancer knowledge showed no significant mediator role. CONCLUSIONS: The importance of isolation and fear as mediators of community connection is highlighted by this research. The study could serve as a model for other researchers seeking to understand connection in ethnic groups and communities.

Significance of margin and extent of dysplasia in loop electrosurgery excision procedure biopsies performed for high-grade squamous intraepithelial lesion in predicting persistent disease.

CONTEXT: High-grade squamous intraepithelial lesions (cervical intraepithelial neoplasia 2 and 3) are commonly treated with loop electrosurgery excision procedure (LEEP) biopsies. OBJECTIVE: To highlight the significance of positive margins and extent of positive margins of the cervical LEEP biopsies in predicting the persistence of high-grade squamous intraepithelial lesion and to provide suggestions for reporting margins in cervical LEEP biopsies. DESIGN: The pathology files at the University of Arkansas for Medical Sciences were searched for cervical intraepithelial neoplasia 2 and 3 treated by LEEP biopsy from 1990 to 2001. RESULTS: A total of 489 LEEP biopsy specimens were retrieved and reviewed; 270 patients had follow-up within 1 year. The biopsy specimens of 110 patients showed positive endocervical margins. One hundred sixty specimens had negative ectocervical-endocervical margins. Follow-up of 54% of the cases with initial positive margins showed residual high-grade squamous intraepithelial lesions. This association was even greater when multiple blocks showed positive endocervical margins and in cases with positive deep margins. On the other hand, a negative margin predicted ability to completely remove the lesion in 95% of patients. CONCLUSION: This study reiterates the significance of the evaluation of the margin, even in samples that were received as multiple fragments. Reporting of LEEP biopsy findings should include the extent of the dysplasia, the status of the ectocervical-endocervical margin, and the status of the deep margin.