Association of Incident Stroke Risk With an IL-18-Centered Inflammatory Network Biomarker Composite.

BACKGROUND: A coordinated network of circulating inflammatory molecules centered on the pleotropic pro-atherogenic cytokine interleukin-18 (IL-18) is linked to cerebral small vessel disease. We sought to validate the association of this inflammatory biomarker network with incident stroke risk, cognitive impairment, and imaging metrics in a sample of the Framingham Offspring Cohort. METHODS: Using available baseline measurements of serum levels of IL-18, GDF (growth and differentiation factor)-15, soluble form of receptor for advanced glycation end products, myeloperoxidase, and MCP-1 (monocyte chemoattractant protein-1) from Exam 7 of the Framingham Offspring Cohort (1998-2001), we constructed a population-normalized, equally weighted log-transformed mean Z-score value representing the average level of each serum analyte to create an inflammatory composite score (ICS5). Multivariable regression models were used to determine the association of ICS5 with incident stroke, brain magnetic resonance imaging features, and cognitive testing performance. RESULTS: We found a significant association between ICS5 score and increased risk for incident all-cause stroke (hazard ratio, 1.48 [95% CI, 1.05-2.08]; P=0.024) and ischemic stroke (hazard ratio, 1.51 [95% CI, 1.03-2.21]; P=0.033) in the Exam 7 cohort of 2201 subjects (mean age 62±9 years; 54% female) aged 45+ years with an all-cause incident stroke rate of 6.1% (135/2201) and ischemic stroke rate of 4.9% (108/2201). ICS5 and its component serum markers are all associated with the Framingham Stroke Risk Profile score (ß±SE, 0.19±0.02; P<0.0001). In addition, we found a significant inverse association of ICS5 with a global cognitive score, derived from a principal components analysis of the neuropsychological battery used in the Framingham cohort (-0.08±0.03; P=0.019). No association of ICS5 with magnetic resonance imaging metrics of cerebral small vessel disease was observed. CONCLUSIONS: Circulating serum levels of inflammatory biomarkers centered on IL-18 are associated with an increased risk of stroke and cognitive impairment in the Framingham Offspring Cohort. Linking specific inflammatory pathways to cerebral small vessel disease may enhance individualized quantitative risk assessment for future stroke and vascular cognitive impairment.

Analyzing gender differentials in dietary diversity across urban and peri-urban areas of Hyderabad, India.

BACKGROUND: India's recent increase in urbanization alongside with feminization of rural agriculture could increase the existing gender disparities in dietary diversity. With many rural men migrating to urban areas, women have increased domestic burdens as well as productive burdens such as making informed crop production decisions so household members consume a diverse diet. Given the rapid and recent onset of this phenomenon, there is a need to explore gender differentials in diet diversity across urban and rural areas to assess if certain populations are being disproportionately impacted by this trend. There are limited established quantitative studies discussing this gender disparity with respect to urbanization. Therefore, this paper compares dietary diversity among adult men, adult women, adolescent males, and adolescent females in urban and peri-urban locations. The authors also assess if various sociodemographic factors correlate with dietary diversity. METHODS: Analyses were conducted on dietary diversity data collected by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) from selected urban (1108 individuals) and peri-urban (808 individuals) locations of Hyderabad, India. The total sample size of the population is n = 1816: 660 adult males, 662 adult females, 205 adolescent males, and 289 adolescent females. RESULTS: Adult women and adolescent females have a higher diet disparity between peri-urban and urban areas when compared to adult males and adolescent males. Multivariate analyses followed by post hoc multiple comparisons testing further support that peri-urban adult women consume a less diverse diet compared to their urban counterparts and less than other peri-urban adult men and adolescent women. It was also found that marital status, type of household card owned, and the highest degree of education are statistically significant correlators of an individual's dietary diversity. CONCLUSIONS: Given that urbanization could negatively impact already vulnerable populations such as peri-urban adult women, who play a key role in children's nutrition, it is important to provide support to these populations. This paper suggests it is possible to do so through government subsidization of peri-urban farmers to grow more diverse crops, fortifying easily accessible foods with commonly lacking micronutrients, including Vitamin A, folic acid, and iron, market access, and affordable prices.