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BACKGROUND: Obesity is a cardiovascular disease risk factor and affects approximately 13.7 million U.S. children and adolescents between the ages 2 and 19 years old in 2015-2016. PURPOSE: To determine the relationship between children's average long-term exposure to maternal depressive symptoms age 1 month to Grade 6 and adolescents' body mass index (BMI) z-score at age 15 mediated by the adolescents' depressive symptom experience. METHODS: A total of 1,364 infants and their families from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were recruited. RESULTS: Mediation analyses revealed a significant relationship between children's average long-term exposure to maternal depressive symptoms from age 1 month to Grade 6 and adolescents' BMI z-score at age 15 (total effect = 0.015, p = .013, 95% confidence interval (CI): 0.0032, 0.027). The adolescents' experience of depressive symptoms significantly mediated this relationship (indirect effect = 0.0021, bias-corrected bootstrapped 95% CI: 0.0004, 0.0044), with this mediated relationship more pronounced in girls. CONCLUSIONS: Findings indicate the possible existence of a mediating role of adolescents' depressive symptoms experience in the pathway from average long-term exposure to maternal depressive symptoms during children's early life to adolescents' elevated BMI.
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Saúde do Adolescente , Índice de Massa Corporal , Depressão/epidemiologia , Análise de Mediação , Relações Mãe-Filho/psicologia , Mães/psicologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Saúde Mental , Obesidade Infantil/epidemiologiaRESUMO
BACKGROUND AND AIMS: Patients with diabetes mellitus (DM) are at an increased risk of acute coronary syndrome (ACS); however, the factors predicting those at highest risk are not well understood. We identified risk factors in those with DM that best predict high ACS risk based on a multiple endothelial injury biomarker algorithm. METHODS: We studied adults with DM from a clinical registry with measures of a coronary artery disease prediction algorithm (CADPA) score identifying 5-year ACS risk from nine markers. Stepwise logistic regression provided odds ratios for the relationship of age, gender, and individual risk factors not part of the CADPA algorithm with the likelihood of a high risk CADPA score. RESULTS: We studied 1,613 adults with DM (women: 47.3%, ages 22 to 100, mean age 63.2 years). Of these, 6.1% had a low, 13.2% intermediate, and 80.7% high risk CADPA score. From stepwise logistic regression, women were less likely to have a high risk CADPA score (odds ratio [OR] 0.21, 95% confidence intervals [CI] 0.15-0.29, p<.0001), while age (per standard deviation [SD]) (OR 5.04, [4.12-6.17], p<.0001), body mass index (BMI per SD) (OR 1.34, [1.14-1.58], p = 0.004), hypertension (OR 1.60, [1.15-2.24], p = 0.006), current smoking (OR 2.55, [1.56-4.16], p = 0.0002), hsCRP (per SD) (OR 1.24, [1.01-1.53], p = 0.04), and triglycerides (per SD) (OR 1.26, [1.04-1.54], p = 0.02) were more likely to have a high risk CADPA score. CONCLUSIONS: Age, men, hypertension, BMI, current smoking, hsCRP, and triglycerides are key factors in those with DM associated with higher ACS risk.
Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Diabetes Mellitus , Hipertensão , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Proteína C-Reativa , Doença da Artéria Coronariana/complicações , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Triglicerídeos , Adulto JovemRESUMO
BACKGROUND: Obesity is associated with an increased risk of heart failure (HF); however, how metabolic weight groups relate to HF risk, especially in postmenopausal women, has not been demonstrated. METHODS: We included 19 412 postmenopausal women ages 50 to 79 without cardiovascular disease from the Women's Health Initiative. Normal weight was defined as a body mass index ≥18.5 and <25 kg/m2 and waist circumference <88 cm and overweight/obesity as a body mass index ≥25 kg/m2 or waist circumference ≥88 cm. Metabolically healthy was based on <2 and unhealthy ≥2 cardiometabolic traits: triglycerides ≥150 mg/dL, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg or blood pressure medication, fasting glucose ≥100 mg/dL or diabetes medication, and HDL-C (high-density lipoprotein cholesterol) <50 mg/dL. Risk factor-adjusted Cox regression examined the hazard ratios (HRs) for incident hospitalized HF among metabolically healthy normal weight (reference), metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese. RESULTS: Among our sample, 455 (2.34%) participants experienced HF hospitalizations over a mean follow-up time of 11.3±1.1 years. Compared with metabolically healthy normal weight individuals, HF risk was greater in metabolically unhealthy normal weight (HR, 1.66 [95% CI, 1.01-2.72], P=0.045) and metabolically unhealthy overweight/obese individuals (HR, 1.95 [95% CI, 1.35-2.80], P=0.0004), but not metabolically healthy overweight/obese individuals (HR, 1.15 [95% CI, 0.78-1.71], P=0.48). Subdividing the overweight/obese into separate groups showed HRs for metabolically unhealthy obese of 2.62 (95% CI, 1.80-3.83; P<0.0001) and metabolically healthy obese of 1.52 (95% CI, 0.98-2.35; P=0.06). CONCLUSIONS: Metabolically unhealthy overweight/obese and metabolically unhealthy normal weight are associated with an increased risk of HF in postmenopausal women.
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Insuficiência Cardíaca/epidemiologia , Obesidade/complicações , Sobrepeso/complicações , Pós-Menopausa , Idoso , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/complicações , Incidência , Lipídeos/sangue , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Circunferência da CinturaRESUMO
To identify sociodemographic and metabolic correlates of weight categories in postmenopausal women. METHODS: The Women's Health Initiative enrolled 161 808 postmenopausal women ages 50-79. We included those free of cardiovascular disease (CVD) and with CVD risk factors and biomarkers (n = 19 412). Normal weight was defined as a BMI ≥18.5 and <25 kg/m2 and waist circumference <88 cm and overweight/obesity as a BMI ≥25 kg/m2 or waist circumference ≥88 cm. Metabolically healthy was based on <2 and metabolically unhealthy ≥2 traits: triglycerides ≥150 mg/dl, systolic blood pressure (BP) ≥130 mmHg or diastolic BP ≥85 mmHg or antihypertensives or diuretics, fasting glucose ≥100 mg/dl or diabetes medication, and high-density lipoprotein cholesterol <50 mg/dl. Polytomous multinomial logistic regression with generalized link logit function provided the odds of metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO) according to demographic and risk factor measures. RESULTS: Among the 19 412 postmenopausal women, 2369 (12.2%) participants had prevalent diabetes. Advanced age was associated with an increased odds of MUHNW as compared with the MHNW after adjusting for covariates [odds ratio (OR) 1.04, P < 0.0001]. Black/African American ethnicity was associated with a decreased odds of MUHNW (OR 0.64, P < 0.0001) and MUHO (OR 0.77, P = 0.0004), while an increased odds for MHO (OR 1.50, P < 0.0001) as compared with White MHNW. CONCLUSIONS: Advanced age and ethnicity are important indicators of metabolic weight categories among postmenopausal women.
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OBJECTIVE: While diabetes has been previously noted to be a stronger risk factor for cardiovascular disease (CVD) in women compared with men, whether this is still the case is not clear. Coronary artery calcium (CAC) predicts coronary heart disease (CHD) and CVD in people with diabetes; however, its sex-specific impact is less defined. We compared the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality. RESEARCH DESIGN AND METHODS: We studied adults with diabetes from a large registry of patients with CAC scanning with mortality follow-up over 11.5 years. Cox regression examined the relation of CAC with mortality end points. RESULTS: Among 4,503 adults with diabetes (32.5% women) aged 21-93 years, 61.2% of women and 80.4% of men had CAC >0. Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100. Age- and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total mortality (1.28 vs. 1.18) (interaction P = 0.01) and CVD mortality (1.47 vs. 1.27) (interaction P = 0.04) but were similar for CHD mortality (1.48 and 1.48). For CVD mortality, HRs with CAC scores of 101-400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men (interaction P = 0.04). For total mortality, HRs were 2.56 and 4.05 for women, respectively, and 1.88 and 2.66 for men, respectively (interaction P = 0.01). CONCLUSIONS: CAC predicts CHD, CVD, and all-cause mortality in patients with diabetes; however, greater CAC predicts CVD and total mortality more strongly in women.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/epidemiologia , Calcificação Vascular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Cálcio/metabolismo , Doenças Cardiovasculares/etiologia , Causas de Morte , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/mortalidade , Angiopatias Diabéticas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Caracteres Sexuais , Fatores de Tempo , Estados Unidos/epidemiologia , Calcificação Vascular/complicações , Adulto JovemRESUMO
OBJECTIVE: To determine the relationship of metabolic weight categories with incident diabetes mellitus (DM) in postmenopausal women. METHODS: The Women's Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50 to 79 years. We included those with cardiovascular disease (CVD) biomarkers and free of CVD and prevalent DM (nâ=â17,043) at baseline. Normal weight was defined as a body mass index (BMI) ≥18.5 and <25âkg/m, and waist circumference (WC) <88âcm and overweight/obesity as a BMI ≥25âkg/m or WC ≥88âcm. Metabolically healthy was based on <2 and metabolically unhealthy ≥2 traits of the following: triglycerides ≥150âmg/dL, systolic blood pressure (BP) ≥130âmm Hg or diastolic BP ≥85âmm Hg, or antihypertensives or diuretics, fasting glucose ≥100âmg/dL or DM medication, and high-density lipoprotein cholesterol <50âmg/dL. Cox regression was performed to determine the risk of incident DM among metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO). RESULTS: Among our sample, 2,253 (13.3%) participants developed DM over a mean ± standard deviation follow-up time of 15.6â±â3.4 years. Compared with MHNW (nâ=â162 incident DM cases), an increased risk of incident DM was observed in MUHNW (nâ=â102 cases) (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.74-2.88, Pâ<â0.0001), MHO (nâ=â624 cases) (HR 1.68, 95% CI 1.40-2.00, Pâ<â0.0001), and MUHO (nâ=â1,365 cases) (HR 4.51, 95% CI 3.82-5.35, Pâ<â0.0001). CONCLUSIONS: Among postmenopausal women, MUHNW and MHO confer an approximate doubling in the risk and MUHO more than a four-fold increased risk for developing DM.
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Diabetes Mellitus , Pós-Menopausa , Idoso , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Fatores de Risco , Saúde da MulherRESUMO
BACKGROUND: Physical activity in childhood and adolescence helps support physical and emotional health. PURPOSE: The study aimed to investigate if age was related to motivation for physical activity in minority girls, and whether the relationship may be potentially mediated by psychological or physiological stress. METHODS: This cross-sectional observational study recruited Latino and African American girls ages 8 - 12 years (n = 79) in Tanner stage 1 or 2 via purposive sampling. Intrinsic motivation and perceived stress were measured by self-report survey; morning salivary cortisol samples were taken to calculate cortisol awakening response to estimate biological stress reactivity. RESULTS: Increased age was related to higher intrinsic motivation to engage in physical activity. Lower perceived stress and lower awakening cortisol response were associated with higher intrinsic motivation. Bootstrapped mediation results indicated perceived stress may be a pathway through which age impacts intrinsic motivation for physical activity. CONCLUSION: While motivation to engage in physical activity may increase with age, perceived stress may dampen this motivation, resulting in decreased physical activity. Interventions to help increase pre-adolescent girls' engagement in active behaviors may benefit from reducing children's perceptions of stress.