Inflammatory potential of diet and all-cause, cardiovascular, and cancer mortality in National Health and Nutrition Examination Survey III Study.

BACKGROUND: Various dietary components have been studied in relation to overall mortality; however, little is known about the relationship between the inflammatory potential of overall diet and mortality. MATERIALS AND METHODS: We examined the association between the dietary inflammatory index (DII) and mortality in the National Health and Nutrition Examination Survey III follow-up study. The DII was computed from baseline dietary intake assessed using 24-h dietary recalls (1988-1994). Mortality was determined from the National Death Index records through 2006. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence interval (95 % CI). During the follow-up, 2795 deaths were identified, including 1233 due to cardiovascular disease (CVD), and 615 due to cancer, 158 of which were due to digestive-tract cancers. RESULTS: Multivariate Cox proportional hazards regression analyses, adjusting for age, race, diabetes status, hypertension, physical activity, body mass index, poverty index, and smoking, revealed positive associations between higher DII scores and mortality. Comparing subjects in DII tertile 3 versus tertile 1, significant associations were noted for all-cause mortality (HRTertile3vs1 1.34; 95 % CI 1.19-1.51, P trend < 0.0001), CVD mortality (HRTertile3vs1 1.46; 95 % CI 1.18-1.81, P trend = 0.0006), cancer mortality (HRTertile3vs1 1.46; 95 % CI 1.10-1.96, P trend = 0.01), and digestive-tract cancer mortality (HRTertile3vs1 2.10; 95 % CI 1.15-3.84, P trend = 0.03). CONCLUSION: These results indicate that a pro-inflammatory diet, as indicated by higher DII scores, was associated with higher risk of all-cause, CVD, and cancer mortality.

The Effects of a Park Awareness Campaign on Rural Park Use and Physical Activity.

To examine the effects of a park awareness campaign on park use in 6 community parks. One-group pretest-posttest design. Six community parks located in a South Carolina county. Children, adolescents, and adults observed in community parks. A 1-month awareness campaign that culminated in single 1.5-hour events at 6 parks in April 2011 and May 2011. The System for Observing Play and Recreation in Communities was used to objectively measure park use in May 2010 (baseline) and May 2011 (postcampaign). Zero-inflated Poisson models tested whether the number of total park users and the number of park users engaged in sedentary, walking, and vigorous activities differed by observation date. Park use was significantly greater at baseline than postcampaign (97 vs 84 users, respectively; χ = 4.69, P = .03). There were no significant differences in the number of park users engaged in sedentary (χ = 2.45, P = .12), walking (χ = 0.29, P = .59), and vigorous (χ = 0.20, P = .65) activities between baseline and postcampaign. Although only 97 and 84 people were observed across all parks at baseline and postcampaign, a total of 629 people were observed during the 6 separate 1.5-hour campaign park events. This suggests that there is potential for greater park utilization in these communities, and important questions remain on how to conduct effective awareness campaigns and how to harness interest in park events for the purpose of contributing to future community-wide physical activity and health promotion efforts.

Structures of lipoyl synthase reveal a compact active site for controlling sequential sulfur insertion reactions.

Lipoyl cofactors are essential for living organisms and are produced by the insertion of two sulfur atoms into the relatively unreactive C-H bonds of an octanoyl substrate. This reaction requires lipoyl synthase, a member of the radical S-adenosylmethionine (SAM) enzyme superfamily. In the present study, we solved crystal structures of lipoyl synthase with two [4Fe-4S] clusters bound at opposite ends of the TIM barrel, the usual fold of the radical SAM superfamily. The cluster required for reductive SAM cleavage conserves the features of the radical SAM superfamily, but the auxiliary cluster is bound by a CX4CX5C motif unique to lipoyl synthase. The fourth ligand to the auxiliary cluster is an extremely unusual serine residue. Site-directed mutants show this conserved serine ligand is essential for the sulfur insertion steps. One crystallized lipoyl synthase (LipA) complex contains 5'-methylthioadenosine (MTA), a breakdown product of SAM, bound in the likely SAM-binding site. Modelling has identified an 18 Å (1 Å=0.1 nm) deep channel, well-proportioned to accommodate an octanoyl substrate. These results suggest that the auxiliary cluster is the likely sulfur donor, but access to a sulfide ion for the second sulfur insertion reaction requires the loss of an iron atom from the auxiliary cluster, which the serine ligand may enable.

Designing and developing a literature-derived, population-based dietary inflammatory index.

OBJECTIVE: To design and develop a literature-derived, population-based dietary inflammatory index (DII) to compare diverse populations on the inflammatory potential of their diets. DESIGN: Peer-reviewed primary research articles published through December 2010 on the effect of diet on inflammation were screened for possible inclusion in the DII scoring algorithm. Qualifying articles were scored according to whether each dietary parameter increased (+1), decreased (-1) or had no (0) effect on six inflammatory biomarkers: IL-1ß, IL-4, IL-6, IL-10, TNF-α and C-reactive protein. SETTING: The Dietary Inflammatory Index Development Study was conducted in the Cancer Prevention and Control Program of the University of South Carolina in Columbia, SC, USA from 2011 to 2012. RESULTS: A total of ≈6500 articles published through December 2010 on the effect of dietary parameters on the six inflammatory markers were screened for inclusion in the DII scoring algorithm. Eleven food consumption data sets from countries around the world were identified that allowed individuals' intakes to be expressed relative to the range of intakes of the forty-five food parameters observed across these diverse populations. Qualifying articles (n 1943) were read and scored based on the forty-five pro- and anti-inflammatory food parameters identified in the search. When fit to this composite global database, the DII score of the maximally pro-inflammatory diet was +7·98, the maximally anti-inflammatory DII score was -8·87 and the median was +0·23. CONCLUSIONS: The DII reflects both a robust literature base and standardization of individual intakes to global referent values. The success of this first-of-a-kind attempt at relating intakes of inflammation-modulating foods relative to global norms sets the stage for use of the DII in a wide variety of epidemiological and clinical studies.

A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS).

OBJECTIVE: To perform construct validation of the population-based Dietary Inflammatory Index (DII) using dietary data from two different dietary assessments and serum high-sensitivity C-reactive protein (hs-CRP) as the construct validator. DESIGN: Using data derived from (i) three 24 h dietary recalls (24HR) at baseline and at the end of each subsequent quarter (i.e. up to fifteen over a year) and (ii) a 7 d dietary recall (7DDR) measured at baseline and then quarterly, regression analyses were conducted to test the effect of the DII score on serum hs-CRP as dichotomous (≤3 mg/l, >3 mg/l), while controlling for important potential confounders. SETTING: Existing data from the Seasonal Variation of Blood Cholesterol Study (SEASONS), a longitudinal observational study of healthy participants recruited in Worcester, MA, USA and participants were followed for 1 year. SUBJECTS: Participants who had at least one hs-CRP measurement over her/his 1-year participation (n 495 for 24HR, n 559 for 7DDR). RESULTS: Higher DII scores were associated with values of hs-CRP >3 mg/l (OR = 1·08; 95 % CI 1·01, 1·16, P = 0·035 for the 24HR; and OR = 1·10; 95 % CI 1·02, 1·19, P = 0·015 for the 7DDR). CONCLUSIONS: The population-based DII was associated with interval changes in hs-CRP using both the 24HR and 7DDR. The success of this first-of-a-kind attempt at relating individuals' intakes of inflammation-modulating foods using this refined DII, and the finding that there is virtually no drop-off in predictive capability using a structured questionnaire in comparison to the 24HR standard, sets the stage for use of the DII in a wide variety of other epidemiological and clinical studies.

Proportion of gestational diabetes mellitus attributable to overweight and obesity among non-Hispanic black, non-Hispanic white, and Hispanic women in South Carolina.

Objective was to estimate race-specific proportions of gestational diabetes mellitus (GDM) attributable to overweight and obesity in South Carolina. South Carolina birth certificate and hospital discharge data were obtained from 2004 to 2006. Women who did not have type 2 diabetes mellitus before pregnancy were classified with GDM if a diagnosis was reported in at least one data source. Relative risks (RR) and 95 % confidence intervals were calculated using the log-binomial model. The modified Mokdad equation was used to calculate population attributable fractions for overweight body mass index (BMI: 25.0-29.9 kg/m(2)), obese (30.0-34.9 kg/m(2)), and extremely obese (≥35 kg/m(2)) women after adjusting for age, gestational weight gain, education, marital status, parity, tobacco use, pre-pregnancy hypertension, and pregnancy hypertension. Overall, the adjusted RR of GDM was 1.6, 2.3, and 2.9 times higher among the overweight, obese, and extremely obese women compared to normal-weight women in South Carolina. RR of GDM for extremely obese women was higher among White (3.1) and Hispanic (3.4) women than that for Black women (2.6). The fraction of GDM cases attributable to extreme obesity was 14.0 % among White, 18.1 % among Black, and 9.6 % among Hispanic women. The fraction of GDM cases attributable to obesity was about 12 % for all racial groups. Being overweight (BMI: 25.0-29.9) explained 8.8, 7.8, and 14.4 % of GDM cases among White, Black, and Hispanic women, respectively. Results indicate a significantly increased risk of GDM among overweight, obese, and extremely obese women. The strength of the association and the proportion of GDM cases explained by excessive weight categories vary by racial/ethnic group.

Racial disparities in colorectal cancer incidence by type 2 diabetes mellitus status.

PURPOSE: Type 2 diabetes mellitus (T2DM) prevalence has increased dramatically in the United States since the early 1970s. Though T2DM is known to be associated with colorectal cancer (CRC), information on racial differences in the relationship between T2DM and CRC is limited. METHODS: Using a retrospective cohort design, we compared the association between T2DM and CRC, including subsites of the colon, in African Americans (AAs) and European Americans (EAs) in South Carolina, a region with large racial disparities in rates of both diseases. A total of 91,836 individuals who were ≥30 years old on 1 January 1990 and had ≥12 months of South Carolina Medicaid eligibility between 1 January 1990 and 31 December 1995 were included in the analyses. Cancer data from 1996 to 2007 included information on anatomic subsite. RESULTS: Subjects who had T2DM (n = 6,006) were >50 % more likely to be diagnosed with colon cancer compared to those without T2DM (n = 85,681). The association between T2DM and colon cancer was higher in AAs [odds ratio (OR) = 1.72 (95 % confidence interval: 1.21, 2.46); n = 47,984] than among EAs (OR = 1.24; 0.73, 2.11; n = 43,703). Overall, individuals with T2DM were over twice as likely to be diagnosed with in situ or local colon cancer (OR = 2.12; 1.40, 3.22; n = 191) compared to those without T2DM, with a higher likelihood among AAs (OR = 2.49; 1.52, 4.09; n = 113). CONCLUSIONS: Results from a Medicaid population in a high-risk region of the United States showed an increased likelihood of CRC with T2DM and suggest a racial disparity that disfavors AAs and provides further impetus for efforts aimed at diabetes prevention in this group.

Occurrence of new sexually transmitted diseases in males after HIV diagnosis.

Risk reduction following an HIV diagnosis is important for controlling the epidemic. The objective of this retrospective cohort study of 6,965 HIV-positive males was to evaluate the joint risk of new reportable STDs in males after HIV diagnosis by race/ethnicity and risk behavior. This investigation linked HIV case reports with STD surveillance, clinical care and laboratory datasets to determine new STD acquisition in HIV positive individuals.Compared to White MSM with high care engagement,Black MSM had a significantly higher rate of new reportable STDs for the full time period after HIV diagnosis, B1 year after diagnosis, and[1 year after diagnosis. High HIV care engagement was not as protective against new STD acquisition for Black MSM as it was for White MSM and reasons for this health disparity should be explored.

Power of a reproducing kernel-based method for testing the joint effect of a set of single-nucleotide polymorphisms.

This study explored a semi-parametric method built upon reproducing kernels for estimating and testing the joint effect of a set of single nucleotide polymorphisms (SNPs). The kernel adopted is the identity-by-state kernel that measures SNP similarity between subjects. In this article, through simulations we first assessed its statistical power under different situations. It was found that in addition to the effect of sample size, the testing power was impacted by the strength of association between SNPs and the outcome of interest, and by the SNP similarity among the subjects. A quadratic relationship between SNP similarity and testing power was identified, and this relationship was further affected by sample sizes. Next we applied the method to a SNP-lung function data set to estimate and test the joint effect of a set of SNPs on forced vital capacity, one type of lung function measure. The findings were then connected to the patterns observed in simulation studies and further explored via variable importance indices of each SNP inferred from a variable selection procedure.

An analysis of shiftwork and self-reported depressive symptoms in a police cohort from Buffalo, New York.

Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004-2009 (n = 428) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms.

Maternal social support and neighborhood income inequality as predictors of low birth weight and preterm birth outcome disparities: analysis of South Carolina Pregnancy Risk Assessment and Monitoring System survey, 2000-2003.

Effects of income inequality on health and other social systems have been a subject of considerable debate, but only a few studies have used multilevel models to evaluate these relationships. The main objectives of the study were to (1) Evaluate the relationships among neighborhood income inequality, social support and birth outcomes (low birth weight, and preterm delivery) and (2) Assess variations in racial disparities in birth outcomes across neighborhood contexts of income distribution and maternal social support. We evaluated these relationships by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for 2000-2003 geocoded to 2000 US Census data for South Carolina. Multilevel analysis was used to simultaneously evaluate the association between income inequality (measured as Gini), maternal social relationships and birth outcomes (low birth weight and preterm delivery). The results showed residence in neighborhoods with medium levels of income inequality was independently associated with low birth weight (OR: 2.00; 95% CI 1.14-3.26), but not preterm birth; low social support was an independent risk for low birth weight or preterm births. The evidence suggests that non-Hispanic black mothers were at increased risks of low birth weight or preterm birth primarily due to greater exposures of neighborhood deprivations associated with low income and reduced social support and modified by unequal income distribution.

Effects of maternal stress on low birth weight and preterm birth outcomes across neighborhoods of South Carolina, 2000-2003.

OBJECTIVE: Studies evaluating the effect of maternal stress on preterm birth (PTB) or low birth weight (LBW) and variations across neighborhood contexts have been inconclusive. The purpose of the study was to examine the relationships among neighborhood contexts, prenatal stress, and birth outcomes, and to further explore the modifying effects of neighborhood contexts. METHODS: We evaluated this objective by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS), 2000-2003 data linked to the 2000 U.S. census data for 8064 women (N = 8064). Principal component analysis with varimax rotation was used to group stress constructs into four main domains (Financial, Emotional, Traumatic, and Spousal-related). We used multilevel logistic regression analysis to estimate the adjusted odds ratio for different models. RESULTS: Maternal stress was significantly associated with increased risks of low birth weight and preterm deliveries. Neighborhood high poverty and low education (upper quartiles) were independently associated with low birth weight but not preterm deliveries and stress appeared as a partial mediator of contextual effects on birth outcomes. The interaction models showed that the relationship between stress and LBW or PTB was modified by neighborhood contexts with risks being greater for infants born in disadvantaged neighborhoods. CONCLUSIONS: Effects of maternal stress on LBW and PTB outcomes may be different for mothers living in different neighborhood contexts. Therefore, investigations that fail to examine places of residence would most likely not identify mothers at risk of LBW or PTB. Policies to improve birth outcomes need to target both places of residence and specific mediating or moderating factors associated with deprived neighborhoods of residence.

High incidence of brain and other nervous system cancer identified in two mining counties, 2001-2015.

Two counties in Montana, Deer Lodge and Silver Bow (DL/SB), have two Superfund sites, as well as an active copper and molybdenum mine in SB. The population living in proximity to these sites are exposed to additional metals and some have been shown to be neurotoxic, especially for children; thus, this study focused on the incidence of brain and other nervous system cancers. The Montana Central Tumor Registry data was used to identify the cases in DL/SB and the remaining 54 counties of Montana (comparison group). After controlling for sex, cancer stage, and year of diagnosis, we found an incidence rate ratio for DL/SB versus comparison group of 6.28 (95% CI: 2.32-17.02) for children ages birth to 4 years, and 3.95 (95% CI: 1.66-9.38) for adults age 30-34 years. The high incidence rate of the brain cancer in the two age groups requires public health action.

Logistic regression with incomplete covariate data in complex survey sampling: application of reweighted estimating equations.

Weighted survey data with missing data for some covariates presents a substantial challenge for analysis. We addressed this problem by using a reweighting technique in a logistic regression model to estimate parameters. Each survey weight was adjusted by the inverse of the probability that the possibly missing covariate was observed. The reweighted estimating equations procedure was compared with a complete case analysis (after discarding any subjects with missing data) in a simulation study to assess bias reduction. The method was also applied to data obtained from a national health survey (National Health and Nutritional Examination Survey or NHANES). Adjusting the sampling weights by the inverse probability of being completely observed appears to be effective in accounting for missing data and reducing the bias of the complete case estimate of the regression coefficients.

A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein.

Inflammation is associated with a number of chronic conditions, such as cancer and cardiovascular disease. Reducing inflammation may help prevent or treat these conditions. Diet has consistently been shown to modulate inflammation. To facilitate research into the inflammatory effect of diet on health in humans, we sought to develop and validate an Inflammatory Index designed to assess the inflammatory potential of individuals' diets. An Inflammatory Index was developed based on the results of an extensive literature search. Using data from a longitudinal observational study that carefully measured diet and the inflammatory marker, serum high-sensitivity (hs) C-reactive protein (CRP), in approximately 600 adults for 1 y, we conducted analyses to test the effect of Inflammatory Index score on hs-CRP as a continuous and dichotomous (3 mg/L) indicator of inflammatory response, while controlling for important potential confounders. Results based on continuous measures of hs-CRP suggested that an increasing Inflammatory Index score (representing movement toward an antiinflammatory diet) was associated with a decrease in hs-CRP. Analyses using hs-CRP as a dichotomous variable showed that an antiinflammatory diet was associated with a decrease in the odds of an elevated hs-CRP (P = 0.049). The results are consistent with the ability of the Inflammatory Index to predict hs-CRP and provide additional evidence that diet plays a role in the regulation of inflammation, even after careful control of a wide variety of potential confounders.

Functional status assessment for community long-term care: preliminary observations.

The Community Long-Term Care (CLTC) program in South Carolina offers services to nursing home eligible persons that allow them to remain at home and receive help with activities of daily living. Variation in the ways potential clients are evaluated often produces inconsistent eligibility determinations. We developed a simple, objective assessment tool to complement CLTC evaluations. A conceptual framework, based on Nagi's model of disablement, was tested on community-dwelling healthy older adults and CLTC clients. Three simple physiologic tasks assessing mobility, functional leg strength, and manual dexterity discriminated between community-dwelling older adults and CLTC clients, classifying them with 80% to 90% accuracy.

Perspective: The Dietary Inflammatory Index (DII)-Lessons Learned, Improvements Made, and Future Directions.

The literature on the role of inflammation in health has grown exponentially over the past several decades. Paralleling this growth has been an equally intense focus on the role of diet in modulating inflammation, with a doubling in the size of the literature approximately every 4 y. The Dietary Inflammatory Index (DII) was developed to provide a quantitative means for assessing the role of diet in relation to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. Based on literature from a variety of different study designs ranging from cell culture to observational and experimental studies in humans, the DII was designed to be universally applicable across all human studies with adequate dietary assessment. Over the past 4 y, the DII has been used in >200 studies and forms the basis for 12 meta-analyses. In the process of conducting this work, lessons were learned with regard to methodologic issues related to total energy and nutrient intake and energy and nutrient densities. Accordingly, refinements to the original algorithm have been made. In this article we discuss these improvements and observations that we made with regard to misuse and misinterpretation of the DII and provide suggestions for future developments.

Impact of a 12-month Inflammation Management Intervention on the Dietary Inflammatory Index, inflammation, and lipids.

BACKGROUND AND AIMS: The objective of this study was to assess the feasibility (ability to recruit participants and develop the 12-month intervention), acceptability (retention of participants in the intervention), and impact on systemic inflammation and Dietary Inflammatory Index (DII®) scores over a 12-month DII-based intervention. METHODS: Adults were recruited to participate in a self-selection trial (intervention: n = 61, in-person classes; control: n = 34, newsletters). Classes included participatory cooking and dietary recommendations focused on consuming a plant-based diet rich in anti-inflammatory foods (spices, vegetables, etc.). Changes in markers of inflammation, lipids, and DII were analyzed using general linear models with repeated measurements. RESULTS: At 3 months, intervention participants had significantly lower DII scores (-2.66 ± 2.44) compared to controls (-0.38 ± 2.56) (p < 0.01); but not at 12 months (P = 0.10). The only biomarker to approach a significant group effect or group-by-time interaction was CRP (P = 0.11 for the group-by-time interaction). CRP decreased by -0.65 mg/L (95%CI = 0.10-1.20, P = 0.02) at 12 months in the intervention group; no significant decrease was seen for the control group. With both groups combined at 3 months, those with the greatest decrease/improvement in DII score (tertile 1) compared with those whose scores increased (tertile 3) had greater reductions in CRP (-1.09 vs. +0.52 mg/L, P = 0.04), total cholesterol (-9.38 vs. +12.02 mg/dL, P = 0.01), and LDL cholesterol (-11.99 vs. +7.16 mg/dL, P = 0.01). CONCLUSIONS: Although the intervention group had reductions in DII and CRP, main inflammation and lipid outcomes did not differ between groups. Overall, those participants with the largest reduction in DII scores had the largest reductions in CRP and LDL and total cholesterol. Future interventions may need to have more components in place to support maintenance and continued reductions in the DII. CLINICALTRIALS. GOV IDENTIFIER: NCT02382458.

Dietary patterns based on the Mediterranean diet and DASH diet are inversely associated with high aggressive prostate cancer in PCaP.

BACKGROUND: Several foods and nutrients have been linked to the development of prostate cancer, but the association between healthy dietary patterns and prostate cancer aggressiveness is less studied. The aim of this study was to evaluate the relationship between the Mediterranean diet (MED) and Dietary Approaches to Stop Hypertension (DASH) diet scores and prostate cancer aggressiveness by race. METHODS: Data from the population-based, case-only North Carolina-Louisiana Prostate Cancer Project (PCaP) were used to examine the association between diet quality, measured by MED and DASH scores, and prostate cancer aggressiveness in 1899 African American (AA) and European American (EA) research subjects. Dietary intake was assessed using a modified National Cancer Institute Diet History Questionnaire. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for high versus low-intermediate aggressive prostate cancer. RESULTS: Higher MED scores were inversely associated with high aggressive prostate cancer overall (OR: 0.66; 95% CI: 0.46, 0.95 for high versus low scores); results were similar for AA and EA men. A weaker inverse association between DASH scores and prostate cancer aggressiveness was found (OR: 0.76; 95% CI: 0.55, 1.06). CONCLUSIONS: Higher diet quality, as represented by a Mediterranean-style diet or DASH diet, may reduce the odds of high aggressive prostate cancer.