Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey.

Background and Objectives: Headache is an adverse event associated with the use of proton pump inhibitors (PPIs). Recently, migraine has emerged more specifically as a potential adverse event with PPI use. The objectives of this work were to capitalize on existing data to evaluate the association between migraine and severe headache prevalence and use of acid-suppression therapy, including PPIs, H2 receptor antagonists (H2RAs), and generic antacids; to compare risk from PPIs vs H2RAs; and to assess for potential mitigation by a dietary factor affected by acid-suppression therapy. Methods: Data from adults in the 1999-2004 National Health and Nutrition Examination Survey were used for this cross-sectional analysis. Acid-suppression therapy use was identified from self-report confirmed by product packaging review. Respondents who endorsed migraine or severe headache in the past 3 months were classified in the migraine or severe headache group. Dietary intake of magnesium was determined using one 24-hour recall interview. Multivariable logistic regression models were generated to analyze the relationship between acid-suppression therapy use and migraine or severe headache, and an interaction test was conducted to evaluate whether migraine or severe headache prevalence differed in relation to nutritional magnesium intake across acid-suppression therapy users and nonusers. Results: In 11,818 US adults, the use of acid-suppression therapy was associated with higher odds of migraine or severe headache for all types of acid-suppression therapy and use of any type, as compared with those who did not use acid-suppression therapy: use of PPIs (70% higher), H2RAs (40% higher), and generic antacids (30% higher). Differences between acid-suppression therapy were not significant. An interaction was observed for H2RA use and magnesium intake (p = 0.024). Discussion: These observations in US adults agree with previous findings that migraine or severe headache is a potential adverse event of PPIs, the most efficacious and most frequently used type of acid suppressing medication, and further suggest that other classes of acid suppressing medications (H2RAs and generic antacids) may also be implicated for migraine and severe headache. Future prospective analyses are needed to investigate migraine risk associated with acid suppressing medications while current evidence is sufficient to evaluate patients with migraine in light of recent deprescribing advice for PPIs.

Methods in Nutrition & Gut Microbiome Research: An American Society for Nutrition Satellite Session [13 October 2022].

The microbial cells colonizing the human body form an ecosystem that is integral to the regulation and maintenance of human health. Elucidation of specific associations between the human microbiome and health outcomes is facilitating the development of microbiome-targeted recommendations and treatments (e.g., fecal microbiota transplant; pre-, pro-, and post-biotics) to help prevent and treat disease. However, the potential of such recommendations and treatments to improve human health has yet to be fully realized. Technological advances have led to the development and proliferation of a wide range of tools and methods to collect, store, sequence, and analyze microbiome samples. However, differences in methodology at each step in these analytic processes can lead to variability in results due to the unique biases and limitations of each component. This technical variability hampers the detection and validation of associations with small to medium effect sizes. Therefore, the American Society for Nutrition (ASN) Nutritional Microbiology Group Engaging Members (GEM), sponsored by the Institute for the Advancement of Food and Nutrition Sciences (IAFNS), hosted a satellite session on methods in nutrition and gut microbiome research to review currently available methods for microbiome research, best practices, as well as tools and standards to aid in comparability of methods and results. This manuscript summarizes the topics and research discussed at the session. Consideration of the guidelines and principles reviewed in this session will increase the accuracy, precision, and comparability of microbiome research and ultimately the understanding of the associations between the human microbiome and health.

Food sources of energy and nutrients among US college students: The Health Starts Here cohort study.

Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.

Household Financial Hardship Factors Are Strongly Associated with Poorer Latino Mental Health During COVID-19.

BACKGROUND: Latinos have suffered disproportionate adversity during the COVID-19 pandemic. Many studies have focused on comparing Latinos to other groups, potentially masking critical concerns within population. This study identifies potential pathways to poor mental health among Latinos during the pandemic. METHODS: Data from US Census Household Pulse Survey, covering April 23, 2020, to October 11, 2021, were analyzed. Ordinal logistic regression evaluated categorical frequencies of problems with anxiety, loss of interest, worry, and feeling down. Findings were stratified by gender, poverty status, metropolitan location, and work. Demographic, household, financial, and work covariates were mutually adjusted, and jackknife replications and population weights applied. RESULTS: Adverse mental health was common, with higher frequencies of 2 or more adverse mental health symptoms for at least several days in the prior 2 weeks (59.1-76.3%, depending on stratified group). Food insufficiency was strongly associated with adverse mental health symptoms across all characteristics. Odds ratios of often not having enough to eat compared to enough of foods wanted being associated with adverse mental health ranged from 2.6 to 6.56 (depending on stratified group). Difficulty with expenses was also strongly associated with adverse mental health across characteristics, with odds ratios very difficult compared to not at all ranging from 2.7 to 7.7 (depending on stratified group). CONCLUSION: These observations suggest household financial hardship factors influence mental health regardless of other personal characteristics, and this could inform services for Latinos. Targeted programs to ensure food sufficiency and income may be necessary to improve mental health in US Latinos.

Medically-attended anxiety and depression is increased among newly diagnosed patients with cold agglutinin disease: Analysis of an integrated claim-clinical cohort in the United States.

BACKGROUND: Cold agglutinin disease (CAD) is a rare, chronic form of autoimmune hemolytic anemia. Clinical manifestations can include classical complement pathway-mediated chronic hemolysis, anemia, and profound fatigue. Research has shown that patients with other anemias may develop anxiety and depression, but this has not been studied previously in patients with CAD. METHODS: CAD patients were identified in the Optum Claims-Clinical dataset (between January 1, 2006-June 30, 2016) and matched to comparison patients without CAD by patient factors. Adjusted Cox regression models estimated time to anxiety and depression, defined by three different outcomes: medication use, hospitalization, and therapy related to anxiety and depression. Subset analyses were performed for primary CAD. Patients were followed until they had anxiety and depression, they left the Optum system, death, or the study period ended (June 30, 2016). RESULTS: Patients with CAD (n = 384) were more likely to have medically attended anxiety and depression (adjusted hazard ratio [aHR]: 1.6; 95% confidence interval [CI]: 1.3-2.1), to be prescribed antidepressants or psychotherapy after their CAD diagnosis (aHR: 1.8; 95% CI: 1.2-2.9), or to be hospitalized for an anxiety and depression-related event along with medication or psychotherapy (aHR: 2.0; 95% CI: 1.4-2.9) relative to matched comparisons (n = 2789), during the follow-up period. Patients with primary CAD were at increased risk for medically attended anxiety and depression (aHR: 1.8; 95% CI: 1.4-2.4), with the highest risk for prescription medication or therapy (aHR: 2.7; 95% CI: 1.6-4.6). CONCLUSIONS: Our study indicates that medically attended anxiety and depression manifest at a higher rate in CAD patients than in a matched non-CAD cohort. Study findings suggest that CAD patients may experience a greater burden on mental health that may negatively contribute to their overall quality of life. Further investigation on this topic is warranted.

Loneliness is associated with unhealthful dietary behaviors and physical inactivity among US college students.

Objective: To evaluate dietary and physical activity behavior in relation to loneliness among college students. Participants: Three-hundred forty-six incoming first-year students in Fall 2019 at a large state University in the US. Methods: Students completed online surveys in Fall 2019. Multivariable regression analyses were used to model associations of health behaviors with loneliness, adjusting for gender and body mass index (BMI). Results: Two-hundred sixty-four students were included in this analysis. Students in loneliness score ranges of 4-6 and 7-9 have higher fat diet than students in score range of 10-12 (p = .007). Sedentary (19.2%) and low active (53.8%) behaviors were more frequent in students reporting high loneliness than those reporting low loneliness (13.8%, 36.7%, respectively) (p = .006). Conclusions: In this sample of college students, loneliness was related to altered diet quality and physical inactivity. Interventions to reduce loneliness may have a positive effect on health promotion in this population.

Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010-2015.

PURPOSE: To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations. METHODS: We utilized Georgia state cancer registry data (2010-2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted. RESULTS: Average income of the Census tract and racial residential segregation of the diagnosing hospital's neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy. CONCLUSION: Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments.

Substance use and firearm access among college freshmen.

OBJECTIVE: Examine the proportion of students with rapid firearm access and associations with recent alcohol and marijuana use. PARTICIPANTS: Cross-sectional data from college freshmen (n = 183) in 2020 who participated in the Mason: Health Starts Here study. METHODS: Using logistic regression, associations were examined between past 30-day substance use and access to firearms within 15-min. RESULTS: More than 10% of students could rapidly access a firearm, 53% of whom were current binge drinkers, compared to 13% of those who could not rapidly access firearms. Non-Hispanic White students (AOR = 4.1, 95%CI = 1.3,12.7) and past 30-day binge drinkers (AOR = 6.4, 95%CI = 2.1,19.7) had greater odds of having rapid firearm access. Age, sex, and past 30-day marijuana use were not associated with rapid access. CONCLUSIONS: A notable proportion of students had rapid firearm access, which was strongly associated with recent binge drinking. Campus prevention programs should consider how their alcohol and firearm policies could be enhanced to prevent violence/self-harm.

Differentiating Black and Hispanic: outcome differences of segregated communities and police shootings in the USA, 2015-2020.

BACKGROUND: Police shootings are unevenly spatially distributed, with substantive spikes throughout the USA. While minorities are disproportionately the victims of police force, social or structural factors associated with this distribution are not well understood. The objective of this work was to evaluate police shootings in relation to victim race or ethnicity and residential segregation and racial diversity. METHODS: Validated crowdsourced data from the Washington Post's Fatal Force (2015-2020) were linked with census tract-level data from the American Community Survey. Residential minority dissimilarity, interaction, and a racial and ethnic diversity metric were calculated in order to assess the potentially variant importance of evenness in distribution, exposure likelihood, and general representation. Logistic and multinomial regression was used to model associations between segregation and diversity, adjusted for other ecological characteristics. Analyses were stratified by victim race or ethnicity (Black, Asian, or Hispanic). RESULTS: Across all races combined, the odds of a police shooting in a particular census tract were associated with non-Hispanic Black dissimilarity (OR = 0.98, 95% CI 0.97, 0.99) and racial and ethnic diversity (1.046, 95% CI 1.044, 1.060). Areas with higher racial diversity had a higher likelihood of having a police shooting event with Black victims (OR = 1.092, 95% CI 1.064, 1.120) or Asian victims (OR = 1.188, 1.051, 1.343) than less diverse areas. Higher non-Hispanic Black interaction was associated with a lower likelihood of having a police shooting event with Black victims (OR = 0.914, 95% CI 0.833, 0.946) than lower interaction areas. Higher Hispanic dissimilarity was associated with a lower likelihood of having a police shooting event with a Hispanic victim (OR = 0.398, 95% CI 0.324, 0.489) than lower dissimilarity areas. CONCLUSIONS: The variant effects of residential segregation are only seen when victims are analyzed separately by race. There appears to be a protective effect for Hispanic populations in Hispanic communities, while the reverse is true of Black individuals. We urge law enforcement responsible for locations with segregated communities to monitor individual interactions that police have with residents as well as the patterns of frequency and context of those interactions.

Why don't college freshmen meet the US dietary guidelines for added sugar, refined grains, sodium, and saturated fat?

OBJECTIVE: The objective of the study was to evaluate how well college students meet U.S. dietary guidelines by examining the mean intakes of nutrients to limit (sodium, sugar, refined grains, and saturated fat), and what factors lead to exceeding the dietary recommendations. PARTICIPANTS: Participants were first-year undergraduate students (N = 269). METHODS: Diet was assessed using a DHQ-III and estimated with food source composition tables. Multivariable logistic regression analysis was used to model variables associated with exceeding the recommendations. One-sample t-tests were performed to compare the cohort with national intakes. RESULTS: One-third met added sugar guidelines; only 4% met daily refined grains requirements, Fewer than half met saturated fat guidelines, and slightly over half met recommended sodium guidelines. Level of physical activity, race/ethnicity, and living on campus were the important predictors for exceeding recommended intakes. CONCLUSIONS: Most students do not adhere to the U.S. dietary guidelines for nutrients to limit.

The Gut Microbiome Is Associated with Circulating Dietary Biomarkers of Fruit and Vegetable Intake in a Multiethnic Cohort.

BACKGROUND: Results from observational studies suggest high diet quality favorably influences the human gut microbiome. Fruit and vegetable consumption is often a key contributor to high diet quality. OBJECTIVE: To evaluate measures of gut bacterial diversity and abundance in relation to serum biomarkers of fruit and vegetable intake. DESIGN: Secondary analysis of cross-sectional data. PARTICIPANTS AND SETTING: Men and women from Los Angeles, CA, and Hawai'i who participated in the Multiethnic Cohort-Adiposity Phenotype Study from 2013 to 2016 (N = 1,709). MAIN OUTCOME MEASURES: Gut microbiome diversity and composition in relation to dietary biomarkers. STATISTICAL ANALYSIS: Carotenoid (beta carotene, alpha carotene, cryptoxanthins, lutein, lycopene, and zeaxanthin), tocopherol (α, ß + γ, and δ), and retinol concentrations were assessed in serum. The α and ß diversity and composition of the gut microbiome were classified based on 16S rRNA gene sequencing of bacterial DNA from self-collected fecal samples. Global differences in microbial community profiles in relation dietary biomarkers were evaluated using multivariable permutational analysis of variance. Associations of α diversity (Shannon index), ß diversity (weighted and unweighted UniFrac) with center log-ratio-transformed phyla and genera abundances were evaluated using linear regression, adjusted for covariates. RESULTS: Increasing total carotenoid, beta carotene, alpha carotene, cryptoxanthin, and lycopene concentrations were associated with higher gut bacterial diversity (Shannon Index) (P < 0.001). Total tocopherol, α-tocopherol, and δ-tocopherol concentrations contributed significantly to more than 1% of the microbiome variation in gut bacterial community: total tocopherol: 1.74%; α-tocopherol: 1.70%; and δ-tocopherol: 1.16% (P < 0.001). Higher total carotenoid was associated with greater abundance of some genera relevant for microbial macronutrient metabolism (P < 0.001). CONCLUSIONS: Objective biomarkers of fruit and vegetable intake, particularly carotenoids, were favorably associated with gut bacterial composition and diversity in this multiethnic population. These observations provide supportive evidence that fruit and vegetable intake is related to gut bacterial composition; more work is needed to elucidate how this influences host health.

All-cause mortality and residential racial and ethnic segregation and composition as experienced differently by individual-level race, ethnicity, and gender: Mortality disparities in american communities data.

PURPOSE: Use a large nationally representative population to evaluate whether differences in mortality in relation to residential racial and ethnic segregation and diversity varied by gender, and race or Hispanic ethnicity in the United States. METHODS: The Mortality Disparities in American Communities (MDAC) was used to evaluate mortality risk in relation to segregation. MDAC is a nationally representative record linkage of the 2008 American Community Survey data with mortality outcomes derived from the National Death Index through 2015. Gender-stratified mortality risk for White, Black, and Hispanic groups in relation to quartiles of residential segregation, composition, and diversity were modeled using parametric survival regression with an exponential distribution, adjusted for individual-level socioeconomic characteristics. RESULTS: The study population included >3,950,000 individuals and >273,000 all-cause mortality outcomes. Statistically significant differences in associations were observed with Black segregation vs. Hispanic segregation across Black or Hispanic groups; some differences in stratification by gender for Hispanic and Non-Hispanic Black groups, but gender-stratified associations were more similar in non-Hispanic Whites. CONCLUSIONS: Future multidisciplinary and ethnographic research is needed to identify the specific structural mechanisms by which these associations differ to support means by which to more effectively target public health interventions.

Metabolomics profiles of premenopausal women are different based on O-desmethylangolensin metabotype.

Urinary O-desmethylangolensin (ODMA) concentrations provide a functional gut microbiome marker of dietary isoflavone daidzein metabolism to ODMA. Individuals who do not have gut microbial environments that produce ODMA have less favourable cardiometabolic and cancer risk profiles. Urinary metabolomics profiles were evaluated in relation to ODMA metabotypes within and between individuals over time. Secondary analysis of data was conducted from the BEAN2 trial, which was a cross-over study of premenopausal women consuming 6 months on a high and a low soya diet, each separated by a 1-month washout period. In all of the 672 samples in the study, sixty-six of the eighty-four women had the same ODMA metabotype at seven or all eight time points. Two or four urine samples per woman were selected based on temporal metabotypes in order to compare within and across individuals. Metabolomics assays for primary metabolism and biogenic amines were conducted in sixty urine samples from twenty women. Partial least-squares discriminant analysis was used to compare metabolomics profiles. For the same ODMA metabotype across different time points, no profile differences were detected. For changes in metabotype within individuals and across individuals with different metabotypes, distinct metabolomes emerged. Influential metabolites (variables importance in projection score > 2) included several phenolic compounds, carnitine and derivatives, fatty acid and amino acid metabolites and some medications. Based on the distinct metabolomes of producers v. non-producers, the ODMA metabotype may be a marker of gut microbiome functionality broadly involved in nutrient and bioactive metabolism and should be evaluated for relevance to precision nutrition initiatives.

Dietary Intake and Representativeness of a Diverse College-Attending Population Compared with an Age-Matched US Population.

Young adults typically gain more dietary autonomy as they start college, though this can also present nutritional challenges; however, research on the generalizability of their dietary intake data is scarce. To address this representativeness concern, we compared food and nutrient intakes reported by college freshmen attending a large, diverse university to an age-matched sample from the National Health and Nutrition Examination Survey (NHANES). We studied 269 students 18-24 years old recruited through the Mason: Health Start Here (HSH) study, a population-based cohort study of college students. Diet was assessed using a diet history questionnaire (DHQ-III) and estimated with food source composition tables. The NHANES sample of 835 adults was the reference dataset. Reported dietary intakes were weighted and compared with national intakes via t-tests. We observed comparable energy, carbohydrate, fat, and protein intakes in both groups; however, the HSH cohort reported a higher density intake of most micronutrients than the NHANES sample. Differences between these samples in intake, mode of dietary assessment administration, and reactivity may help explain the differences detected. These results demonstrate that when appropriately contextualized in terms of methodology and potential sources of bias, single college studies can be useful for understanding nutrition in young adults more broadly.

Longer time-to-treatment but better survival for colorectal cancer patients presumptively not diagnosed in a hospital.

PURPOSE: To evaluate time-to-treatment and survival time in colorectal cancer (CRC) patients who presumptively were not diagnosed in a hospital. METHODS: Colorectal tumor-level data from Georgia Cancer Registry (GCR) was merged with American Hospital Association data for 2010-2015 using hospital identification number. Patients with tumors lacking a diagnosis hospital in the GCR were classified as presumptive non-hospital diagnosis (PNHD). Cox proportional hazard models were used to model PNHD and time-to-treatment and time-to-death following cancer diagnosis, stratified by race and controlling for personal and tumor characteristics. RESULTS: PNHD (n = 6,885, 29.6%) was associated with a lower likelihood of treatment at a given point in time (i.e., longer time-to-treatment), but did not differ for Black (HR = 0.77, 95% CI: 0.73, 0.82) and White (HR = 0.73, 95% CI: 0.71, 0.76) patients. Time-to-death was longer (i.e., better survival) with PNHD, which also did not differ for Black (HR = 0.70, 95% CI: 0.64, 0.76) and White (HR = 0.71, 95% CI: 0.67, 0.75) patients. These results were not explained by confounding factors or differences in tumor stage at diagnosis. CONCLUSIONS: These observations warrant further research to understand whether there are potentially modifiable factors associated with the diagnosing location that can be used to benefit patient treatment trajectory and survival.