The association between local area immigrant fraction and prevalence of cardiovascular diseases in the United States: an observational study.

Background: Local area immigrant fraction is strongly and positively correlated with local life expectancy in the United States. The aim of the study was to determine the relationship between local area immigrant fraction and local prevalence of coronary heart disease (CHD) and stroke. Methods: Cross-sectional study design, with ZIP code as the unit of observation. Demographic data was obtained from the American Community Survey, and linked to indicators of health access (e.g., insurance, annual check-ups, cholesterol screening), obesity, behavior (smoking, exercise), and cardiovascular outcomes data from the 2020 Population Level Analysis and Community Estimates. Multivariable regression and path analyses were used to assess both direct and indirect relationships among variables. Findings: CHD prevalence was lower in the second (3.9% relative difference, 95% CI: 3.1-4.5%), third (6.5%, 95% CI: 5.8-7.1%), and fourth (14.8%, 95% CI: 14.1-15.8%) quartiles of immigrant fraction compared to the lowest (p-trend <0.001). These effects remained robust in multivariable analysis following adjustment for indicators of access, obesity, and behavioral variables (p-trend <0.0001). For stroke, only the highest quartile demonstrated a significant difference in prevalence (2.1%, 95% CI: 1.2-3.0% with full adjustment). In CHD path analysis, ∼45% of the association of immigrant fraction was direct, and ∼55% was mediated through lower prevalence of deleterious behaviors (e.g., smoking). In stroke path analysis, the effect was entirely mediated through indirect effects. Interpretation: In the United States, ZIP codes with higher immigrant fractions have lower prevalence of cardiovascular diseases. These associations are partially mediated through differences in health behaviors at the community level. Funding: NIH (K08CA252635, P30AG0059304, K24HL150476), Stanford University, Rutgers University.

Assessment of food environment at work and its association with cardiometabolic health among employed adults in Delhi, India.

BACKGROUND AND AIMS: Unhealthy food environment at work is believed to be playing a role in the burgeoning obesity, cardiometabolic risk, diabetes and cardiovascular diseases in India. Therefore, food environment assessment at work is crucial to understand the effect of food environment and to find its association with cardiometabolic risk among adults in Delhi, India. METHODOLOGY: Mix-methods study to find association between worksite food environment on the food choices, dietary behavior, and cardio-metabolic health of 455 apparently healthy adults (both males and females) aged 25-55 years was done in urban India. RESULTS: Unhealthy food environment, poor eating pattern and sedentary lifestyle at work resulted in clustering of CMR factors among the study participants. Work environment assessment revealed that worksites with canteens had higher overall CHEW score for all its domains (Physical, nutritional, and information environment), in comparison to worksites without or no canteens. Four out of ten apparently healthy adults had metabolic syndrome indicating poor cardiometabolic health. The odds of CMR in subjects with access to canteen (unhealthy food) were estimated to be 0.74 (CI: 0.51 to 1.07; p = 0.11) times the odds of CMR in subjects without canteen (limited access to food). Females (ß:0.34; 95% CI:0.23, 0.44; p = 0.00) had high CMR factors in comparison to males. Overall cardiometabolic risk factors increased with age (ß:0.01; 95% CI:0.01,0.01; p = 0.00). CONCLUSION: Findings of the present study urge the need for dietary and lifestyle intervention along with longitudinal studies to further disentangle the association of the food and work environment on the prevalence of CMR among adults.

Association between cardio-metabolic risks and depressive symptoms among US adults (NHANES 2013-2018).

OBJECTIVES: To elucidate the association between cardio-metabolic risk factors and depressive symptoms among US adults. METHODS: Data on 9,477 adults ≥ age 18 from the US National Health and Nutrition Examination Survey (NHANES) 2013-2018 were used. Number of cardio-metabolic risk (CMR) factors, from 0 to 5, was based on BMI, blood pressure, fasting blood glucose, and lipid levels. Depressive symptoms by Patient Health Questionnaire (PHQ-9) scores were categorized "no to mild symptoms" (0-9) and "clinically-significant depressive (CSD) symptoms" (10-27). Logistic regression analysis tested associations between CMR factors and CSD symptoms, adjusted for age, gender, education, income, race/ethnicity and smoking status. RESULTS: CSD symptoms were significantly associated with low HDL, abdominal obesity, and high triglycerides. Increased numbers of CMR factors were associated with increased odds of CSD symptoms, from 1.45 times for 1 CMR to 2.55 times for 5 CMRs. The cross-sectional nature of the present study has resulted in some limitations like the inability to determine the direction and causality of the effects between depression and CMR. The study data was subject to response bias and recall errors as the participants self-reported the use of medications. CONCLUSIONS: In US adults, cardio-metabolic risk factors were associated with clinically-significant depressive symptoms. Public health and clinical programs should include screening for both health issues, intervention for modifiable risk factors, and support for social determinants of health.

What We Eat and Where We Work Is What We Become: Worksite Food Environment Exposure and Cardio-Metabolic Health among Employed Adults of Urban Delhi, India.

The incidence of metabolic syndrome (MS) which is a predictor of increasing CVD is on the rise among adults in urban India. The present study was designed to measure the prevalence of cardio metabolic risk (CMR) as per MS among employed adults in Delhi, India. Study design was cross-sectional. Anthropometric and biochemical measurements were carried out using standard techniques on apparently healthy males and females (n=455) working in various government and private organisations in Delhi, India after obtaining ethical permissions. It was found that more than one-third of the study population had MS (43.8%). A significant difference in the prevalence of MS was seen among males (34.7%) and females (57.5%, p<0.05). The prevalence of MS components was: abdominal obesity (54.3%), hypertriglyceridemia (61.9%), hypertension (56.6%), hypertriglyceridemia (27.4%), low HDL-c levels (63.7%). CMR (assessed from 0-5, where 0 means no MS). It was found that CMR increased with age (ß: 0.01; 95% CI: 0.009,0.01; p=0.000) especially among females (ß: 0.29; 95% CI: 0.19,0.38; p=0.000) who were consuming frequent non-vegetarian foods (ß: 0.04; 95% CI: 0.01,0.09; p=0.07), had family history of diseases (ß: 0.08; 95% CI: 0.01,0.18; p=0.09) and were sedentary workers (ß: 0.05; 95% CI: 0.00,0.10; p=0.06). Unhealthy worksite food environment characterised by high fast food outlet density (ß: 0.003; 95% CI: 0.00,0.007; p=0.04) in close proximity (ß: 0.17; 95% CI: 0.36,0.00; p=0.05) to worksite were also associated with MS. There is a high prevalence of individual components of MS and overall prevalence of MS. Food environment and physical inactivity were two paramount factors resulting in increased CMR among the study population.

Prevalence of Cardio-metabolic Risk Factors: A Cross-sectional Study among Employed Adults in Urban Delhi, India.

INTRODUCTION: Many studies have shown increasing prevalence of Cardiovascular Diseases (CVD) among employed adults. Metabolic Syndrome (MS) which is a predictor of increasing CVD is a cluster of risk factors like central obesity, dyslipidemia, hyperglycaemia and hypertension. Heredity, poor dietary choice, unhealthy lifestyle, job stress are some of the causes responsible for increased prevalence of cardiovascular risk among employed adults. AIM: To measure the prevalence of cardio-metabolic risk factors among employed adults in urban Delhi, India. MATERIALS AND METHODS: Study design was cross-sectional with purposive sampling of 200 apparently healthy adults (both males and females) working in urban Delhi, India. Sociodemographic profile, anthropometric measurements (height, weight and waist circumference) and biochemical measurements (lipid profile and fasting glucose) and blood pressure were documented. Physical activity pattern was assessed using WHO Global Physical Activity Questionnaire (GPAQ). Univariate and multivariate regression analysis for associating cardio-metabolic risk factors among adults were performed using the SPSS 18.0 software. RESULTS: High prevalence of metabolic syndrome among males (66.6%) and females (57.2%) of 25 to 45 years of age was reported. Overall prevalence of MS was 62% among the study population. Central obesity (50.5%, p<0.04), low HDL (62%, p<0.05), hypertriglyceridemia (56.5%, p<0.00), hypertension (39%, p<0.00) and high fasting glucose (10.5%, p<0.76) were the most common abnormalities among males and females. Incidence of high BMI (54.5%, p<0.05) was positively correlated with MS risk factors. Associated cardio-metabolic risk factors besides MS were family history (43.5%, p<0.72), smoking (17.6%, p<0.001), drinking (18%, p<0.001) and physical inactivity. It was found that 32.8% of the subjects had low, 60.4% had moderate and only 7.0% had high physical activity. CONCLUSION: Employed adults in urban Delhi, India are at high risk of developing CVD due to high prevalence of MS and high Body Mass Index (BMI).

Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in north India.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world's largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean family-size being 5.5 (SD +/- 2.5) and the mean monthly household income being INR 9,784 (SD +/- 631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p < or = 0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p < or = 0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.