Family function and eating behaviours among Hispanic/Latino youth: results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth).

OBJECTIVE: To elucidate mechanisms across family function, home environment and eating behaviours within sociocultural context among Hispanic youth. DESIGN: Two models tested via path analysis (youth fruit and vegetable (FV) consumption; empty energy consumption) using data from the Study of Latino Youth (2011-2013). SETTING: Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA. PARTICIPANTS: Youth (8-16-year-olds), n 1466. RESULTS: Youth ate 2·4 servings of FV per d and received 27 % of total energy from empty energies. Perceiving higher acculturative stress was indirectly associated with lower FV consumption via a pathway of low family function and family support for FV (ß = -0·013, P < 0·001) and via lower family closeness and family support (ß = -0·004, P = 0·004). Being >12-year-olds was indirectly associated with lower FV consumption via lower family closeness and family support (ß = -0·006, P < 0·001). Household food security was indirectly associated with greater FV consumption via family closeness and family support (ß = 0·005, P = 0·003). In contrast, perceiving higher acculturative stress was indirectly associated with higher empty energy consumption (via family closeness and family support: ß = 0·003, P = 0·028 and via low family function and low family support: ß = 0·008, P = 0·05). Being older was associated with higher consumption of empty energies via family closeness (related to family support: ß = 0·04, P = 0·016; parenting strategies for eating: ß = 0·002, P = 0·049). CONCLUSIONS: Findings suggest pathways of influence across demographic and sociocultural context, family dynamics and home environment. The directionality of these associations needs confirmation using longitudinal data.

Trans-ethnic analysis of metabochip data identifies two new loci associated with BMI.

OBJECTIVE: Body mass index (BMI) is commonly used to assess obesity, which is associated with numerous diseases and negative health outcomes. BMI has been shown to be a heritable, polygenic trait, with close to 100 loci previously identified and replicated in multiple populations. We aim to replicate known BMI loci and identify novel associations in a trans-ethnic study population. SUBJECTS: Using eligible participants from the Population Architecture using Genomics and Epidemiology consortium, we conducted a trans-ethnic meta-analysis of 102 514 African Americans, Hispanics, Asian/Native Hawaiian, Native Americans and European Americans. Participants were genotyped on over 200 000 SNPs on the Illumina Metabochip custom array, or imputed into the 1000 Genomes Project (Phase I). Linear regression of the natural log of BMI, adjusting for age, sex, study site (if applicable), and ancestry principal components, was conducted for each race/ethnicity within each study cohort. Race/ethnicity-specific, and combined meta-analyses used fixed-effects models. RESULTS: We replicated 15 of 21 BMI loci included on the Metabochip, and identified two novel BMI loci at 1q41 (rs2820436) and 2q31.1 (rs10930502) at the Metabochip-wide significance threshold (P<2.5 × 10-7). Bioinformatic functional investigation of SNPs at these loci suggests a possible impact on pathways that regulate metabolism and adipose tissue. CONCLUSION: Conducting studies in genetically diverse populations continues to be a valuable strategy for replicating known loci and uncovering novel BMI associations.

The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality worldwide. Traditional risk factors predict 75-80% of an individual's risk of incident CVD. However, the role of early life experiences in future disease risk is gaining attention. The Barker hypothesis proposes fetal origins of adult disease, with consistent evidence demonstrating the deleterious consequences of birth weight outside the normal range. In this study, we investigate the role of birth weight in CVD risk prediction. METHODS AND RESULTS: The Women's Health Initiative (WHI) represents a large national cohort of post-menopausal women with 63,815 participants included in this analysis. Univariable proportional hazards regression analyses evaluated the association of 4 self-reported birth weight categories against 3 CVD outcome definitions, which included indicators of coronary heart disease, ischemic stroke, coronary revascularization, carotid artery disease and peripheral arterial disease. The role of birth weight was also evaluated for prediction of CVD events in the presence of traditional risk factors using 3 existing CVD risk prediction equations: one body mass index (BMI)-based and two laboratory-based models. Low birth weight (LBW) (<6 lbs.) was significantly associated with all CVD outcome definitions in univariable analyses (HR = 1.086, p = 0.009). LBW was a significant covariate in the BMI-based model (HR = 1.128, p < 0.0001) but not in the lipid-based models. CONCLUSION: LBW (<6 lbs.) is independently associated with CVD outcomes in the WHI cohort. This finding supports the role of the prenatal and postnatal environment in contributing to the development of adult chronic disease.

A lifestyle assessment and intervention tool for pediatric weight management: the HABITS questionnaire.

BACKGROUND: Lifestyle assessment and intervention tools are useful in promoting pediatric weight management. The present study aimed to establish convergent validity and reliability for a quick simple measure of food intake and physical activity/sedentary behaviour. The HABITS questionnaire can be used to identify and monitor behavioural intervention targets. METHODS: Thirty-five youths (ages 7-16 years) were recruited from the waiting area of the Jacobi Medical Center Child and Teen Health Services. To establish convergent validity for the HABITS questionnaire, study participants completed the HABITS questionnaire, a 24-h recall and a modified version of the Modifiable Activity Questionnaire for Adolescents (MAQ). Participants completed a second HABITS questionnaire within 1 month to assess test-retest reliability. Internal consistency for dietary and physical activity/sedentary behaviour subscales was assessed using Cronbach's alpha, and test-retest reliability was assessed using Cohen's Kappa coefficient. Spearman's rank correlation coefficients were calculated for individual items using the 24-h recall and the MAQ as reference standards. RESULTS: The HABITS questionnaire subscales showed moderate internal consistency (Cronbach's alpha of 0.61 and 0.59 for the dietary and physical activity/sedentary behaviour subscale, respectively). The test-retest reliability was 0.94 for the dietary subscale and 0.87 for the physical activity/sedentary behaviour subscale. Several items on the HABITS questionnaire were moderately correlated with information reported in the MAQ and the 24-h recall (r = 0.38-0.59, P < 0.05). CONCLUSIONS: The HABITS questionnaire can reliably be used in a paediatric setting to quickly assess key dietary and physical activity/sedentary behaviours and to promote behaviour change for weight management.

Associations of changes in fat free mass with risk for type 2 diabetes: Hispanic Community Health Study/Study of Latinos.

AIMS: To determine whether loss of muscle mass (approximated using fat free mass [FFM]) is associated with risk for type 2 diabetes mellitus (T2DM) in Hispanic/Latino adults in the United States. METHODS: Participants were Hispanic/Latino adults (18-74-year-olds) who completed Visit 2 of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; multi-site, prospective cohort study; 6.1-year follow-up) and did not have T2DM at baseline (n = 6264). At baseline and Visit 2, FFM was measured using bioelectrical impedance analysis and fasting glucose, HbA1c, and fasting insulin were measured by examiners. Diabetes was defined according to American Diabetes Association criteria. Survey-weighted Poisson regression models examined the association of percent change in relative FFM (%ΔFFM) with incident prediabetes and T2DM. Survey-weighted multivariable regression models examined associations of %ΔFFM with changes in glucose and insulin measures. RESULTS: Relative FFM declined by 2.1% between visits. %ΔFFM was inversely associated with incident prediabetes (p-for-trend = 0.001) and with changes in glucose and insulin measures (p-for-trend <0.0001). Findings were null, except for HOMA-IR, after adjustment for changes in adiposity measures. Associations were generally stronger for individuals with baseline overweight/obesity. CONCLUSIONS: Reducing loss of FFM during adulthood may reduce prediabetes risk (primarily insulin resistance), particularly among individuals with overweight/obesity.

Self-reported and accelerometer-measured physical activity by body mass index in US Hispanic/Latino adults: HCHS/SOL.

The association between obesity and physical activity has not been widely examined in an ethnically diverse sample of Hispanic/Latino adults in the US. A cross-sectional analysis of 16,094 Hispanic/Latino adults 18-74 years was conducted from the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Body mass index (BMI) was measured and categorized into normal, overweight, and obese; underweight participants were excluded from analyses. Physical activity was measured using the 16-item Global Physical Activity Questionnaire and by an Actical accelerometer. Minutes/day of physical activity and prevalence of engaging in ≥ 150 moderate-vigorous physical activity (MVPA) minutes/week were estimated by BMI group and sex adjusting for covariates. No adjusted differences were observed in self-reported moderate (MPA), vigorous (VPA), or MVPA across BMI groups. Accelerometry-measured MPA, VPA, and MVPA were significantly higher for the normal weight (females: 18.9, 3.8, 22.6 min/day; males: 28.2, 6.1, 34.3 min/day, respectively) compared to the obese group (females: 15.3, 1.5, 16.8 min/day; males: 23.5, 3.6, 27.1 min/day, respectively). The prevalence of engaging in ≥ 150 MVPA minutes/week using accelerometers was lower compared to the self-reported measures. Efforts are needed to reach the Hispanic/Latino population to increase opportunities for an active lifestyle that could reduce obesity in this population at high risk for metabolic disorders.

Predictors of postprandial triacylglycerol response in children: the Columbia University Biomarkers Study.

BACKGROUND: Predictors of postprandial lipemia have not been explored in children. OBJECTIVE: Our objective was to determine whether the postprandial triacylglycerol response is associated with low HDL-cholesterol and high fasting triacylglycerol concentrations and family history of early-onset ischemic heart disease (IHD) in children. DESIGN: We administered a standardized fat load (52.5 g fat/m(2)) to 60 children (mean age: 14.0 y), 20 with and 40 without a family history of early-onset IHD, and to 29 mothers, all recruited from families enrolled in the Columbia University Biomarkers Study. Plasma lipid and retinyl palmitate concentrations were measured in the fasting state and 3, 6, and 8 h after the oral fat load. RESULTS: In children, postprandial lipemia, as indicated by the incremental area under the triacylglycerol response curve, was associated with elevated fasting triacylglycerol concentrations (>/=1.13 mmol/L; P: < 0.01), with low fasting HDL-cholesterol concentrations (

Candida arthritis in adult patients who are not intravenous drug addicts: report of three cases and review of the literature.

Candida species are an uncommon cause of infectious arthritis, although the frequency has increased during recent years. Three cases of septic arthritis caused by Candida species are reported, and the literature is reviewed. The first patient developed a popliteal cyst infected by Candida albicans after multiple intravenous antibiotic treatments. The second patient had acute myelogenous leukemia and experienced knee arthritis after chemotherapy, and the third suffered oligoarthritis after a second heart transplantation. All patients received treatment with a standard dose of intravenous amphotericin B. Responses were achieved only in the first two cases; the third patient died despite therapy. Thirty-six previously reported Candida arthritis cases are reviewed, and epidemiologic, diagnostic, therapeutic, and prognostic features are analyzed. Cases are divided into two categories: direct inoculation of fungus and hematogenously disseminated disease; these two categories are compared in terms of sex, age, pathogen species, treatment, and survival. Arthritis induced through direct inoculation of fungus is seen in older individuals, is more frequently produced by species other than C albicans (Candida parapsilosis especially), and has a better prognosis than arthritis caused by disseminated candidiasis. Arthritis can be resolved even in the persistence of the systemic disease. It is believed that the first case of Baker's cyst infected by C albicans and the first case of Candida arthritis in a heart transplant patient are reported here.

Intra-articular osteoid osteoma at the elbow: report of a case and review of the literature.

Osteoid osteoma is a benign tumor that may occur in almost any part of any bone. Diagnosis can be difficult, particularly when it is intra-articular. In these cases, osteoid osteoma may present initially with symptoms suggestive of inflammatory arthritis, degenerative joint disease, neoplasm, or infection. We report a case of intra-articular osteoid osteoma in a teenager who presented with a monoarthritis of the elbow. The patient did not have a typical pattern of pain, did not have the typical relief with anti-inflammatory agents, and misinterpretation of the radiographs led to a delay in the diagnosis and definitive treatment. Surgical excision confirmed the diagnosis and resulted in resolution of the monoarthritis. Intra-articular osteoid osteoma must be taken into account in cases of unexplained chronic monoarthritis, with a sterile and relatively noninflammatory synovial fluid. A definitive diagnosis depends on surgical excision and histologic confirmation. Ahigh index of suspicion is necessary to make the diagnosis.

Adjusting for confounding due to population admixture when estimating the effect of candidate genes on quantitative traits.

When analyzing the relationship between allelic variability and traits, a potential source of confounding is population admixture. An approach to adjusting for potential confounding due to population admixture when estimating the influence of allelic variability at a candidate gene is presented. The approach involves augmenting linear regression models with additional regressors. Family genotype data are used to define the regressors, and inclusion of the regressors ensures that, even in the presence of population admixture, the estimates of the regression coefficients that parameterize the influence of allelic variability on the trait are unbiased. The approach is illustrated through an analysis of the influence of apolipoprotein E genotype on plasma low density lipoprotein cholesterol concentrations.

Modulation by interferon alpha of the decreased natural killer activity in patients with glioblastoma.

It is known that natural killer (NK) cells are involved in immunosurveillance against tumours. This study examines the NK activity of mononuclear cells (MNC) from the peripheral blood of patients with glioblastoma. The cytotoxic inducer effect of interferon-alpha (IFN-alpha) upon these MNC has also been studied. A marked decrease in NK activity mediated by MNC from these patients was found. This functional defected in MNC is not due to a decrease in phenotypically defined NK cells. After long-term (5-day) incubation with IFN-alpha, MNC from 5 out of 14 patients showed strong lytic activity against NK-sensitive target cells. In this system, IFN-alpha failed to induce cytotoxic activity against NK-resistant target cells in MNC from all the patients studied. This in vitro induction of cytotoxic activity in MNC from some patients with glioblastoma by IFN-alpha suggests a potential immunotherapeutic use of the lymphokine in these subjects.

Interleukin 2 and interferon alpha modulation of the lymphocyte non-major histocompatibility-restricted lytic activity in glioblastoma patients.

We studied the non-major histocompatibility-restricted cytotoxic activity induced by interleukin 2 (IL-2) and interferon alpha (IFN-alpha) in mononuclear cells of peripheral blood (PBMNC) from glioblastoma patients. We observed a depressed cytotoxic activity against natural killer (NK)-sensitive target cells in PBMNC from all the patients studied. Culture of these PBMNC with IFN-alpha for 5 days augmented the cytotoxic activity against NK-sensitive target cells in a small group of patients. Incubation with IL-2 for 5 days normalizes the decreased cytotoxic activity against NK-sensitive target cells of PBMNC from all the glioblastoma patients studied. When PBMNC from these patients were incubated with IL-2 for 5 days and IFN-alpha was added to the culture medium in the last 2 h of culture, an enhancement of non-major histocompatibility-restricted cytotoxic activity was observed compared with that obtained with either IL-2 or IFN-alpha alone. This improvement of the cytotoxic activity was more relevant when it was tested against NK-resistant target cells. The potential utility of the sequential use of the two cytokines in generating non-major histocompatibility cytotoxic activity in glioblastoma patients is discussed.

Inverse association of physical fitness with plasma fibrinogen level in children: the Columbia University BioMarkers Study.

Plasma fibrinogen has emerged as a risk factor for cardiovascular disease in adults, but relatively little is known about the correlates of plasma fibrinogen level in childhood. In the Columbia University BioMarkers Study (1994-1998), the authors evaluated the association between physical fitness and plasma fibrinogen level in 193 children 4-25 years old; 68% were Hispanic and 46% male. Fitness level assessed by treadmill testing was inversely associated with plasma fibrinogen (r = -0.24, p<0.001). Plasma fibrinogen levels showed a graded inverse relation with tertiles of fitness assessed by treadmill (p<0.001). In multivariate analyses, after adjustment for age, sex, race/ethnicity, body mass index, and presence of the A allele in the -455 position of the beta-fibrinogen promoter gene, the fitness level remained inversely associated with plasma fibrinogen level (beta = -1.3, 95% confidence interval (CI): -2.3, -0.34). Resting heart rate was also correlated with plasma fibrinogen level (r = 0.18, p<0.05). Fibrinogen levels (mg/dl) increased over tertiles of resting heart rate (p = 0.002) and were significantly associated with resting heart rate in multivariate analysis (beta = 0.82, 95% CI: 0.17, 1.5). These findings indicate that plasma fibrinogen is inversely associated with physical fitness in children independent of body mass index.

Felty's syndrome: response to low dose oral methotrexate.

We describe a case of Felty's syndrome with persistent severe neutropenia below 200 granulocytes/mm3, splenomegaly and repeated infections. The patient did not respond to treatment with intramuscular gold salts and lithium carbonate. After 2 months of oral methotrexate administration, 7.5 mg weekly, clinical improvement was notable: she remained afebrile, neutropenia disappeared and splenomegaly regressed. This clinical and laboratory improvement persisted 5 months later. Moreover, accidental discontinuance of the drug and later readministration supported the evidence that the improvement was due to methotrexate.

Apolipoprotein epsilon2 allele is associated with an anti-atherogenic lipoprotein profile in children: The Columbia University BioMarkers Study.

OBJECTIVE: We examined associations between allelic variation in the apo epsilon gene, which codes for apolipoprotein E, and plasma lipid levels in children. MATERIALS AND METHODS: We analyzed genotype and fasting lipid levels, including lipid particle size by nuclear magnetic resonance spectroscopy, in 515 children from 297 families. RESULTS: Children carrying the apo epsilon2 allele (1 or 2 epsilon2 alleles; n = 45) had higher mean high-density lipoprotein (HDL) cholesterol level (49.5 +/- 13.0 vs 42.4 +/- 8.9 mg/dL) and lower mean low-density lipoprotein (LDL) cholesterol level (82.2 +/- 48.6 vs 105.9 +/- 45.0 mg/dL) compared with apo epsilon3/epsilon3 children (n = 322). Mean HDL size was larger and mean level of the atheroprotective large HDL subpopulation was higher among apo epsilon2 carriers compared with epsilon3/epsilon3 children (9.5 +/- 0.4 vs 9.3 +/-.4 nm, and 32.8 +/- 9.9 vs 27.6 +/- 8.2 mg/dL). In multivariate models adjusting for age, sex, ethnicity, family history, body mass index, and fasting triglyceride level, the apo epsilon2 allele was independently predictive of higher levels of HDL cholesterol and the large HDL subpopulation and of lower level of LDL cholesterol. CONCLUSION: The apo epsilon2 allele is associated with an anti-atherogenic lipid pattern in children.apolipoprotein epsilon, children, cholesterol.

Relations of plasma fibrinogen level in children to measures of obesity, the (G-455-->A) mutation in the beta-fibrinogen promoter gene, and family history of ischemic heart disease: the Columbia University BioMarkers Study.

Higher plasma fibrinogen levels are associated with increased risk of myocardial infarction in adults, but little is known about factors that influence fibrinogen levels in childhood. The authors examined the associations of measures of obesity, presence of the (G-455-->A) allele in the beta-fibrinogen promoter gene, and family history of early onset of ischemic heart disease with plasma fibrinogen levels in children. Children (n = 299) were recruited during 1994-1997 from 276 families living in a racially mixed area of New York City. The mean age of the study children was 9.9 years; 79% were Hispanic. The frequency of the (G-455-->A) allele was lower in Hispanics than in non-Hispanic Whites (15.5% vs. 28.3% in children (p < 0.01) and 13.9% vs. 28.3% in parents (p < 0.001)). Graded relations of children's plasma fibrinogen levels were found with tertiles of body mass index (weight (kg)/height (m)2) and sum of skinfolds (tests for linear trend: p < 0.001). Plasma fibrinogen levels in the children were not related to race/ethnicity, presence of the (G-455-->A) allele, or family history. Multiple linear regression analyses adjusting plasma fibrinogen levels for age, sex, race/ethnicity, the (G-455-->A) allele, and family history of early onset of heart disease showed a significant association with either body mass index or sum of skinfolds (p < 0.001 for both models) but not with the other variables.