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Brown RL, Alegria KE, Hamlat E, Tomiyama AJ, Laraia B, Crimmins EM, Moffitt TE, Epel ES. Psychosocial Disadvantage During Childhood and Midlife Health: NIMHD Social Epigenomics Program. JAMA Netw Open 2024; 7:e2421841. [PMID: 39073819 PMCID: PMC11287423 DOI: 10.1001/jamanetworkopen.2024.21841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/22/2024] [Indexed: 07/30/2024] Open
Abstract
Importance Low childhood socioeconomic status (SES) is a social hallmark of aging that contributes to adult health disparities and earlier morbidity and mortality. Childhood perceptions of stress are associated with child health outcomes and may contribute to premature biological aging into adulthood. Objective To describe the association of childhood SES and perceived stress with midlife insulin resistance and epigenetic age and to explore whether late adolescent adiposity mediates the observed associations. Design, Setting, and Participants The longitudinal cohort National Heart, Lung, and Blood Institute Growth and Health Study enrolled girls aged 10 years from January 1987 to May 1988, and followed them up to 19 years of age. Participants from Richmond, California, were recruited again at midlife in 2016 to assess insulin resistance and epigenetic age. Analyses were conducted from August 2, 2023, to March 18, 2024. A total of 433 participants were eligible and included in the analyses (specific sample sizes ranged across analyses from 303 to 391). Exposures Childhood levels of SES at 10 years of age (parental educational level and income) and perceived stress at 11 years of age. Main Outcomes and Measures The hypotheses tested were formulated after data collection. Outcomes included the homeostatic model assessment of insulin resistance (HOMA-IR) and the GrimAge and DunedinPACE epigenetic clocks. Waist circumference in late adolescence was tested as a mediator. Results Among the 433 participants, the mean (SD) age was 39.4 (1.2) years; 218 (50.3%) were Black and 215 (49.7%) were White; and 135 (31.2%) had parents with a college degree or higher. Higher parental educational level was associated with lower HOMA-IR (B = -0.22 [95% CI, -0.41 to -0.02]; P = .03), lower midlife GrimAge (B = -1.76 [95% CI, -2.85 to -0.66] years; P = .002), and slower midlife DunedinPACE (B = -0.03 [95% CI, -6.29 to -0.002]; P = .04). Childhood perceived stress was indirectly associated through late adolescent adiposity with midlife HOMA-IR (B = 0.01 [95% CI, 0.001-0.01]; P = .02) and midlife GrimAge (B = 0.02 [95% CI, 0.003-0.04] years; P = .01). Conclusions and Relevance In this longitudinal cohort study of midlife health and aging, childhood social hallmarks of aging were associated with midlife insulin resistance and epigenetic age (GrimAge and DunedinPACE). Future studies should identify malleable factors that may slow the impact of social hallmarks of aging.
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Affiliation(s)
- Ryan L. Brown
- Center for Health and Community, University of California, San Francisco
| | - Katie E. Alegria
- Center for Health and Community, University of California, San Francisco
| | - Elissa Hamlat
- Center for Health and Community, University of California, San Francisco
| | | | - Barbara Laraia
- School of Public Health, University of California, Berkeley
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Elissa S. Epel
- Center for Health and Community, University of California, San Francisco
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Brokamp C, Jones MN, Duan Q, Rasnick Manning E, Ray S, Corley AMS, Michael J, Taylor S, Unaka N, Beck AF. Causal Mediation of Neighborhood-Level Pediatric Hospitalization Inequities. Pediatrics 2024; 153:e2023064432. [PMID: 38426267 DOI: 10.1542/peds.2023-064432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Population-wide racial inequities in child health outcomes are well documented. Less is known about causal pathways linking inequities and social, economic, and environmental exposures. Here, we sought to estimate the total inequities in population-level hospitalization rates and determine how much is mediated by place-based exposures and community characteristics. METHODS We employed a population-wide, neighborhood-level study that included youth <18 years hospitalized between July 1, 2016 and June 30, 2022. We defined a causal directed acyclic graph a priori to estimate the mediating pathways by which marginalized population composition causes census tract-level hospitalization rates. We used negative binomial regression models to estimate hospitalization rate inequities and how much of these inequities were mediated indirectly through place-based social, economic, and environmental exposures. RESULTS We analyzed 50 719 hospitalizations experienced by 28 390 patients. We calculated census tract-level hospitalization rates per 1000 children, which ranged from 10.9 to 143.0 (median 45.1; interquartile range 34.5 to 60.1) across included tracts. For every 10% increase in the marginalized population, the tract-level hospitalization rate increased by 6.2% (95% confidence interval: 4.5 to 8.0). After adjustment for tract-level community material deprivation, crime risk, English usage, housing tenure, family composition, hospital access, greenspace, traffic-related air pollution, and housing conditions, no inequity remained (0.2%, 95% confidence interval: -2.2 to 2.7). Results differed when considering subsets of asthma, type 1 diabetes, sickle cell anemia, and psychiatric disorders. CONCLUSIONS Our findings provide additional evidence supporting structural racism as a significant root cause of inequities in child health outcomes, including outcomes at the population level.
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Affiliation(s)
- Cole Brokamp
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Margaret N Jones
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Qing Duan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sarah Ray
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexandra M S Corley
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph Michael
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stuart Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ndidi Unaka
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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3
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Lam PH, Chen E, Jiang T, Moon H, Passarelli V, Kim J, Miller GE. Responsive parental support buffers the link between chronic stress and cardiometabolic risk among adolescents. Brain Behav Immun 2024; 116:114-123. [PMID: 38052410 DOI: 10.1016/j.bbi.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/31/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
Youth exposed to chronic stress exhibit increased cardiometabolic risk which parental social support may attenuate. Notably, theories emphasize that support should be delivered responsively for it to exert buffering effects, but this has not been thoroughly tested empirically. This study examined whether timing of support is an important but unrecognized element of responsiveness during adolescence in buffering the link between chronic stress and cardiometabolic risk. Participants were 242 adolescents aged 15 years (63 % female, 38 % Black). Adolescents completed assessments of chronic stress (Life Stress Interview), and trained personnel collected anthropometric measures and blood samples to assess cardiometabolic risk (reflected in low-grade inflammation and metabolic syndrome). Adolescents also completed an eight-day diary assessment to report daily stressor exposure and parental support. Using the diary data, responsiveness of parental support was operationalized as the within-individual difference in parental support received on stressor (vs. non-stressor) days, such that increased parental support on stressor days reflected more timely support. Results suggest that responsive parental support buffered the link between chronic stress and cardiovascular risk. Specifically, chronic stress was associated with greater risk only when parental support was not temporally aligned with stress exposure, but this association was not observed among adolescents who received timely parental support. These findings shed light on why parental support may not always exert buffering effects during adolescence, highlighting the importance of taking a developmental approach to understanding protective effects.
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Affiliation(s)
- Phoebe H Lam
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Edith Chen
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Tao Jiang
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Hee Moon
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | | | - Jungwon Kim
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Gregory E Miller
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA
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4
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Koutny F, Aigner E, Datz C, Gensluckner S, Maieron A, Mega A, Iglseder B, Langthaler P, Frey V, Paulweber B, Trinka E, Wernly B. Relationships between education and non-alcoholic fatty liver disease. Eur J Intern Med 2023; 118:98-107. [PMID: 37541922 DOI: 10.1016/j.ejim.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Individuals with lower levels of education are at a higher risk of developing various health conditions due to limited access to healthcare and unhealthy lifestyle choices. However, the association between non-alcoholic fatty liver disease (NAFLD) and educational level remains unclear. Therefore, the aim of this study was to investigate whether there is an independent relationship between NAFLD and educational level as a surrogate marker for socioeconomic status (SES). METHODS This cross-sectional study included 8,727 participants from the Paracelsus 10,000 study. The association between NAFLD and educational level was assessed using multivariable logistic regression models and multivariable linear regression. The primary endpoints were NAFLD (FLI score > 60) and liver fibrosis (FIB-4 score > 1.29). Further subgroup analysis with liver stiffness measurement was done. RESULTS In the study, NAFLD prevalence was 23% among participants with high education, 33% among intermediate, and 40% among those with low education (p<0.01). Importantly, a significantly reduced risk of NAFLD was observed in individuals with higher education, as indicated by an adjusted relative risk of 0.52 (p < 0.01). Furthermore, higher education level was associated with significantly lower odds of NAFLD and fibrosis. Additionally, a subgroup analysis revealed that higher liver stiffness measurements were independently associated with lower levels of education. CONCLUSION The study's findings indicate that a lower education level increases the risk of NAFLD independent of confounding factors. Therefore, these findings highlight the potential impact of educational attainment on NAFLD risk and emphasize the need for targeted interventions in vulnerable populations.
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Affiliation(s)
- Florian Koutny
- Department of internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, lower Austria, Austria
| | - Elmar Aigner
- First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Sophie Gensluckner
- First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Maieron
- Department of internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, lower Austria, Austria
| | - Andrea Mega
- Gastroenterology Department, Bolzano Regional Hospital, Bolzano 39100, Italy
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University Salzburg, Salzburg Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Austria; Department of Artificial Intelligence and Human Interfaces, Paris Lodron University of Salzburg, Salzburg, Austria; Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Austria; Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Austria
| | - Bernhard Paulweber
- First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria; Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria.
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Pantell MS, Holmgren AJ, Leary JC, Iott BE, Neuhaus J, Adler-Milstein J, Gottlieb LM. Social and Medical Care Integration Practices Among Children's Hospitals. Hosp Pediatr 2023; 13:886-894. [PMID: 37718963 PMCID: PMC10520266 DOI: 10.1542/hpeds.2023-007246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVES In response to evidence linking social risk factors and adverse health outcomes, new incentives have emerged for hospitals to screen for adverse social determinants of health (SDOH). However, little information is available about the current state of social risk-related care practices among children's hospitals. To address outstanding knowledge gaps, we sought to describe social risk-related care practices among a national sample of children's hospitals. METHODS We analyzed responses to the 2020 American Hospital Association Annual Survey. Among children's hospitals, we calculated the prevalence of screening for social needs, strategies to address social risks/needs, partnerships with community-based organizations to address social risks/needs at the individual and community level, and rates of impact assessments of how social risk-related interventions affect outcomes. We also used χ2 tests to compare results by hospital characteristics. We weighted results to adjust for nonresponse. RESULTS The sample included 82 children's hospitals. A total of 79.6% screened for and 96.0% had strategies to address at least 1 social risk factor, although rates varied by SDOH domain. Children's hospitals more commonly partnered with community-based organizations to address patient-level social risks than to participate in community-level initiatives. A total of 39.2% of hospitals assessed SDOH intervention effectiveness. Differences in social risk-related care practices commonly varied by hospital ownership and Medicaid population but not by region. CONCLUSIONS We found wide variability in social risk-related care practices among children's hospitals based on the risk domain and hospital characteristics. Findings can be used to monitor whether social risk-related care practices change in the setting of new incentives.
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Affiliation(s)
- Matthew S. Pantell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
- Social Interventions Research and Evaluation Network, San Francisco, California
| | - A. Jay Holmgren
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Clinical Informatics and Improvement Research Center, San Francisco, California
| | - Jana C. Leary
- Department of Pediatrics, Tufts Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Bradley E. Iott
- Social Interventions Research and Evaluation Network, San Francisco, California
- Clinical Informatics and Improvement Research Center, San Francisco, California
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Clinical Informatics and Improvement Research Center, San Francisco, California
| | - Laura M. Gottlieb
- Social Interventions Research and Evaluation Network, San Francisco, California
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Kamari N, Fateh HL, Darbandi M, Najafi F, Moradi M, Pasdar Y. Fatty liver index relationship with biomarkers and lifestyle: result from RaNCD cohort study. BMC Gastroenterol 2023; 23:172. [PMID: 37217853 DOI: 10.1186/s12876-023-02785-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Lifestyle intervention can effectively treat patients with non-alcoholic fatty liver disease (NAFLD). The present study aimed to investigate the association between lifestyle factors with fatty liver index (FLI) in Iranian adults. METHODS This study enrolled 7114 subjects from the Ravansar Non-Communicable Diseases (RaNCD) cohort study in western Iran. To compute the FLI score, anthropometric measures, and a few non-invasive liver status indicators were used. Binary logistic regression models examined the association between FLI score and lifestyle. RESULTS Participants with FLI < 60 had a lower daily energy intake compared to those with FLI ≥ 60 (2740.29 vs. 2840.33 kcal/day, P = < 0.001). The risk of NAFLD in males with high socioeconomic status (SES) was 72% higher than in those with low SES (OR: 1.72; 95% CIs 1.42-2.08). An adjusted logistic regression model showed a significantly negative association between high physical activity and fatty liver index in both men and women. (OR: 0.44, p-value < 0.001 and OR: 0.54, p-value < 0.001, respectively). The odds of NAFLD in female participants with depression were 71% higher than in non-depressed participants (OR: 1.71, 95% CI: 1.06-2.64). Dyslipidemia and high visceral fat area (VFA) were also associated with a significant increase in the risk of NAFLD (P < 0.05). CONCLUSION In our study, we found that good SES, high VFA, and dyslipidemia were associated with an increased risk of NAFLD. Conversely, high physical activity reduces the risk of NAFLD. Therefore, lifestyle modification may help improve liver function.
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Affiliation(s)
- Negin Kamari
- School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hawal Lateef Fateh
- Nursing Department, Kalar Technical College, Sulaimani Polytechnic University, Sulaymaniyah, Iraq
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Moradi
- Internal Medicine Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Andersson MA, Wilkinson LR, Schafer MH. The Long Arm of Childhood: Does It Vary According to Health Care System Quality? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:79-97. [PMID: 36062757 DOI: 10.1177/00221465221120099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Increasing evidence points to the salience of early life experiences in shaping health inequalities, but scant research has considered the role of institutional resources as buffers in this relationship. Health care systems in particular are an understudied yet important context for the generation of inequalities from childhood into adulthood. This research investigates associations between childhood disadvantage and adult morbidity and examines the role of health care system quality in this relationship. We also consider the role of adult socioeconomic status. We merge individual-level data on major disease (2014 European Social Survey) with nation-level health care indicators. Results across subjective and objective approaches to health care system quality are similar, indicating a reduced association between childhood socioeconomic status and adult disease in countries with higher quality health care. In total, our results reiterate the long-term influence of childhood disadvantage on health while suggesting health care's specific role as an institutional resource for ameliorating life course health inequalities.
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Tell D, Burr RL, Mathews HL, Janusek LW. Heart Rate Variability and Inflammatory Stress Response in Young African American Men: Implications for Cardiovascular Risk. Front Cardiovasc Med 2021; 8:745864. [PMID: 34722677 PMCID: PMC8548416 DOI: 10.3389/fcvm.2021.745864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/20/2021] [Indexed: 01/23/2023] Open
Abstract
Background: African American men have a disproportionately higher incidence of and suffer greater severity and earlier death from cardiovascular disease (CVD). A common feature of many diseases, which disproportionately afflict disadvantaged African Americans, is inflammation. In particular, inflammation plays a decisive role in the pathogenesis of CVD in that persistent inflammation contributes to plaque evolution and destabilization. Adverse childhood experiences increase the risk for adult inflammatory based disease, particularly cardiovascular disease. This inflammatory burden becomes evident during stressful events and may be related to alterations in autonomic nervous system (ANS) activity. We previously reported that African American men who experienced childhood adversity exhibited a greater inflammatory (IL-6) response to acute stress challenge (Trier Social Stress Test - TSST). The purpose of this study was to determine whether altered ANS activity, as measured by heart rate variability (HRV), contributes to a greater proinflammatory response to stress in those exposed to childhood adversity. Methods: Thirty-four African American adult males underwent the TSST while instrumented with Holter monitors to record continuous heart rate for HRV determination. HRV was calculated as the low frequency (LF) to high frequency (HF) heart rate ratio (LF/HF), with higher LF/HF ratios corresponding to higher sympathetic vs. parasympathetic activity. Salivary samples were collected pre- and post-TSST to measure the proinflammatory cytokine IL-6. Childhood adversity was assessed by the Childhood Trauma Questionnaire. Results: Hierarchical linear modeling demonstrated that higher levels of physical abuse were related to a steeper rise in LF/HF ratio during the TSST. Further, a higher LF/HF ratio, in combination with greater exposure to emotional and physical abuse was associated with a greater IL-6 response to the TSST. Conclusions: These findings suggest that adverse childhood experiences associate with an adult phenotype characterized by an altered ANS response to stress as well as a greater proinflammatory (IL-6) response to an acute stressor. Elevations in salivary inflammatory markers have been associated with increased CVD risk. In conclusion, these findings suggest a role for the ANS in the underlying neuro-biological processes whereby childhood adversity predisposes to a more intense inflammatory response to stressful challenge during adulthood.
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Affiliation(s)
- Dina Tell
- Department of Health Systems and Adult Health, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, United States
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Herbert L Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, United States
| | - Linda Witek Janusek
- Department of Health Promotion, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, United States
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Bleil ME, Spieker SJ, Booth-LaForce C. Targeting Parenting Quality to Reduce Early Life Adversity Impacts on Lifespan Cardiometabolic Risk. Front Psychol 2021; 12:678946. [PMID: 34149571 PMCID: PMC8211431 DOI: 10.3389/fpsyg.2021.678946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Mounting evidence that early life adversity (ELA) exposures confer risk for cardiometabolic disease over the lifespan motivated this narrative review to examine parenting quality as a potential intervention target to reduce ELA exposures or mitigate their impact as a way of reducing or preventing cardiometabolic disease. We describe findings from the limited number of family-based intervention studies in ELA-exposed children that have tested parenting impacts on cardiometabolic health outcomes. We then describe the implications of this work and make recommendations for future research that will move this field forward.
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Affiliation(s)
- Maria E. Bleil
- Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
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Jimenez V, Sanchez N, Clark ELM, Miller RL, Casamassima M, Verros M, Conte I, Ruiz-Jaquez M, Gulley LD, Johnson SA, Melby C, Lucas-Thompson RG, Shomaker LB. Associations of adverse childhood experiences with stress physiology and insulin resistance in adolescents at risk for adult obesity. Dev Psychobiol 2021; 63:e22127. [PMID: 33991342 DOI: 10.1002/dev.22127] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022]
Abstract
Adverse childhood experiences (ACEs) heighten the risk for adult obesity and cardiometabolic disease, but physiological factors underlying this connection are not well understood. We determined if ACEs were associated with physiological stress response and insulin resistance in adolescents at risk for adult obesity. Participants were 90 adolescents 12.0-17.5 years (50% female, 30% Hispanic/Latinx), at risk for adult obesity by virtue of above-average body mass index (BMI; kg/m2 ≥ 70th percentile) or parental obesity (BMI ≥ 30 kg/m2 ). ACEs were determined as presence (vs. absence) based upon the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Physiological stress response was measured as heart rate/blood pressure response to the Trier Social Stress Test. Homeostatic model assessment of insulin resistance was determined from fasting glucose/insulin. Sixty-one percent of adolescents reported positive ACE history. The presence of ACEs predicted greater heart rate (p < .001) and diastolic blood pressure (p = .02) response to stress, controlling for age, sex, race/ethnicity, puberty, and BMI standard score. Systolic blood pressure and insulin resistance did not differ by ACE history (p-values > .08). Findings suggest heightened sympathetic stress response in adolescence could be explanatory in how ACEs increase the risk for later cardiometabolic disease. Future studies should characterize ACEs in relationship to day-to-day variations in adolescents' stress physiology and glucose homeostasis.
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Affiliation(s)
- Virginia Jimenez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
| | - Emma L M Clark
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Reagan L Miller
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Milena Casamassima
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
| | - Megan Verros
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
| | - Isabella Conte
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Metztli Ruiz-Jaquez
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA.,Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sarah A Johnson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - Christopher Melby
- Colorado School of Public Health, Aurora, Colorado, USA.,Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado, USA
| | - Rachel G Lucas-Thompson
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA.,Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, Colorado, USA
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11
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Tooley UA, Mackey AP, Ciric R, Ruparel K, Moore TM, Gur RC, Gur RE, Satterthwaite TD, Bassett DS. Associations between Neighborhood SES and Functional Brain Network Development. Cereb Cortex 2021; 30:1-19. [PMID: 31220218 PMCID: PMC7029704 DOI: 10.1093/cercor/bhz066] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Higher socioeconomic status (SES) in childhood is associated with stronger cognitive abilities, higher academic achievement, and lower incidence of mental illness later in development. While prior work has mapped the associations between neighborhood SES and brain structure, little is known about the relationship between SES and intrinsic neural dynamics. Here, we capitalize upon a large cross-sectional community-based sample (Philadelphia Neurodevelopmental Cohort, ages 8-22 years, n = 1012) to examine associations between age, SES, and functional brain network topology. We characterize this topology using a local measure of network segregation known as the clustering coefficient and find that it accounts for a greater degree of SES-associated variance than mesoscale segregation captured by modularity. High-SES youth displayed stronger positive associations between age and clustering than low-SES youth, and this effect was most pronounced for regions in the limbic, somatomotor, and ventral attention systems. The moderating effect of SES on positive associations between age and clustering was strongest for connections of intermediate length and was consistent with a stronger negative relationship between age and local connectivity in these regions in low-SES youth. Our findings suggest that, in late childhood and adolescence, neighborhood SES is associated with variation in the development of functional network structure in the human brain.
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Affiliation(s)
- Ursula A Tooley
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allyson P Mackey
- Department of Psychology, College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Rastko Ciric
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyler M Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle S Bassett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Physics & Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.,Department of Electrical & Systems Engineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
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12
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Fuligni AJ, Chiang JJ, Tottenham N. Sleep disturbance and the long-term impact of early adversity. Neurosci Biobehav Rev 2021; 126:304-313. [PMID: 33757816 DOI: 10.1016/j.neubiorev.2021.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/04/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
Sleep disturbance may be a central, yet underappreciated mechanism by which early adversity has a long-term impact upon mental and physical health. The fundamental regulatory processes shaped by early adversity - neural, neuroendocrine, and immune - are also central to sleep. Sleep problems, in turn, lead to a similar constellation of chronic health problems that have been linked to early adversity. We bring together work from the fields of early adversity and sleep in order to suggest a model by which sleep disturbance plays a critical role in the far-reaching impacts of early adversity on health. Future research should employ more longitudinal designs and pay particular attention to the impact of developmental periods such as adolescence and midlife when maturational and environmental factors conspire to create a unique time of sleep disturbance. We also suggesting that intervening to minimize sleep disturbance may be a promising means by which to test the model, as well as potentially blunt the long-term impact of early adversity on health.
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13
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Relationships between Socioeconomic Status, Handgrip Strength, and Non-Alcoholic Fatty Liver Disease in Middle-Aged Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041892. [PMID: 33669288 PMCID: PMC7920055 DOI: 10.3390/ijerph18041892] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 02/08/2023]
Abstract
Although low socioeconomic status (SES) and decreased muscle strength have been found to be associated with the risk factors of non-alcoholic fatty liver disease (NAFLD), including insulin resistance, obesity, and metabolic syndrome, the associations among SES, muscle strength, and NAFLD are still unclear. We aimed to investigate the combined effect of SES and relative handgrip strength (HGS) on the risk of NAFLD in middle-aged adults. Data from 5272 middle-aged adults who participated in the Korea National Health and Nutrition Examination Surveys (KNHANES) from 2014–2018 were analyzed. NAFLD was defined using the hepatic steatosis index (HSI) > 36 and the comprehensive NAFLD score (CNS) ≥ 40 in the absence of other causes of liver disease. SES was based on a self-reported questionnaire. Overall, individuals with low SES (odds ratio (OR) = 1.703, 95% confidence interval (CI): 1.424–2.037, p < 0.001) or low HGS (OR = 12.161, 95% CI: 9.548–15.488, p < 0.001) had a significantly higher risk of NAFLD. The joint association analysis showed that a low SES combined with a low HGS (OR = 2.479, 95% CI: 1.351–4.549, p = 0.003) further significantly increased the risk of NAFLD when adjusted for all the covariates, compared with individuals with a high SES and a high HGS (OR = 1). The current findings suggest that both low SES and low HGS were independently and synergistically associated with an increased risk of NAFLD in middle-aged Korean adults.
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14
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Pantell MS, Kaiser SV, Torres JM, Gottlieb LM, Adler NE. Associations Between Social Factor Documentation and Hospital Length of Stay and Readmission Among Children. Hosp Pediatr 2020; 10:12-19. [PMID: 31888952 DOI: 10.1542/hpeds.2019-0123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Social risk factors are linked to children's health, but little is known about how frequently these factors are documented using the International Classification of Diseases (ICD) or whether documentation is associated with health care use outcomes. Using a large administrative database of pediatric hospitalizations, we examined the prevalence of ICD social risk code documentation and hypothesized that social code documentation would be associated with longer length of stay (LOS) and readmission. METHODS We analyzed hospitalizations of children ages ≤18 using the 2012 Nationwide Readmissions Database. The following ICD social codes were used as predictors: family member with alcohol and/or drug problem, history of abuse, parental separation, foster care, educational circumstance, housing instability, other economic strain, and legal circumstance. Outcomes included long LOS (top quintile) and readmission within 30 days after discharge. Covariates included individual, hospital, and season variables. RESULTS Of 926 073 index hospitalizations, 7432 (0.8%) had International Classification of Diseases, Ninth Revision, social codes. Social code documentation was significantly associated with long LOS. Adjusting for covariates, family alcohol and/or drug problem (odds ratio [OR] 1.65; 95% confidence interval [CI] 1.16-2.35), foster care (OR 2.37, 95% CI 1.53-3.65), other economic strain (OR 2.12, 95% CI 1.38-3.26), and legal circumstances (OR 1.66; 95% CI 1.02-2.71) remained significant predictors of long LOS. Social code documentation was not associated with readmission after adjusting for covariates. CONCLUSIONS Social ICD codes are associated with prolonged LOS and readmission in pediatric hospitalizations, but they are infrequently documented. Future work exploring these associations could help to determine if addressing social risk factors in inpatient settings might improve child health outcomes.
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Affiliation(s)
- Matthew S Pantell
- Division of Hospital Medicine, Department of Pediatrics,
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | | | | | - Laura M Gottlieb
- Family and Community Medicine, and
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Nancy E Adler
- Psychiatry, and
- Center for Health and Community, University of California, San Francisco, San Francisco, California
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15
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Childhood social preference and adolescent insulin resistance: Accounting for the indirect effects of obesity. Psychoneuroendocrinology 2019; 113:104557. [PMID: 31884323 PMCID: PMC6953604 DOI: 10.1016/j.psyneuen.2019.104557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/07/2019] [Accepted: 12/13/2019] [Indexed: 11/21/2022]
Abstract
Insulin resistance, hyperinsulinemia, and Type II diabetes are increasingly common among young people in the United States. The quality of social relationships is a predictor of cardiometabolic health among adults, but has not been studied as a predictor of earlier insulin resistance. The purpose of this study was to test whether social preference (likeability) during childhood predicts insulin resistance and a measure of central adiposity during adolescence. Obesity also was examined as one mechanism through which this association occurs. Data came from a long-term longitudinal community study. At approximately age 7, 240 children were rated by their classmates on how liked and how disliked they were (difference score indexes social preference). Nine years later, at age 16, the same children visited the university laboratory where height, weight, and several measures of central adiposity (waist circumference, sagittal diameter, and waist-to-height ratio) were assessed by trained interviewers. Adolescents also provided fasted blood samples, from which HOMA-estimated insulin resistance was assessed. A path model yielded adequate to good fit indices, χ2 (3, N = 240) = 6.689, p = .08, CFI = .97, RMSEA = .07 [95% CI = .00, .14], sRMR = .03. Results indicated that greater social preference at age 7 was significantly associated with lower IR at age 16. These findings suggest that children who are less liked by their classmates are more likely to demonstrate increased risk of IR. Additionally, BMI at age 15 was positively associated with both IR and WC at age 16. A bootstrapping procedure (10,000 draws) indicated that a child's likeability is associated with IR and WC through the association of likeability with later weight status. The quality of social relationships in childhood is important to consider when trying to understand the recent rise in adolescents' cardiometabolic risk and when considering intervention strategies.
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16
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Students of color show health advantages when they attend schools that emphasize the value of diversity. Proc Natl Acad Sci U S A 2019; 116:6013-6018. [PMID: 30858317 DOI: 10.1073/pnas.1812068116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
As the United States becomes more diverse, the ways in which mainstream institutions recognize and address race and ethnicity will be increasingly important. Here, we show that one novel and salient characteristic of an institutional environment, that is, whether a school emphasizes the value of racial and ethnic diversity, predicts better cardiometabolic health among adolescents of color. Using a diverse sample of adolescents who attend more than 100 different schools in predominantly urban locations, we find that when schools emphasize the value of diversity (operationalized as mentioning diversity in their mission statements), students of color, but not white students, have lower values on a composite of five biomarkers of inflammation, have less insulin resistance and compensatory β-cell activity, and have fewer metabolic syndrome signs and score lower on a continuous metabolic syndrome composite. These results suggest that institutions that emphasize diversity may play an unacknowledged role in protecting the health of people of color and, thus, may be a site for future interventions to reduce health disparities.
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17
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Beck AF, Cohen AJ, Colvin JD, Fichtenberg CM, Fleegler EW, Garg A, Gottlieb LM, Pantell MS, Sandel MT, Schickedanz A, Kahn RS. Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care. Pediatr Res 2018; 84:10-21. [PMID: 29795202 DOI: 10.1038/s41390-018-0012-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/05/2018] [Accepted: 03/10/2018] [Indexed: 02/06/2023]
Abstract
The social determinants of health (SDoH) are defined by the World Health Organization as the "conditions in which people are born, grow, live, work, and age." Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and "adult diseases" such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.
| | - Alicia J Cohen
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Jeffrey D Colvin
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Caroline M Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
| | - Eric W Fleegler
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvin Garg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Matthew S Pantell
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Megan T Sandel
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Adam Schickedanz
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Robert S Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
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18
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Condon EM. Chronic Stress in Children and Adolescents: A Review of Biomarkers for Use in Pediatric Research. Biol Res Nurs 2018; 20:473-496. [PMID: 29865855 DOI: 10.1177/1099800418779214] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PROBLEM Incorporating biomarkers of chronic stress into pediatric research studies may help to explicate the links between exposure to adversity and lifelong health, but there are currently very few parameters to guide nurse researchers in choosing appropriate biomarkers of chronic stress for use in research with children and adolescents. METHODS Biomarkers of chronic stress are described, including primary mediators (glucocorticoids, catecholamines, and cytokines) and secondary outcomes (neurologic, immune, metabolic, cardiovascular, respiratory, and anthropometric) of the chronic stress response. RESULTS Evidence of the use of each biomarker in pediatric research studies is reviewed. Recommendations for pediatric researchers, including selection of appropriate biomarkers, measurement considerations, potential moderators, and future directions for research, are presented. DISCUSSION A wide range of biomarkers is available for use in research studies with children. While primary mediators of chronic stress have been frequently measured in studies of children, measurement of secondary outcomes, particularly immune and metabolic biomarkers, has been limited. With thoughtful and theoretically based approaches to selection and measurement, these biomarkers present an important opportunity to further explore the physiologic pathways linking exposure to chronic stress with later health and disease. CONCLUSION The incorporation of chronic stress biomarkers into pediatric research studies may provide valuable insight into the mechanisms through which stressful environments "get under the skin" and ultimately inform efforts to promote health and reduce inequities among children exposed to adversity.
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Affiliation(s)
- Eileen M Condon
- 1 Yale School of Nursing, West Campus Drive, Orange, CT, USA
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19
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Kim GR, Jee SH, Pikhart H. Role of allostatic load and health behaviours in explaining socioeconomic disparities in mortality: a structural equation modelling approach. J Epidemiol Community Health 2018; 72:545-551. [DOI: 10.1136/jech-2017-209131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 11/04/2022]
Abstract
BackgroundThe relationship between socioeconomic status and mortality has been well established; however, the extent to which biological factors mediate this relationship is less clear, and empirical evidence from non-Western settings is limited. Allostasis, a cumulative measure of physiological dysregulation, has been proposed as the underlying mechanism linking socioeconomic status to adverse health outcomes. The current study aimed to ascertain the contribution of allostatic load (AL) and health behaviours to socioeconomic inequalities in mortality among Korean adults.MethodsThe sample comprised 70 713 middle-aged and older-aged adults, aged 40–79 years from the Korean Metabolic Syndrome Mortality Study. Using structural equation modelling (SEM), mediation analyses were performed to estimate the effects of socioeconomic position (SEP) on mortality over the follow-up and the extent to which AL, physical exercise and non-smoking status mediate the association between SEP and mortality.ResultsA total of 5618 deaths (7.9%) occurred during the mean follow-up of 15.2 years (SD 2.9). SEM confirmed a direct significant effect of SEP on mortality, as well as significant indirect paths through AL, physical exercise and non-smoking status.ConclusionsOur findings provide support for the mediating role of AL and health behaviours in the link between SEP and mortality. Policies designed to reduce social disparities in mortality in the long term should primarily focus on reducing stress and promoting healthy lifestyles among the socially disadvantaged groups. Future studies should further assess the role of other mediators such as psychosocial factors, which may contribute to socioeconomic inequalities in mortality.
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20
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Thota P, Perez-Lopez FR, Benites-Zapata VA, Pasupuleti V, Hernandez AV. Obesity-related insulin resistance in adolescents: a systematic review and meta-analysis of observational studies. Gynecol Endocrinol 2017; 33:179-184. [PMID: 28102091 DOI: 10.1080/09513590.2016.1273897] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Insulin resistance is common among obese adolescents; however, the extent of this problem is not clear. We conducted a systematic review of PubMed-Medline, CINAHL, The Web of Science, EMBASE and Scopus for observational studies evaluating components defining insulin resistance (insulin, C-peptide and homeostatic model assessment-insulin resistance [HOMA-IR]) in obese adolescents (12-18 years) versus non-obese adolescents. Our systematic review and meta-analysis followed the PRISMA guidelines. Data were combined using a random-effects model and summary statistics were calculated using the mean differences (MDs). 31 studies were included (n = 8655). In 26 studies, fasting insulin levels were higher in obese adolescents when compared to non-obese adolescents (MD = 64.11 pmol/L, 95%CI 49.48-78.75, p < 0.00001). In three studies, fasting C-peptide levels were higher in obese adolescents when compared to non-obese adolescents (MD = 0.29 nmol/L, 95%CI 0.22-0.36, p < 0.00001). In 24 studies, HOMA-IR values were higher in obese adolescents when compared to non-obese adolescents (MD = 2.22, 95%CI 1.78-2.67, p < 0.00001). Heterogeneity of effects among studies was moderate to high. Subgroup analyses showed similar results to the main analyses. Circulating insulin and C-peptide levels and HOMA-IR values were significantly higher in obese adolescents compared to those non-obese.
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Affiliation(s)
- P Thota
- a School of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - F R Perez-Lopez
- b Department of Obstetrics and Gynecology , University of Zaragoza Faculty of Medicine and Lozano Blesa University Hospital , Domingo Miral s/n, Zaragoza , Spain
| | - V A Benites-Zapata
- c Center for Public Health Research, Research Institute, Faculty of Medicine, University of San Martin de Porres , Lima , Peru
| | - V Pasupuleti
- a School of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - A V Hernandez
- d School of Medicine , Universidad Peruana de Ciencias Aplicadas (UPC) , Lima , Peru , and
- e Department of Quantitative Health Sciences , Health Outcomes and Clinical Epidemiology Section, Cleveland Clinic, Cleveland, OH , USA
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21
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Williams AN, Konopken YP, Keller CS, Castro FG, Arcoleo KJ, Barraza E, Patrick DL, Olson ML, Shaibi GQ. Culturally-grounded diabetes prevention program for obese Latino youth: Rationale, design, and methods. Contemp Clin Trials 2017; 54:68-76. [PMID: 28104469 DOI: 10.1016/j.cct.2017.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 2 diabetes (T2D) disproportionately impacts Latino youth yet few diabetes prevention programs address this important source of health disparities. OBJECTIVES To address this knowledge gap, we describe the rationale, design, and methodology underpinning a culturally-grounded T2D prevention program for obese Latino youth. The study aims to: 1) to test the efficacy of the intervention for reducing T2D risk, 2) explore potential mediators and moderators of changes in health behaviors and health outcomes and, 3) examine the incremental cost-effectiveness for reducing T2D risk. Latino adolescents (N=160, age 14-16) will be randomized to either a 3-month intensive lifestyle intervention or a control condition. The intervention consists of weekly health education delivered by bilingual/bicultural promotores and 3 moderate-to-vigorous physical activity (PA) sessions/week. Control youth receive health information and results from their laboratory testing. Insulin sensitivity, glucose tolerance, and weight-specific quality of life are assessed at baseline, 3-months, 6-months, and 12-months. We will explore whether enhanced self-efficacy and/or social support mediate improvements in nutrition/PA behaviors and T2D outcomes. We will also explore whether effects are moderated by sex and/or acculturation. Cost-effectiveness from the health system perspective will be estimated by the incremental cost-effectiveness ratio using changes in insulin sensitivity at 12-months. CONCLUSIONS The results of this study will provide much needed information on how T2D prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent T2D in this and other high-risk populations.
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Affiliation(s)
- Allison N Williams
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Southwest Interdisciplinary Research Center, Arizona State University, United States
| | - Yolanda P Konopken
- Family Wellness Program, Virginia G. Piper, St. Vincent de Paul Medical and Dental Clinic, United States
| | - Colleen S Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | - Felipe Gonzalez Castro
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | | | - Estela Barraza
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States
| | - Donald L Patrick
- Seattle Quality of Life Group, Department of Health Services, School of Public Health and Community Medicine, University of Washington, United States
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Division of Endocrinology and Diabetes, Phoenix Children's Hospital, United States
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, United States; Southwest Interdisciplinary Research Center, Arizona State University, United States; Division of Endocrinology and Diabetes, Phoenix Children's Hospital, United States.
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Abstract
For the past quarter century, scientists at the Center for Family Research at the University of Georgia have conducted research designed to promote understanding of normative developmental trajectories among low socioeconomic status African American children, youths, and young adults. In this paper, we describe a recent expansion of this research program using longitudinal, epidemiological studies and randomized prevention trials to test hypotheses about the origins of disease among rural African American youths. The contributions of economic hardship, downward mobility, neighborhood poverty, and racial discrimination to allostatic load and epigenetic aging are illustrated. The health benefits of supportive family relationships in protecting youths from these challenges are also illustrated. A cautionary set of studies is presented showing that some psychosocially resilient youths demonstrate high allostatic loads and accelerated epigenetic aging, suggesting that, for some, "resilience is just skin deep." Finally, we end on an optimistic note by demonstrating that family-centered prevention programs can have health benefits by reducing inflammation, helping to preserve telomere length, and inhibiting epigenetic aging.
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Affiliation(s)
- Gene H. Brody
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
| | - Steven R. H. Beach
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
- Department of Psychology, University of Georgia, Athens, GA 30602 USA
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23
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Abstract
There is widespread public health concern about the upsurge in diabetes and its cardiometabolic comorbidities. Unfortunately, too many patients still do not receive best practices care. This review discusses some key contributing dynamics as well as considerations for progress toward the more comprehensive, strategic management of diabetes and its associated risks.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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24
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Nusslock R, Miller GE. Early-Life Adversity and Physical and Emotional Health Across the Lifespan: A Neuroimmune Network Hypothesis. Biol Psychiatry 2016; 80:23-32. [PMID: 26166230 PMCID: PMC4670279 DOI: 10.1016/j.biopsych.2015.05.017] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 05/07/2015] [Accepted: 05/26/2015] [Indexed: 12/29/2022]
Abstract
Children who experience chronic stressors are vulnerable to emotional and physical health problems across the lifespan. This phenomenon raises questions for scientists and clinicians alike. How does adversity get under the skin of the developing child? Through what mechanisms does it confer vulnerability to a heterogeneous set of mental and physical illnesses? And how does it instantiate risk across different life stages, engendering vulnerability to conditions that develop shortly after stressor exposure-like depression-and conditions that manifest decades later, like heart disease? Although answers to these questions have started to emerge, research has typically focused on single diseases or organ systems. To understand the plethora of health problems associated with childhood adversity, we argue that the field needs a second generation of research that recognizes multidirectional transactions among biological systems. To help facilitate this process, we propose a neuroimmune network hypothesis as a heuristic framework for organizing knowledge from disparate literatures and as a springboard for generating integrative research. Drawing on existing data, we argue that early-life adversity amplifies crosstalk between peripheral inflammation and neural circuitries subserving threat-related, reward-related, and executive control-related processes. This crosstalk results in chronic low-grade inflammation, thereby contributing to adiposity, insulin resistance, and other predisease states. In the brain, inflammatory mediators act on cortico-amygdala threat and cortico-basal ganglia reward, circuitries in a manner that predisposes individuals to self-medicating behaviors like smoking, drug use, and consumption of high-fat diets. Acting in concert with inflammation, these behaviors accelerate the pathogenesis of emotional and physical health problems.
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Affiliation(s)
| | - Gregory E. Miller
- Department of Psychology, Northwestern University,Institute for Policy Research, Northwestern University
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Chen E, Shalowitz MU, Story RE, Ehrlich KB, Levine CS, Hayen R, Leigh AKK, Miller GE. Dimensions of Socioeconomic Status and Childhood Asthma Outcomes: Evidence for Distinct Behavioral and Biological Associations. Psychosom Med 2016; 78:1043-1052. [PMID: 27749682 PMCID: PMC5096956 DOI: 10.1097/psy.0000000000000392] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objective of this study was to investigate 2 key dimensions of socioeconomic status (SES)-prestige and resources-and their associations with immune, behavioral, and clinical outcomes in childhood asthma. METHODS Children ages 9 to 17 years with a physician's diagnosis of asthma (N = 150), and one of their parents participated in this study. Children and parents completed interviews and questionnaires about SES (prestige = parent education; resources = family assets), environmental exposures, and clinical asthma measures. Spirometry was conducted to assess children's pulmonary function, and blood was collected to measure cytokine production in response to nonspecific stimulation, allergen-specific stimulation, and microbial stimulation. RESULTS Higher scores on both dimensions of childhood SES were associated with better clinical outcomes in children (β's from |.18 to .27|, p values < .05). Higher prestige, but not resources, was associated with better home environment control behaviors and less exposure to smoke (β's from |.21 to .22|, p values < .05). Higher resources, but not prestige, was associated with more favorable immune regulation, as manifest in smaller peripheral blood mononuclear cell (PBMC) TH1 and TH2 cytokine responses (β's from -.18 to -.19; p values < .05), and smaller proinflammatory cytokine responses (β = -.19; p < .05) after ex vivo stimulation. Higher resources also were associated with more sensitivity to glucocorticoid inhibition of TH1 and TH2 cytokine production (β's from -.18 to -.22; p values < .05). CONCLUSIONS These results suggest that prestige and resources in childhood family environments have different implications for behavioral and immunological processes relevant to childhood asthma. They also suggest that childhood SES relates to multiple aspects of immunologic regulation of relevance to the pathophysiology of asthma.
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Affiliation(s)
- Edith Chen
- Northwestern University, Institute for Policy Research & Department of Psychology
| | | | | | - Katherine B. Ehrlich
- Northwestern University, Institute for Policy Research & Department of Psychology
| | - Cynthia S. Levine
- Northwestern University, Institute for Policy Research & Department of Psychology
| | - Robin Hayen
- Northwestern University, Institute for Policy Research & Department of Psychology
| | - Adam K. K. Leigh
- Northwestern University, Institute for Policy Research & Department of Psychology
| | - Gregory E. Miller
- Northwestern University, Institute for Policy Research & Department of Psychology
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Shomaker LB, Goodman E. An 8-Year Prospective Study of Depressive Symptoms and Change in Insulin From Adolescence to Young Adulthood. Psychosom Med 2015; 77:938-45. [PMID: 26368574 PMCID: PMC4658292 DOI: 10.1097/psy.0000000000000230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate whether depressive symptoms predict change in fasting insulin among adolescents followed into young adulthood. We hypothesized that higher depressive symptoms would predict increased insulin and that puberty and race/ethnicity would moderate this relationship. METHODS Data came from the Princeton School District Study, a school-based longitudinal cohort of non-Hispanic black and white adolescents (2001-2011). Depressive symptoms, fasting insulin, and body mass index were measured at baseline (adolescence) and 8 years later (young adulthood) in 685 participants. Puberty was assessed using a validated protocol measuring sex steroids and physical changes. The primary outcome was change in fasting insulin. Analyses accounted for age, sex, race, parental education, baseline insulin, body mass index z score, puberty, and time to follow-up. RESULTS At baseline, depressive symptoms were correlated with insulin (ρ = 0.13, p = .001). High baseline insulin predicted insulin change (B = -11.50, standard error [SE] = 2.30, p < .001). Depressive symptoms also predicted insulin change, but only for pubertal adolescents (B = -0.23, SE = 0.11, p = .038). This relationship was moderated by race (p = .047); depressive symptoms predicted insulin change only among pubertal black adolescents (p = .030), not white (p = .49), and in the direction opposite that hypothesized (Bblacks = -0.51, SE = 0.23). Post hoc analyses revealed that pubertal black adolescents with high depressive symptoms had the highest baseline insulin, which stayed high across the follow-up period. CONCLUSIONS Among pubertal black adolescents, elevated depressive symptoms are associated with increased risk for sustained hyperinsulinemia from adolescence into adulthood. These youths may be particularly vulnerable for Type 2 diabetes.
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Affiliation(s)
- Lauren B. Shomaker
- Department of Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado
| | - Elizabeth Goodman
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Sakou II, Psaltopoulou T, Sergentanis TN, Karavanaki K, Karachaliou F, Ntanasis-Stathopoulos I, Tzanninis S, Sdogou T, Greydanus D, Tsitsika A. Insulin resistance and cardiometabolic risk factors in obese children and adolescents: a hierarchical approach. J Pediatr Endocrinol Metab 2015; 28:589-96. [PMID: 25781532 DOI: 10.1515/jpem-2014-0431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/21/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study aims to globally assess the network of insulin resistance (IR)-related factors in a sample of overweight and obese Greek youths. METHODS A total of 185 subjects were examined, and IR was quantified by homeostasis model assessment (HOMA-IR). Multivariate hierarchical approach was performed, and five distinct levels were recognized, namely, immutable demographic features and early life parameters, current anthropometric measures, IR, unfavorable clinical conditions, and social parameters. Two analyses were performed based on HOMA-IR cut-off values (3.16 and, as an alternative, 3.99). RESULTS Obesity was associated with IR (adjusted OR=3.19, 95% CI: 1.12-9.09). IR steadily predicted low HDL (adjusted OR=5.75, 95% CI: 1.58-20.87), hypertriglyceridemia (adjusted OR=10.28, 95% CI: 1.18-89.55), and systolic hypertension. At the alternative analysis, IR was also associated with older age, older age at menarche, hyperuricemia, and low school grades. CONCLUSION Emerging on the grounds of obesity, IR confers risks for dyslipidemia and hypertension at a relatively early age. Along with weight loss, interventions targeted at IR are required to prevent cardiometabolic risk in adolescence.
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Brody GH, Yu T, Miller GE, Chen E. Discrimination, racial identity, and cytokine levels among African-American adolescents. J Adolesc Health 2015; 56:496-501. [PMID: 25907649 PMCID: PMC4409660 DOI: 10.1016/j.jadohealth.2015.01.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Low-grade inflammation, measured by circulating levels of cytokines, is a pathogenic mechanism for several chronic diseases of aging. Identifying factors related to inflammation among African-American youths may yield insights into mechanisms underlying racial disparities in health. The purpose of the study was to determine whether (1) reported racial discrimination from ages 17-19 years forecasts heightened cytokine levels at the age of 22 years and (2) this association is lower for youths with positive racial identities. METHODS A longitudinal research design was used with a community sample of 160 African-Americans who were aged 17 years at the beginning of the study. Discrimination and racial identity were measured with questionnaires, and blood was drawn to measure basal cytokine levels. Ordinary least squares regression analyses were used to examine the hypotheses. RESULTS After controlling for socioeconomic risk, life stress, depressive symptoms, and body mass index, racial discrimination (β = .307; p < .01), racial identity (β = -.179; p < .05), and their interaction (β = -.180; p < .05) forecast cytokine levels. Youths exposed to high levels of racial discrimination evinced elevated cytokine levels 3 years later. This association was not significant for young adults with positive racial identities. CONCLUSIONS High levels of interpersonal racial discrimination and the development of a positive racial identity operate jointly to determine low-grade inflammation levels that have been found to forecast chronic diseases of aging, such as coronary disease and stroke.
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Affiliation(s)
- Gene H. Brody
- Center for Family Research, Institute for Behavioral Research, University of Georgia, 1095 College Station Road, Athens, Georgia 30602-4527
| | - Tianyi Yu
- Center for Family Research, Institute for Behavioral Research, University of Georgia, 1095 College Station Road, Athens, Georgia 30602-4527
| | - Gregory E. Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, 2029 Sheridan Road, Evanston, Illinois 60208
| | - Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, 2029 Sheridan Road, Evanston, Illinois 60208
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Spirituality moderates the relationship of psychosocial stress to metabolic risk factors among Afro-Caribbean immigrants in the US Virgin Islands. J Racial Ethn Health Disparities 2015; 2:132-8. [PMID: 25745593 DOI: 10.1007/s40615-014-0056-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Spirituality may contribute to the health advantage of foreign-born blacks compared to United States (US)-born blacks. The objective of this study was to test the hypothesis that spirituality attenuates the association of psychosocial stress to stress-associated metabolic risk factors among foreign-born Caribbean blacks living in a US jurisdiction. METHODS Data on demographic factors, anthropometric measurements (height, weight and waist), fasting glucose and insulin, lifestyle behaviors (smoking and alcohol use), psychosocial stress and spirituality were collected from a population-based sample of 319 Afro-Caribbean immigrants, ages 20 and older, who were recruited between 1995 and 2000 in the Virgin Islands of the United States (USVI). Glucose and insulin measurements were used to estimate insulin resistance by the homeostasis model assessment (HOMA-IR) method. Participants were classified into three levels of spirituality, "low", "medium" and "high" based on the distribution of spirituality scores. Stepwise regression analyses were used to identify the significant predictors of waist circumference and HOMA-IR within each level of spirituality. RESULTS The predictors of waist circumference and HOMA-IR varied across the levels of spirituality. Psychosocial stress was an independent predictor of waist and HOMA-IR only among participants with a low level of spirituality. CONCLUSION Spirituality appears to attenuate the association of psychosocial stress to waist circumference and insulin resistance among Afro-Caribbean immigrants in the USVI.
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A family-oriented psychosocial intervention reduces inflammation in low-SES African American youth. Proc Natl Acad Sci U S A 2014; 111:11287-92. [PMID: 25049403 DOI: 10.1073/pnas.1406578111] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Children of low socioeconomic status (SES) are at elevated risk for health problems across the lifespan. Observational studies suggest that nurturant parenting might offset some of these health risks, but their design precludes inferences about causal direction and clinical utility. Here we ask whether a psychosocial intervention, focused improving parenting, strengthening family relationships, and building youth competencies, can reduce inflammation in low-SES, African Americans from the rural South. The trial involved 272 mothers and their 11-y-old children from rural Georgia, half of whose annual household incomes were below the federal poverty line. Families were randomly assigned to a 7-wk psychosocial intervention or to a control condition. When youth reached age 19, peripheral blood was collected to quantify six cytokines that orchestrate inflammation, the dysregulation of which contributes to many of the health problems known to pattern by SES. Youth who participated in the intervention had significantly less inflammation on all six indicators relative to controls (all P values < 0.001; effect sizes in Cohen's d units ranged from -0.69 to -0.91). Mediation analyses suggested that improved parenting was partially responsible for the intervention's benefits. Inflammation was lowest among youth who received more nurturant-involved parenting, and less harsh-inconsistent parenting, as a consequence of the intervention. These findings have theoretical implications for research on resilience to adversity and the early origins of disease. If substantiated, they may also highlight a strategy for practitioners and policymakers to use in ameliorating social and racial health disparities.
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Kakinami L, Séguin L, Lambert M, Gauvin L, Nikiema B, Paradis G. Comparison of three lifecourse models of poverty in predicting cardiovascular disease risk in youth. Ann Epidemiol 2013; 23:485-91. [PMID: 23830840 DOI: 10.1016/j.annepidem.2013.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Childhood poverty heightens the risk of adulthood cardiovascular disease (CVD), but the underlying pathways are poorly understood. Three lifecourse models have been proposed but have never been tested among youth. We assessed the longitudinal association of childhood poverty with CVD risk factors in 10-year-old youth according to the timing, accumulation, and mobility models. METHODS The Québec Longitudinal Study of Child Development birth cohort was established in 1998 (n = 2120). Poverty was defined as annual income below the low-income thresholds defined by Statistics Canada. Multiple imputation was used for missing data. Multivariable linear regression models adjusted for gender, pubertal stage, parental education, maternal age, whether the household was a single parent household, whether the child was overweight or obese, the child's physical activity in the past week, and family history. RESULTS Approximately 40% experienced poverty at least once, 16% throughout childhood, and 25% intermittently. Poverty was associated with significantly elevated triglycerides and insulin according to the timing and accumulation models, although the timing model was superior for predicting insulin and the accumulation model was superior for predicting triglycerides. CONCLUSIONS Early and prolonged exposure to poverty significantly increases CVD risk among 10-year-old youth.
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Affiliation(s)
- Lisa Kakinami
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
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Slopen N, Goodman E, Koenen KC, Kubzansky LD. Socioeconomic and other social stressors and biomarkers of cardiometabolic risk in youth: a systematic review of less studied risk factors. PLoS One 2013; 8:e64418. [PMID: 23691213 PMCID: PMC3656855 DOI: 10.1371/journal.pone.0064418] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/13/2013] [Indexed: 12/29/2022] Open
Abstract
Background Socioeconomic disadvantage and other social stressors in childhood have been linked with cardiometabolic diseases in adulthood; however the mechanisms underlying these observed associations and the timing of their emergence are unclear. The aim of this review was to evaluate research that examined relationships between socioeconomic disadvantage and other social stressors in relation to less-studied cardiometabolic risk factors among youth, including carbohydrate metabolism-related factors, lipids, and central adiposity. Methods We searched PubMed and ISI Web of Science to identify relevant publications between 2001 and 2013.Studies were selected based on 4 criteria: (1) the study examined an association between at least one social or economic stressor and one relevant outcome prior to age 21; (2) the sample originated from a high-income country; (3) the sample was not selected based on a health condition; and (4) a central aim was to evaluate the effect of the social or economic stressor on at least one relevant outcome. Abstracts were screened and relevant publications were obtained and evaluated for inclusion criteria. We abstracted data from selected articles, summarized them by exposures and outcomes, and assigned an evidence grade. Results Our search identified 37 publications from 31 studies. Socioeconomic disadvantage was consistently associated with greater central adiposity. Research to date does not provide clear evidence of an association between childhood stressors and lipids or carbohydrate metabolism-related factors. Conclusions This review demonstrates a paucity of research on the relationship of socioeconomic disadvantage and other social stressors to lipid and carbohydrate metabolism-related factors in youth. Accordingly, it is not possible to form strong conclusions, particularly with regard to stressors other than socioeconomic disadvantage. Findings are used to inform priorities for future research. An improved understanding of these pathways is critical for identifying novel prevention targets and intervention opportunities to protect the long-term health of children and adolescents.
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Affiliation(s)
- Natalie Slopen
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, United States of America.
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Chen E, Lee WK, Cavey L, Ho A. Role Models and the Psychological Characteristics That Buffer Low-Socioeconomic-Status Youth From Cardiovascular Risk. Child Dev 2012; 84:1241-52. [DOI: 10.1111/cdev.12037] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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van den Berg G, van Eijsden M, Vrijkotte TGM, Gemke RJBJ. Socioeconomic inequalities in lipid and glucose metabolism in early childhood in a population-based cohort: the ABCD-Study. BMC Public Health 2012; 12:591. [PMID: 22852830 PMCID: PMC3490773 DOI: 10.1186/1471-2458-12-591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/18/2012] [Indexed: 11/25/2022] Open
Abstract
Background Socioeconomic inequalities in cardiovascular disease are pervasive, yet much remains to be understood about how they originate. The objective of this study was to explore the relations of socioeconomic status to lipid and glucose metabolism as indicators of cardiovascular health in 5–6 year olds. Additionally to explore the explanatory role of maternal factors, birth outcome, and child factors. Methods In 1308 5–6 year old ethnic Dutch children from the ABCD cohort study, lipids (cholesterol, LDL, HDL, triglycerides), glucose and C-peptide were measured after an overnight-fast. Results There were no differences in cholesterol, HDL, LDL, and triglycerides between socioeconomic groups, as indicated by maternal education and income adequacy. However, children of low educated mothers had on average a higher glucose (β = 0.15; 95% confidence interval (CI) 0.03 – 0.27), logC-peptide (β = 0.07; 95% CI 0.04 – 0.09), and calculated insulin resistance (HOMA-IR) (β = 0.15; 95% CI 0.08 – 0.22) compared to children of high educated mothers. Only childhood BMI partly explained these differences (models controlled for age, height, and sex). Conclusions The socioeconomic gradient in cardiovascular risk factors seems to emerge in early childhood. In absence of underlying mechanisms these empirical findings are relevant for public health care and further explanatory research.
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Affiliation(s)
- Gerrit van den Berg
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Tamayo T, Jacobs DR, Strassburger K, Giani G, Seeman TE, Matthews K, Roseman JM, Rathmann W. Race- and sex-specific associations of parental education with insulin resistance in middle-aged participants: the CARDIA study. Eur J Epidemiol 2012; 27:349-55. [PMID: 22565544 DOI: 10.1007/s10654-012-9691-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 04/18/2012] [Indexed: 11/26/2022]
Abstract
Low childhood socioeconomic status (SES) has been linked with insulin resistance (HOMA-IR) in adulthood. Our aim was to examine if maternal and paternal education, as indicators of childhood SES, equally contributed to increased HOMA-IR in later life. Of 5,115 adults from the Coronary Artery Disease Risk Development in Young Adults (CARDIA) Study aged 18-30 years in 1985-1986, data on 1,370 females and 1,060 males with baseline and 20 year follow-up data were used to estimate associations of maternal and paternal education with HOMA-IR, adjusting for personal education, BMI, lipids, blood pressure, and lifestyle factors. Parental education was determined as high with ≥ 12 years of schooling and classified as both high, only mother high, only father high, both low education. Distinct combinations of maternal and paternal education were associated with HOMA-IR across race and sex groups. Lowest year 20 HOMA-IR in European American (EA) females occurred when both parents were better educated, but was highest when only the father had better education. HOMA-IR was lowest in African American (AA) participants when the mother was better educated but the father had less education, but was highest when both parents were better educated. Parental education was unrelated to HOMA-IR in EA males. Associations of parental education with HOMA-IR are seen in AA females, AA males, and EA females but not in EA males. The distinct combinations of parental education and their associations with HOMA-IR especially in AA participants need to be addressed in further research on health disparities.
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Affiliation(s)
- Teresa Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
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Related factors of insulin resistance in Korean children: adiposity and maternal insulin resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 8:4596-607. [PMID: 22408591 PMCID: PMC3290990 DOI: 10.3390/ijerph8124596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 12/02/2011] [Accepted: 12/07/2011] [Indexed: 12/31/2022]
Abstract
Increased adiposity and unhealthy lifestyle augment the risk for type 2 diabetes in children with familial predisposition. Insulin resistance (IR) is an excellent clinical marker for identifying children at high risk for type 2 diabetes. This study was conducted to investigate parental, physiological, behavioral and socio-economic factors related to IR in Korean children. This study is a cross-sectional study using data from 111 children aged 7 years and their parents. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated using fasting glucose and insulin level as a marker of IR. All children’s adiposity indices (r = 0.309–0.318, all P-value = 0.001) and maternal levels of fasting insulin (r = 0.285, P-value = 0.003) and HOMA-IR (r = 0.290, P-value = 0.002) were positively correlated with children’s HOMA-IR level. There was no statistical difference of children’s HOMA-IR level according to children’s lifestyle habits and socioeconomic status of families. An increase of 1 percentage point in body fat was related to 2.7% increase in children’s HOMA-IR (P-value < 0.001) and an increase of 1% of maternal level of HOMA-IR was related to 0.2% increase in children’s HOMA-IR (P-value = 0.002). This study shows that children’s adiposity and maternal IR are positively associated with children’s IR.
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Thomas C, Nightingale CM, Donin AS, Rudnicka AR, Owen CG, Sattar N, Cook DG, Whincup PH. Socio-economic position and type 2 diabetes risk factors: patterns in UK children of South Asian, black African-Caribbean and white European origin. PLoS One 2012; 7:e32619. [PMID: 22412897 PMCID: PMC3296720 DOI: 10.1371/journal.pone.0032619] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 02/02/2012] [Indexed: 11/19/2022] Open
Abstract
Background Socio-economic position (SEP) and ethnicity influence type 2 diabetes mellitus (T2DM) risk in adults. However, the influence of SEP on emerging T2DM risks in different ethnic groups and the contribution of SEP to ethnic differences in T2DM risk in young people have been little studied. We examined the relationships between SEP and T2DM risk factors in UK children of South Asian, black African-Caribbean and white European origin, using the official UK National Statistics Socio-economic Classification (NS-SEC) and assessed the extent to which NS-SEC explained ethnic differences in T2DM risk factors. Methods and Findings Cross-sectional school-based study of 4,804 UK children aged 9–10 years, including anthropometry and fasting blood analytes (response rates 70%, 68% and 58% for schools, individuals and blood measurements). Assessment of SEP was based on parental occupation defined using NS-SEC and ethnicity on parental self-report. Associations between NS-SEC and adiposity, insulin resistance (IR) and triglyceride differed between ethnic groups. In white Europeans, lower NS-SEC status was related to higher ponderal index (PI), fat mass index, IR and triglyceride (increases per NS-SEC decrement [95%CI] were 1.71% [0.75, 2.68], 4.32% [1.24, 7.48], 5.69% [2.01, 9.51] and 3.17% [0.96, 5.42], respectively). In black African-Caribbeans, lower NS-SEC was associated with lower PI (−1.12%; [−2.01, −0.21]), IR and triglyceride, while in South Asians there were no consistent associations between NS-SEC and T2DM risk factors. Adjustment for NS-SEC did not appear to explain ethnic differences in T2DM risk factors, which were particularly marked in high NS-SEC groups. Conclusions SEP is associated with T2DM risk factors in children but patterns of association differ by ethnic groups. Consequently, ethnic differences (which tend to be largest in affluent socio-economic groups) are not explained by NS-SEC. This suggests that strategies aimed at reducing social inequalities in T2DM risk are unlikely to reduce emerging ethnic differences in T2DM risk.
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Affiliation(s)
- Claudia Thomas
- Population Health Research Centre, Division of Population Health Sciences and Education, St Georges, University of London, London, United Kingdom.
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Jackson B, Goodman E. Low Social Status Markers: Do They Predict Depressive Symptoms in Adolescence? RACE AND SOCIAL PROBLEMS 2011; 3:119-128. [PMID: 22707986 PMCID: PMC3373305 DOI: 10.1007/s12552-011-9047-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Some markers of social disadvantage are associated robustly with depressive symptoms among adolescents: female gender and lower socioeconomic status (SES), respectively. Others are associated equivocally, notably Black v. White race/ethnicity. Few studies examine whether markers of social disadvantage by gender, SES, and race/ethnicity jointly predict self-reported depressive symptoms during adolescence; this was our goal. Secondary analyses were conducted on data from a socioeconomically diverse community-based cohort study of non-Hispanic Black and White adolescents (N = 1,263, 50.4% female). Multivariable general linear models tested if female gender, Black race/ethnicity, and lower SES (assessed by parent education and household income), and their interactions predicted greater depressive symptoms reported on the Center for Epidemiological Studies-Depression scale. Models adjusted for age and pubertal status. Univariate analyses revealed more depressive symptoms in females, Blacks, and participants with lower SES. Multivariable models showed females across both racial/ethnic groups reported greater depressive symptoms; Blacks demonstrated more depressive symptoms than did Whites but when SES was included this association disappeared. Exploratory analyses suggested Blacks gained less mental health benefit from increased SES. However there were no statistically significant interactions among gender, race/ethnicity, or SES. Taken together, we conclude that complex patterning among low social status domains within gender, race/ethnicity, and SES predicts depressive symptoms among adolescents.
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Goodman E, Must A, Daniels SR, Dolan LM. Hostility and adiposity mediate disparities in insulin resistance among adolescents and young adults. J Pediatr 2010; 157:572-7, 577.e1. [PMID: 20542297 PMCID: PMC3166621 DOI: 10.1016/j.jpeds.2010.04.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 03/12/2010] [Accepted: 04/26/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study explores whether the relationship between lower socioeconomic status and insulin resistance in adolescents is mediated by both physiological and psychological factors associated with increased cardiometabolic risk. STUDY DESIGN School-based longitudinal cohort study of 1222 healthy, non-Hispanic black and white teens. Parent education (PE), youth-specific Cook-Medley hostility scale, waist circumference, height, weight, pubertal status, and fasting plasma insulin (FPI) were measured and FPI reassessed 1 year later. Regression analyses utilizing bootstrapping (n=2000) were used to estimate the direct and indirect effects of PE on FPI and assess the role of hostility and adiposity while adjusting for covariates. RESULTS Lower PE predicted higher FPI (B=-1.52, P=.003), as did hostility (B=.19, P=.002) and adiposity (waist circumference B=.44, P<.001, BMI B=.98, P<.001). The effect of PE on FPI was mediated by both hostility and adiposity. When adiposity and hostility were accounted for, the effect of PE on FPI decreased by 32% (B=-1.04, P=.04); the total indirect estimate was -.485 (95% CI, -.652, -.041). Hostility accounted for 36% of the meditational effect. CONCLUSIONS Lower PE influences insulin resistance through adiposity and hostility. Thus, interventions to reduce health disparities associated with insulin resistance should consider both physiological and psychological approaches.
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Affiliation(s)
- Elizabeth Goodman
- Floating Hospital for Children at Tufts Medical Center, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02114, USA.
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Tamayo T, Christian H, Rathmann W. Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC Public Health 2010; 10:525. [PMID: 20809937 PMCID: PMC2940917 DOI: 10.1186/1471-2458-10-525] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 09/01/2010] [Indexed: 12/10/2023] Open
Abstract
Background Psychological factors and socioeconomic status (SES) have a notable impact on health disparities, including type 2 diabetes risk. However, the link between childhood psychosocial factors, such as childhood adversities or parental SES, and metabolic disturbances is less well established. In addition, the lifetime perspective including adult socioeconomic factors remains of further interest. We carried out a systematic review with the main question if there is evidence in population- or community-based studies that childhood adversities (like neglect, traumata and deprivation) have considerable impact on type 2 diabetes incidence and other metabolic disturbances. Also, parental SES was included in the search as risk factor for both, diabetes and adverse childhood experiences. Finally, we assumed that obesity might be a mediator for the association of childhood adversities with diabetes incidence. Therefore, we carried out a second review on obesity, applying a similar search strategy. Methods Two systematic reviews were carried out. Longitudinal, population- or community-based studies were included if they contained data on psychosocial factors in childhood and either diabetes incidence or obesity risk. Results We included ten studies comprising a total of 200,381 individuals. Eight out of ten studies indicated that low parental status was associated with type 2 diabetes incidence or the development of metabolic abnormalities. Adjustment for adult SES and obesity tended to attenuate the childhood SES-attributable risk but the association remained. For obesity, eleven studies were included with a total sample size of 70,420 participants. Four out of eleven studies observed an independent association of low childhood SES on the risk for overweight and obesity later in life. Conclusions Taken together, there is evidence that childhood SES is associated with type 2 diabetes and obesity in later life. The database on the role of psychological factors such as traumata and childhood adversities for the future risk of type 2 diabetes or obesity is too small to draw conclusions. Thus, more population-based longitudinal studies and international standards to assess psychosocial factors are needed to clarify the mechanisms leading to the observed health disparities.
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Affiliation(s)
- Teresa Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.
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Abstract
OBJECTIVE This technical report reviews and synthesizes the published literature on racial/ethnic disparities in children's health and health care. METHODS A systematic review of the literature was conducted for articles published between 1950 and March 2007. Inclusion criteria were peer-reviewed, original research articles in English on racial/ethnic disparities in the health and health care of US children. Search terms used included "child," "disparities," and the Index Medicus terms for each racial/ethnic minority group. RESULTS Of 781 articles initially reviewed, 111 met inclusion criteria and constituted the final database. Review of the literature revealed that racial/ethnic disparities in children's health and health care are quite extensive, pervasive, and persistent. Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. Mortality-rate disparities were noted for children in all 4 major US racial/ethnic minority groups, including substantially greater risks than white children of all-cause mortality; death from drowning, from acute lymphoblastic leukemia, and after congenital heart defect surgery; and an earlier median age at death for those with Down syndrome and congenital heart defects. Certain methodologic flaws were commonly observed among excluded studies, including failure to evaluate children separately from adults (22%), combining all nonwhite children into 1 group (9%), and failure to provide a white comparison group (8%). Among studies in the final database, 22% did not perform multivariable or stratified analyses to ensure that disparities persisted after adjustment for potential confounders. CONCLUSIONS Racial/ethnic disparities in children's health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health and health care. Methodologic flaws were identified in how such disparities are sometimes documented and analyzed. Optimal health and health care for all children will require recognition of disparities as pervasive problems, methodologically sound disparities studies, and rigorous evaluation of disparities interventions.
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Schwartz F, Ruhil AVS, Ruhil A, Denham S, Shubrook J, Simpson C, Boyd SL. High self-reported prevalence of diabetes mellitus, heart disease, and stroke in 11 counties of rural Appalachian Ohio. J Rural Health 2010; 25:226-30. [PMID: 19785591 DOI: 10.1111/j.1748-0361.2009.00222.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED CONTEXT/PURPOSE: There is an epidemic of obesity and diabetes in the United States, especially in economically at-risk populations such as rural Appalachia. This survey determined the self-reported prevalence of obesity, diabetes mellitus, and associated macrovascular complications in 11 rural counties of Appalachian Ohio. The impacts of lifestyle, cardiovascular risk factors, income, and access to medical care were also determined. METHODS A telephone survey identical to the 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was conducted. Surveys were collected from 3,927 randomly selected residents 18 years of age and older in 11 counties of Appalachian Ohio and compared to published aggregate Ohio and national 2004 BRFSS data. FINDINGS The self-reported prevalence of diabetes (11.3%) was markedly higher in Appalachian Ohio counties surveyed compared to aggregate Ohio (7.8%) or national (7.2%) 2004 BRFSS data (P < .044). The prevalence of heart disease (7.6%) and stroke (4.1%) in these counties was slightly higher than aggregate Ohio or national 2004 BRFSS data. In persons with diabetes, the prevalence of heart disease was 2-fold higher (20.0%) and stroke 3-fold higher (11.4%) than among nondiabetics (P < .042) in the region and higher than aggregate Ohio and National 2004 BRFSS data. Lower-income levels and decreased access to medications and glucose monitoring supplies correlated with the increased risk for cardiovascular complications in this rural population (P < .042). CONCLUSION The self-reported prevalence of diabetes mellitus and its associated macrovascular complications are much higher in rural Appalachian Ohio compared to aggregate Ohio and National 2004 BRFSS data.
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Affiliation(s)
- Frank Schwartz
- The Appalachian Rural Health Institute (ARHI), Ohio University College of Osteopathic Medicine, Ohio University, Athens, Ohio 45701, USA.
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Goodman E, Graham TE, Dolan LM, Daniels SR, Goodman ER, Kahn BB. The relationship of retinol binding protein 4 to changes in insulin resistance and cardiometabolic risk in overweight black adolescents. J Pediatr 2009; 154:67-73.e1. [PMID: 18783798 PMCID: PMC2770185 DOI: 10.1016/j.jpeds.2008.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 06/16/2008] [Accepted: 07/15/2008] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess, among overweight non-hispanic black adolescents the relationship of changes in plasma retinol binding protein 4 (RBP4) over 3 years to changes in insulin resistance (IR) and 4 associated cardiometabolic risks. STUDY DESIGN Nested, retrospective study of 51 overweight, post-pubertal non-Hispanic black participants in the Princeton School District Study. Participants were in the top (worsening IR) or bottom (improved IR) quartile for 3-year change in IR. RBP4 was measured by quantitative Western blot with frozen plasma. Regression analyses adjusted for age, sex, and adiposity (baseline and change). Three measures of adiposity were assessed (waist circumference, body mass index, and weight) in separate regression models. RESULTS RBP4 increased in one third (n = 17). In logistic regression analyses, increased RBP4 was associated with significantly higher odds of worsening as opposed to improved IR independent of age, sex, or adiposity. Odds ratios were 5.6 (weight, P = .024), 6.0 (BMI, P = .025) and 7.4 (waist circumference, P = .015). Initial RBP4 (beta = 0.81, P = .005) and change in RBP4 (beta = 0.56, P = .046) also predicted change in triglycerides, but not change in high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, or fibrinogen. CONCLUSION This retrospective cohort study provides evidence that RBP4 may be a mechanism through which obesity influences insulin resistance and hypertriglyceridemia in overweight postpubertal black youth and suggests utility of RBP4 as a biomarker of risk.
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Affiliation(s)
- Elizabeth Goodman
- The Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA.
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Abstract
There is widespread public health concern about the upsurge in diabetes and its cardiometabolic comorbidities. Unfortunately, too many patients still do not receive best practices care. This review discusses some key contributing dynamics as well as considerations for progress toward the more comprehensive, strategic management of diabetes and its associated risks.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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