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Perng W, Galai N, Zhao Q, Litonjua A, Geiger S, Sauder KA, O'Shea TM, Hivert MF, Oken E, Dabelea D, Aris IM. Sociodemographic Correlates of High Cardiovascular Health Across Childhood and Adolescence: A Prospective Study Among 2 Cohorts in the ECHO Consortium. J Am Heart Assoc 2024; 13:e036279. [PMID: 39082419 DOI: 10.1161/jaha.124.036279] [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: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND This study seeks to characterize cardiovascular health (CVH) from early childhood to late adolescence and identify sociodemographic correlates of high CVH that serve as levers for optimizing CVH across early life. METHODS AND RESULTS Among 1530 youth aged 3 to 20 years from 2 cohorts in the ECHO (Environmental Influences on Child Health Outcomes) consortium, we first derived CVH scores on the basis of the Life's Essential 8 construct comprising 4 behavioral (nicotine use/exposure, physical activity, sleep, and diet) and 4 health factors (body mass index, blood pressure, non-high-density lipoprotein cholesterol, and fasting glucose) during early childhood (mean age, 3.5 years), middle childhood (8.0 years), early adolescence (13.3 years), and late adolescence (17.8 years). Next, we used generalized regression to estimate the probability of high (versus not high) CVH with respect to sociodemographic characteristics. Overall CVH score was stable across life stages: 81.2±7.6, 83.3±8.0, and 81.7±8.9 of 100 possible points in early childhood, middle childhood, and early adolescence, respectively. Accordingly, during these life stages, most children (63.3%-71.5%) had high CVH (80 to <100). However, CVH declined by late adolescence, with an average score of 75.5±10.2 and 39.4% high CVH. No children had optimal CVH (score=100) at any time. Correlates of high CVH include non-Hispanic White race and ethnicity, maternal college education, and annual household income >$70 000. These associations were driven by behavioral factors. CONCLUSIONS Although most youth maintained high CVH across childhood, the decline by late adolescence indicates that cardiovascular disease prevention should occur before the early teen years. Disparities in high CVH over time with respect to sociodemographic characteristics were explained by behavioral factors, pointing toward prevention targets.
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Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Anschutz Medical Campus Aurora CO
- Department of Epidemiology Colorado School of Public Health University of Colorado Anschutz Medical Campus Aurora CO
| | - Noya Galai
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Qi Zhao
- Department of Preventive Medicine College of Medicine University of Tennessee Health Science Center Memphis TN
| | - Augusto Litonjua
- Department of Pediatrics University of Rochester Medical Center Rochester NY
| | - Sarah Geiger
- Department of Kinesiology and Community Health College of Applied Health Sciences University of Illinois at Urbana-Champaign Champaign IL
| | - Katherine A Sauder
- Department of Implementation Science Wake Forest University School of Medicine Winston-Salem NC
| | - T Michael O'Shea
- Department of Pediatrics University of North Carolina School of Medicine Chapel Hill NC
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Anschutz Medical Campus Aurora CO
- Department of Epidemiology Colorado School of Public Health University of Colorado Anschutz Medical Campus Aurora CO
- Department of Pediatrics School of Medicine University of Colorado Anschutz Medical Campus Aurora CO
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [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: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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Hayes DK, Wiltz JL, Fang J, Loustalot F. Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019. Prev Med 2023; 169:107457. [PMID: 36813249 PMCID: PMC11289852 DOI: 10.1016/j.ypmed.2023.107457] [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: 11/20/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0-2), intermediate (3-5), and ideal (6-7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3-17.1) had poor, 72.4% (95%CI:71.9-72.9) had intermediate, and 10.9% (95%CI:10.5-11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4-37.6), 22.5% (95%CI:22.0-23.0) reported 1, 12.7% (95%CI:12.3-13.1) reported 2, 8.5% (95%CI:8.2-8.9) reported 3, and 19.3% (95%CI:18.8-19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11-1.46), 2 (AOR = 1.63;95%CI:1.36-1.96), 3 (AOR = 2.01;95%CI:1.66-2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11-2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08-1.51), 3 (AOR = 1.48;95%CI:1.25-1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38-1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.
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Affiliation(s)
- Donald K Hayes
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, United States of America.
| | - Jennifer L Wiltz
- Office of Medicine and Science, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, United States of America; U.S. Public Health Service Commissioned Corps, United States of America
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, United States of America
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention, United States of America; U.S. Public Health Service Commissioned Corps, United States of America
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Givens DI. Saturated fats, dairy foods and cardiovascular health: No longer a curious paradox? NUTR BULL 2022; 47:407-422. [PMID: 36285545 PMCID: PMC10091990 DOI: 10.1111/nbu.12585] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023]
Abstract
Cardiovascular diseases (CVDs) are a major cause of death and morbidity in many parts of the world, and many dietary guidelines limit the intake of saturated fatty acids (SFA) as they are regarded as an important risk factor for CVDs due to their association with increased blood cholesterol. Dairy foods are often a major contributor to dietary intake of SFA, and since many dietary guidelines contain restrictions on SFA intake, this can lead to a moderation of dairy food intake despite meta-analyses generally showing dairy to have a neutral or negative association with CVDs. Many prospective studies and randomised controlled trials do not support a simple positive association between SFA intake and the risk of atherosclerotic CVD and its components although some early studies had a number of methodological weakness. Studies that included blood cholesterol data do broadly support the positive relationship between SFA and blood low-density lipoprotein cholesterol (LDL-C) but without increased CVD risk resulting, despite LDL being a causal factor in atherosclerotic CVD. These data suggest that LDL-C alone is not a consistently good predictor or cause of CVD risk, perhaps particularly in relation to dairy food consumption although some non-dairy food studies have also shown LDL-C reduction was not reflected in reduced CVD risk. This narrative review examines some reasons for these findings. Overall, restrictions on dairy food intake do not seem warranted, although there remains a need to further understand the association of different dairy food types with chronic diseases, perhaps particularly for type 2 diabetes.
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Affiliation(s)
- David Ian Givens
- Institute for Food, Nutrition and Health, University of Reading, Reading, UK
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Ideal cardiovascular health, inflammation, and arterial stiffness in the transition to adulthood. Int J Cardiol 2022; 355:45-51. [PMID: 35231550 DOI: 10.1016/j.ijcard.2022.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/27/2021] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ideal cardiovascular health (ICH) promotes primordial prevention of cardiovascular diseases. However, whether ICH is associated with arterial stiffness in the transition to adulthood and the mechanisms associated has yet to be shown. The aim of this investigation was to: 1) investigate whether there is a prospective association between ICH and pulse wave velocity (PWV) in the transition to adulthood; and 2) to stablish whether the association between ICH and PWV is mediated by inflammatory markers. METHODS Participants were part of the 1993 Pelotas Birth Cohort and follow-ups at 18- and 22-years were used in this study. At the age of 18 years, ICH was computed as the presence of ideal for the following metrics: physical activity, diet, smoking, blood cholesterol and glucose, blood pressure, and body mass index. At the age of 22 years, aortic PWV was obtained as well as interleukin-6 (IL-6) and C-reactive protein (CRP). RESULTS A total of 3528 (1851 females) were included in the analysis. A significant linear effect was observed for ICH on PWV. After adjusting for socioeconomical status, skin colour, birth weight, and mother schooling male and female participants with better ICH profile had PWV of 0.70 m·s-1 and 0.60 m·s-1 slower than participants with poor ICH. No evidence for a mediating role of inflammatory markers was observed for male (<1%) and female (<5%) mediated by IL-6 and CRP. CONCLUSIONS ICH is inversely associated with PWV among male and female in the transition to adulthood with no mediating role of inflammation.
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Perng W, Francis EC, Schuldt C, Barbosa G, Dabelea D, Sauder KA. Pre- and Perinatal Correlates of Ideal Cardiovascular Health during Early Childhood: A Prospective Analysis in the Healthy Start Study. J Pediatr 2021; 234:187-194. [PMID: 33741366 PMCID: PMC8238850 DOI: 10.1016/j.jpeds.2021.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To characterize prevalence of ideal cardiovascular health (ICVH) during early childhood (4-7 years of age), and to identify pre- and perinatal biological, sociodemographic, metabolic, and behavioral correlates of ICVH. STUDY DESIGN Among 350 mother-child pairs in the Healthy Start Study, we defined ICVH as no exposure to second hand smoke; ≥1 hour/day of moderate-to-vigorous physical activity; body mass index ≤85th percentile; systolic and diastolic blood pressure <90th percentile; cholesterol <170 mg/dL, fasting glucose <100 mg/dL; and healthy diet, per the American Heart Association. Pre- and perinatal characteristics were obtained from questionnaires, medical records, and in-person visits. Because of low prevalence of ICVH, we focused on prevalence of meeting ≥6 metrics in the analysis. We examined bivariate associations of each characteristic with % meeting ≥6 metrics and included those that were significant (P < .05) in a multivariable logistic regression model. RESULTS ICVH prevalence at mean ± SD age 4.7±0.6 years was 6.9%; boys had twice the prevalence as girls (9% vs 4.4%). Most (>85%) children met criteria for second hand smoke, body mass index, blood pressure, cholesterol, and glucose, and only one-third met criteria for physical activity (31.4%) and diet (35.1%). In multivariable analyses, key correlates of ICVH were maternal weight status (ORoverweight/obese vs nonoverweight/obese = 0.41 [0.23, 0.73]) and offspring sex (ORmale vs female = 2.14 [1.22, 3.65]). CONCLUSIONS At age 4-7 years, ICVH prevalence is already low, with diet and adequate physical activity being the limiting factors. Healthy maternal weight prior to pregnancy and male sex are potential determinants of childhood ICVH. Additional work is required to explore associations of early-life ICVH with future health outcomes.
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Affiliation(s)
- Wei Perng
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO.
| | - Ellen C Francis
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Caylor Schuldt
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Gregory Barbosa
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Dana Dabelea
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Katherine A Sauder
- Lifcourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pediatrics, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
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Abstract
Cardiovascular disease is a leading cause of morbidity and mortality in adults in the United States. Cardiovascular health as a child and adolescent is important in setting the path for a heart-healthy life in adulthood. One major impact on cardiovascular health that can have its roots in childhood is dyslipidemia. Universal screening for all children is a newer concept that has emerged over the last decade; previously children and adolescents were screened based only on risk factors. This review addresses who is at risk for dyslipidemia, how and when to screen children and adolescents, why early identification is important, and how to manage dyslipidemia when it is diagnosed. There are many interventions that can be started in childhood to help decrease cardiovascular risk factors in adults, thus decreasing the morbidity and mortality from heart disease in the future. [Pediatr Ann. 2021;50(1):e4-e9.].
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Abstract
PURPOSE OF REVIEW Atherosclerotic-CVD processes begin early in life and are influenced over the life course by interaction of genetic and potential modifiable risk factors, behaviors, and environmental exposures. The purpose of this review is to highlight importance of primordial and primary prevention beginning early in the life course. RECENT FINDINGS Evidence-based guidelines and recommendations for primordial and primary prevention support importance of individual/clinical and population-based approaches to CVD prevention beginning early in life with goal of reducing the risk and burden of CVD. Substantial evidence supports the individual and societal benefits of prevention of CVD and promotion of optimal cardiovascular health beginning early in life and extending across the life course and the need for additional research to guide and inform practices and policies enabling optimal cardiovascular health for all.
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Affiliation(s)
- Laura L Hayman
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd., Quinn Building-Second Floor, Boston, MA, 02125-3393, USA. .,Division of Preventive & Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
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Razavi AC, Gingras V, Michos ED, Navar AM, Brown S, Delker E, Foti K, Harrison S, Lu Y, Nierenberg JL, Scott J, Tang O, Thomas AG, Turkson‐Ocran R, Wallace A, Zhang M, Lancaster KJ, Lutsey PL, Selvin E. American Heart Association EPI|Lifestyle Scientific Sessions: 2020 Meeting Highlights. J Am Heart Assoc 2020; 9:e017252. [PMID: 32476542 PMCID: PMC7429023 DOI: 10.1161/jaha.120.017252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander C. Razavi
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Véronique Gingras
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMA
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins University School of MedicineBaltimoreMD
| | | | - Sherry‐Ann Brown
- Cardio‐Oncology ProgramDivision of CardiologyMedical College of WisconsinMilwaukeeWI
| | - Erin Delker
- Department of PediatricsSchool of MedicineUniversity of CaliforniaSan DiegoCA
| | - Kathryn Foti
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Stéphanie Harrison
- School of NutritionUniversité LavalQuebecCanada
- Centre NutritionSanté et SociétéInstitute of Nutrition and Functional FoodsUniversité LavalQuebecCanada
| | - Yifei Lu
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillDurhamNC
| | - Jovia L. Nierenberg
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Olive Tang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Alvin G. Thomas
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillDurhamNC
| | - Ruth‐Alma Turkson‐Ocran
- American Heart Association Strategically Focused Obesity Research NetworkJohns Hopkins University School of MedicineBaltimoreMD
| | - Amelia Wallace
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Mingyu Zhang
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Kristie J. Lancaster
- Department of Nutrition and Food StudiesSteinhardt School of Culture, Education, and Human DevelopmentNew York UniversityNew YorkNY
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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