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Amir S, Kim H, Hu EA, Ricardo AC, Mills KT, He J, Fischer MJ, Pradhan N, Tan TC, Navaneethan SD, Dobre M, Anderson CAM, Appel LJ, Rebholz CM. Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024; 83:624-635. [PMID: 38103719 PMCID: PMC11034716 DOI: 10.1053/j.ajkd.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
RATIONALE & OBJECTIVE Studies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in individuals with CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,539 participants with CKD recruited between 2003-2008 into the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE Responses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index. OUTCOME (1) CKD progression defined as≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant) and (2) all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models to compute hazard ratios and 95% confidence intervals adjusting for lifestyle, socioeconomic, and clinical covariates. RESULTS There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74 [95% CI, 0.62-0.88], P trend<0.001) and 21% (HR, 0.79 [95% CI, 0.66-0.95], P trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14 [95% CI, 1.03-1.25) and all-cause mortality (HR, 1.11 [95% CI, 1.00-1.23). LIMITATIONS Self-reported diet may be subject to measurement error. CONCLUSIONS Adherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality. PLAIN-LANGUAGE SUMMARY Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.
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Affiliation(s)
- Saira Amir
- Department of Medicine, UNC Health Southeastern, Lumberton, North Carolina; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Michael J Fischer
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, San Diego, California
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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Gibson R, Aljuraiban GS, Oude Griep LM, Vu TH, Steffen LM, Appel LJ, Rodriguez BL, Daviglus ML, Elliott P, Van Horn L, Chan Q. Relationship of calcium and magnesium intakes with the dietary approaches to stop hypertension score and blood pressure: the International Study of Macro/micronutrients and Blood Pressure. J Hypertens 2024; 42:789-800. [PMID: 38164982 PMCID: PMC10990009 DOI: 10.1097/hjh.0000000000003648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Research investigating calcium and magnesium intakes from the Dietary Approaches to Stop Hypertension (DASH) pattern and other sources in association with blood pressure is limited. We aimed to characterize sources/intake levels of calcium and magnesium in relation to overall diet quality (DASH-score) and determine modification effects with DASH score and blood pressure. METHODS Cross-sectional United States data (average dietary and supplement intake from four 24 h recalls and eight blood pressure measurements) from two separate visits, 2195 men and women (40-59 years) in the International Study of Macro/Micronutrients and Blood Pressure were analysed. Food-based adherence to the DASH diet was estimated. Linear models tested associations between each 1-point DASH score with blood pressure. Participants were stratified by adherence to sex-specific recommended allowance for magnesium and calcium intakes. Effect-modification was tested across DASH-score quintiles and median of urinary sodium. RESULTS DASH-score was inversely associated with SBP in fully adjusted models (-0.27; 95%CI: -0.38 to -0.15 mmHg). SBP was inversely associated with dietary calcium intake from DASH food groups: -1.54 (95% CI: -2.65 to -0.43) mmHg; calcium intake from other non-DASH food groups: -1.62 (95% CI: -2.94 to -0.29) mmHg. Dietary magnesium intake from DASH food groups (-1.59; 95% CI: -2.79, -0.40 mmHg) and from other non-DASH foods (-1.92; 95% CI: -3.31, -0.53 mmHg) was inversely associated with SBP. CONCLUSION A higher DASH score showed a consistent association with lower BP suggesting a relationship between intakes of calcium and Mg with BP regardless of whether the source is part of the DASH diet or not, even when adjusted for supplement intakes.The INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov .
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Affiliation(s)
- Rachel Gibson
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
- Department of Nutritional Sciences, King's College London, United Kingdom
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Linda M. Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
- NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity (DAPA), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Thanh-Huyen Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beatriz L. Rodriguez
- Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
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Blum MF, Surapaneni A, Chang A, Inker LA, Chen TK, Appel LJ, Shin JI, Grams ME. Dihydropyridine Calcium Channel Blockers and Kidney Outcomes. J Gen Intern Med 2024:10.1007/s11606-024-08762-2. [PMID: 38639831 DOI: 10.1007/s11606-024-08762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Early trials of dihydropyridine calcium channel blockers (DCCBs) suggest a detrimental effect on intraglomerular pressure and an association with albuminuria. OBJECTIVE We sought to evaluate the associations of DCCB initiation with albuminuria and kidney failure with replacement therapy (KFRT) and to determine whether renin-angiotensin system (RAS) blockade modified these associations. DESIGN We conducted a target trial emulation study using a new user, active comparator design and electronic health record data from Geisinger Health. PARTICIPANTS We included patients without severe albuminuria or KFRT who were initiated on a DCCB or thiazide (active comparator) between January 1, 2004, and December 31, 2019. MAIN MEASURES Using inverse probability of treatment weighting, we performed doubly robust Cox proportional hazards regression to estimate the association of DCCB initiation with incident severe albuminuria (urine albumin to creatinine ratio > 300 mg/g) and KFRT, overall and stratified by RAS blocker use. KEY RESULTS There were 11,747 and 26,758 eligible patients initiating a DCCB and thiazide, respectively, with a weighted baseline mean age of 60 years, systolic blood pressure of 143 mm Hg, and eGFR of 86 mL/min/1.73 m2, and with a mean follow-up of 8 years. Compared with thiazides, DCCBs were significantly associated with the development of severe albuminuria (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.16-1.43), with attenuation of risk in the presence of RAS blockade (P for interaction < 0.001). The risk of KFRT was increased among patients without RAS blockade (HR, 1.66; 95% CI, 1.19-2.31), but not with RAS blockade (P for interaction = 0.005). CONCLUSIONS DCCBs were associated with increased risk of albuminuria and, in the absence of RAS blockade, KFRT. These findings suggest coupling DCCB therapy with RAS blockade may mitigate adverse kidney outcomes.
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Affiliation(s)
- Matthew F Blum
- Division of Nephrology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | - Aditya Surapaneni
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Teresa K Chen
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jung-Im Shin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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Maruthur NM, Pilla SJ, White K, Wu B, Maw MTT, Duan D, Turkson-Ocran RA, Zhao D, Charleston J, Peterson CM, Dougherty RJ, Schrack JA, Appel LJ, Guallar E, Clark JM. Effect of Isocaloric, Time-Restricted Eating on Body Weight in Adults With Obesity : A Randomized Controlled Trial. Ann Intern Med 2024. [PMID: 38639542 DOI: 10.7326/m23-3132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Time-restricted eating (TRE) lowers body weight in many studies. Whether TRE induces weight loss independent of reductions in calorie intake, as seen in rodent studies, is unknown. OBJECTIVE To determine the effect of TRE versus a usual eating pattern (UEP) on body weight in the setting of stable caloric intake. DESIGN Randomized, isocaloric feeding study. (ClinicalTrials.gov: NCT03527368). SETTING Clinical research unit. PARTICIPANTS Adults with obesity and prediabetes or diet-controlled diabetes. INTERVENTION Participants were randomly assigned 1:1 to TRE (10-hour eating window, 80% of calories before 1 p.m.) or UEP (≤16-hour window, ≥50% of calories after 5 p.m.) for 12 weeks. Both groups had the same nutrient content and were isocaloric with total calories determined at baseline. MEASUREMENTS Primary outcome was change in body weight at 12 weeks. Secondary outcomes were fasting glucose, homeostatic model assessment for insulin resistance (HOMA-IR), glucose area under the curve by oral glucose tolerance test, and glycated albumin. We used linear mixed models to evaluate the effect of interventions on outcomes. RESULTS All 41 randomly assigned participants (mean age, 59 years; 93% women; 93% Black race; mean BMI, 36 kg/m2) completed the intervention. Baseline weight was 95.6 kg (95% CI, 89.6 to 101.6 kg) in the TRE group and 103.7 kg (CI, 95.3 to 112.0 kg) in the UEP group. At 12 weeks, weight decreased by 2.3 kg (CI, 1.0 to 3.5 kg) in the TRE group and by 2.6 kg (CI, 1.5 to 3.7 kg) in the UEP group (average difference TRE vs. UEP, 0.3 kg [CI, -1.2 to 1.9 kg]). Change in glycemic measures did not differ between groups. LIMITATION Small, single-site study; baseline differences in weight by group. CONCLUSION In the setting of isocaloric eating, TRE did not decrease weight or improve glucose homeostasis relative to a UEP, suggesting that any effects of TRE on weight in prior studies may be due to reductions in caloric intake. PRIMARY FUNDING SOURCE American Heart Association.
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Affiliation(s)
- Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland (N.M.M., L.J.A., E.G., J.M.C.)
| | - Scott J Pilla
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore; and Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (S.J.P.)
| | - Karen White
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (K.W.)
| | - Beiwen Wu
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (B.W.)
| | - May Thu Thu Maw
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of General Internal Medicine, University of Maryland Capital Region Medical Center, Largo, Maryland (M.T.T.M.)
| | - Daisy Duan
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland (D.D.)
| | - Ruth-Alma Turkson-Ocran
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts (R.-A.T.)
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health Baltimore; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland (D.Z.)
| | - Jeanne Charleston
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore; and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (J.C.)
| | - Courtney M Peterson
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, Alabama (C.M.P.)
| | - Ryan J Dougherty
- Center on Aging & Health, Johns Hopkins University, Baltimore; and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland (R.J.D.)
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health Baltimore; and Center on Aging & Health, Johns Hopkins University, Baltimore, Maryland (J.A.S.)
| | - Lawrence J Appel
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland (N.M.M., L.J.A., E.G., J.M.C.)
| | - Eliseo Guallar
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland (N.M.M., L.J.A., E.G., J.M.C.)
| | - Jeanne M Clark
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland (N.M.M., L.J.A., E.G., J.M.C.)
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5
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Odu J, Osi K, Nguyen L, Goldstein A, Appel LJ, Matsushita K, Ojji D, Orji IA, Alex-Okoh M, Odoh D, Toma MM, Elemuwa CO, Lamorde S, Baraya H, Dewan MT, Chijioke O, Moran AE, Agogo E, Thomas MP. On-demand mobile hypertension training for primary health care workers in Nigeria: a pilot study. BMC Health Serv Res 2024; 24:444. [PMID: 38594665 PMCID: PMC11005121 DOI: 10.1186/s12913-024-10693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Only one out of every ten Nigerian adults with hypertension has their blood pressure controlled. Health worker training is essential to improve hypertension diagnosis and treatment. In-person training has limitations that mobile, on-demand training might address. This pilot study evaluated a self-paced, case-based, mobile-optimized online training to diagnose and manage hypertension for Nigerian health workers. METHODS Twelve hypertension training modules were developed, based on World Health Organization and Nigerian guidelines. After review by local academic and government partners, the course was piloted by Nigerian health workers at government-owned primary health centers. Primary care physician, nurse, and community health worker participants completed the course on their own smartphones. Before and after the course, hypertension knowledge was evaluated with multiple-choice questions. Learners provided feedback by responding to questions on a Likert scale. RESULTS Out of 748 users who sampled the course, 574 enrolled, of whom 431 (75%) completed the course. The average pre-test score of completers was 65.4%, which increased to 78.2% on the post-test (P < 0.001, paired t-test). Health workers who were not part of existing hypertension control programs had lower pre-test scores and larger score gains. Most participants (96.1%) agreed that the training was applicable to their work, and nearly all (99.8%) agreed that they enjoyed the training. CONCLUSIONS An on-demand mobile digital hypertension training increases knowledge of hypertension management among Nigerian health workers. If offered at scale, such courses can be a tool to build health workforce capacity through initial and refresher training on current clinical guidelines in hypertension and other chronic diseases in Nigeria as well as other countries.
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Affiliation(s)
| | - Kufor Osi
- Resolve To Save Lives, New York, USA
| | - Leander Nguyen
- Columbia University Irving Medical Center, New York, USA
| | | | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Dike Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
| | - Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | | | | | | | | | - Hasana Baraya
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Andrew E Moran
- Resolve To Save Lives, New York, USA
- Columbia University Irving Medical Center, New York, USA
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Ishigami J, Appel LJ, Brady TM. Pitfalls of Cuff Size and Blood Pressure Measurement-Reply. JAMA Intern Med 2024; 184:449-450. [PMID: 38372969 DOI: 10.1001/jamainternmed.2023.6340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Junichi Ishigami
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J Appel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Jeong SY, Wee CC, Kovell LC, Plante TB, Miller ER, Appel LJ, Mukamal KJ, Juraschek SP. Corrigendum to 'Effects of Diet on 10-Year Atherosclerotic Cardiovascular Disease Risk (from the DASH Trial)' [American Journal of Cardiology 187 (2023) 10-17]. Am J Cardiol 2024; 216:112-113. [PMID: 38359896 DOI: 10.1016/j.amjcard.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Sun Young Jeong
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christina C Wee
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Kenneth J Mukamal
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen P Juraschek
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Morales-Alvarez MC, Nissaisorakarn V, Appel LJ, Miller ER, Christenson RH, Rebuck H, Rosas SE, William JH, Juraschek SP. Effects of Reduced Dietary Sodium and the DASH Diet on GFR: The DASH-Sodium Trial. Kidney360 2024; 5:569-576. [PMID: 38326949 DOI: 10.34067/kid.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Key Points
Sodium reduction over a 4-week period decreased eGFR.Combining sodium reduction with the Dietary Approaches to Stop Hypertension diet resulted in larger reductions in eGFR.Changes in diastolic BP seem partially responsible for the observed dietary effects.
Background
A potassium-rich Dietary Approaches to Stop Hypertension (DASH) diet combined with low sodium reduces BP. However, the effects of sodium reduction in combination with the DASH diet on kidney function are unknown. We determined the effects of sodium reduction and the DASH diet, on eGFR using cystatin C.
Methods
DASH-sodium was a controlled, feeding study in adults with elevated or stage 1 hypertension, randomly assigned to the DASH or a control diet. On their assigned diet, participants consumed each of three sodium levels for 30 days after a 2-week run-in period of a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). The primary outcome was change in eGFR based on cystatin C.
Results
Cystatin C was measured in 409 of the original 412 participants, of which 207 were assigned the DASH diet and 202 to the control diet. Compared with control, the DASH diet did not affect eGFR (β=−0.96 ml/min per 1.73 m2; 95% confidence interval [CI], −2.74 to 0.83). By contrast, low versus high sodium intake decreased eGFR (β=−2.36 ml/min per 1.73 m2; 95% CI, −3.64 to −1.07). Together, compared with the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 ml/min per 1.73 m2 (95% CI, −5.46 to −0.73). This effect was attenuated with adjustment for diastolic BP and 24-hour urinary potassium excretion.
Conclusions
A combined low sodium-DASH diet reduced eGFR over a 4-week period. Future research should focus on the effect of these dietary interventions on subclinical kidney injury and their long-term effect on progression to CKD.
Clinical Trial registration number
ClinicalTrials.gov, NCT00000608.
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Affiliation(s)
- Martha Catalina Morales-Alvarez
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Voravech Nissaisorakarn
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence J Appel
- The Johns Hopkins Bloomberg School of Public Health, The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edgar R Miller
- The Johns Hopkins Bloomberg School of Public Health, The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Heather Rebuck
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sylvia E Rosas
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey H William
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen P Juraschek
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Park HS, Yin A, Barranta C, Lee JS, Caputo CA, Sachithanandham J, Li M, Yoon S, Sitaras I, Jedlicka A, Eby Y, Ram M, Fernandez RE, Baker OR, Shenoy AG, Mosnaim GS, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Lau B, Ehrhardt S, Baksh SN, Shapiro JR, Ou J, Na YB, Knoll MD, Ornelas-Gatdula E, Arroyo-Curras N, Gniadek TJ, Caturegli P, Wu J, Ndahiro N, Betenbaugh MJ, Ziman A, Hanley DF, Casadevall A, Shoham S, Bloch EM, Gebo KA, Tobian AA, Laeyendecker O, Pekosz A, Klein SL, Sullivan DJ. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. JCI Insight 2024; 9:e178460. [PMID: 38483534 DOI: 10.1172/jci.insight.178460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) virus-specific antibody levels that translate into recipient posttransfusion antibody levels sufficient to prevent disease progression are not defined.METHODSThis secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double-blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low posttransfusion antibody levels was established by 2 methods: (i) analyzing virus neutralization-equivalent anti-Spike receptor-binding domain immunoglobulin G (anti-S-RBD IgG) responses in donors or (ii) receiver operating characteristic (ROC) curve analysis.RESULTSSARS-CoV-2 anti-S-RBD IgG antibody was volume diluted 21.3-fold into posttransfusion seronegative recipients from matched donor units. Virus-specific antibody delivered was approximately 1.2 mg. The high-antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP-recipient analysis for antibody thresholds correlated to reduced hospitalizations found a statistical significant association between early transfusion and high antibodies versus all other CCP recipients (or control plasma), with antibody cutoffs established by both methods-donor-based virus neutralization cutoffs in posttransfusion recipients (0/85 [0%] versus 15/276 [5.6%]; P = 0.03) or ROC-based cutoff (0/94 [0%] versus 15/267 [5.4%]; P = 0.01).CONCLUSIONIn unvaccinated, seronegative CCP recipients, early transfusion of plasma units in the upper 30% of study donors' antibody levels reduced outpatient hospitalizations. High antibody level plasma units, given early, should be reserved for therapeutic use.TRIAL REGISTRATIONClinicalTrials.gov NCT04373460.FUNDINGDepartment of Defense (W911QY2090012); Defense Health Agency; Bloomberg Philanthropies; the State of Maryland; NIH (3R01AI152078-01S1, U24TR001609-S3, 1K23HL151826NIH); the Mental Wellness Foundation; the Moriah Fund; Octapharma; the Healthnetwork Foundation; the Shear Family Foundation; the NorthShore Research Institute; and the Rice Foundation.
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Affiliation(s)
- Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher A Caputo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steve Yoon
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Jedlicka
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | | | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, UCLA, Los Angeles, California, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, Connecticut, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - Kevin Oei
- Ascada Research, Fullerton, California, USA
| | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, California, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, UCSD, San Diego, California, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington DC, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Karen Lane
- Department of Neurology, Brain Injury Outcomes
| | | | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes
| | | | - Atika Singh
- Department of Neurology, Brain Injury Outcomes
| | - Daniel E Ford
- Institute for Clinical and Translational Research, and
| | - Douglas A Jabs
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes
| | - Yu Bin Na
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria D Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elysse Ornelas-Gatdula
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Netzahualcoyotl Arroyo-Curras
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, Illinois, USA
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jinke Wu
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nelson Ndahiro
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Xu X, Zeng L, Jha V, Cobb LK, Shibuya K, Appel LJ, Neal B, Schutte AE. Potassium-Enriched Salt Substitutes: A Review of Recommendations in Clinical Management Guidelines. Hypertension 2024; 81:400-414. [PMID: 38284271 PMCID: PMC10863666 DOI: 10.1161/hypertensionaha.123.21343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized controlled trials show that potassium-enriched, sodium-reduced salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths. Yet, salt substitutes are inconsistently recommended and rarely used. We sought to define the extent to which evidence about the likely benefits and harms of potassium-enriched salt substitutes has been incorporated into clinical management by systematically searching guidelines for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations about the use of potassium-enriched salt substitutes in the 32 hypertension and 14 kidney guidelines that we reviewed. Discussion among the authors identified the possibility of updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control. Draft wording was chosen to commence debate and progress consensus building: strong recommendation for patients with hypertension-potassium-enriched salt with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. We strongly encourage clinical guideline bodies to review their recommendations about the use of potassium-enriched salt substitutes at the earliest opportunity.
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Affiliation(s)
- Xiaoyue Xu
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Ling Zeng
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India (V.J.)
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
- Prasanna School of Public Health, Manipal Academy of Higher Education, India (V.J.)
| | | | | | - Lawrence J. Appel
- Department of Epidemiology, Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Bruce Neal
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
| | - Aletta E. Schutte
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
- Department of Paediatrics, Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (A.E.S)
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Heianza Y, Zhou T, Wang X, Furtado JD, Appel LJ, Sacks FM, Qi L. MTNR1B genotype and effects of carbohydrate quantity and dietary glycaemic index on glycaemic response to an oral glucose load: the OmniCarb trial. Diabetologia 2024; 67:506-515. [PMID: 38052941 DOI: 10.1007/s00125-023-06056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
AIMS/HYPOTHESIS A type 2 diabetes-risk-increasing variant, MTNR1B (melatonin receptor 1B) rs10830963, regulates the circadian function and may influence the variability in metabolic responses to dietary carbohydrates. We investigated whether the effects of carbohydrate quantity and dietary glycaemic index (GI) on glycaemic response during OGTTs varied by the risk G allele of MTNR1B-rs10830963. METHODS This study included participants (n=150) of a randomised crossover-controlled feeding trial of four diets with high/low GI levels and high/low carbohydrate content for 5 weeks. The MTNR1B-rs10830963 (C/G) variant was genotyped. Glucose response during 2 h OGTT was measured at baseline and the end of each diet intervention. RESULTS Among the four study diets, carrying the risk G allele (CG/GG vs CC genotype) of MTNR1B-rs10830963 was associated with the largest AUC of glucose during 2 h OGTT after consuming a high-carbohydrate/high-GI diet (β 134.32 [SE 45.69] mmol/l × min; p=0.004). The risk G-allele carriers showed greater increment of glucose during 0-60 min (β 1.26 [0.47] mmol/l; p=0.008) or 0-90 min (β 1.10 [0.50] mmol/l; p=0.028) after the high-carbohydrate/high-GI diet intervention, but not after consuming the other three diets. At high carbohydrate content, reducing GI levels decreased 60 min post-OGTT glucose (mean -0.67 [95% CI: -1.18, -0.17] mmol/l) and the increment of glucose during 0-60 min (mean -1.00 [95% CI: -1.67, -0.33] mmol/l) and 0-90 min, particularly in the risk G-allele carriers (pinteraction <0.05 for all). CONCLUSIONS/INTERPRETATION Our study shows that carrying the risk G allele of MTNR1B-rs10830963 is associated with greater glycaemic responses after consuming a diet with high carbohydrates and high GI levels. Reducing GI in a high-carbohydrate diet may decrease post-OGTT glucose concentrations among the risk G-allele carriers.
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Affiliation(s)
- Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jeremy D Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Biogen Epidemiology, Cambridge, MA, USA
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Frank M Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Nyenhuis SM, Dixon AE, Wood L, Lv N, Wittels NE, Ronneberg CR, Xiao L, Dosala S, Marroquin A, Barve A, Harmon W, Poynter ME, Parikh A, Camargo CA, Appel LJ, Ma J. Erratum to "The effects of the DASH dietary pattern on clinical outcomes and quality of life in adults with uncontrolled asthma: Design and methods of the ALOHA Trial" [Contemporary Clinical Trials 131 (2023) 107274]. Contemp Clin Trials 2024; 138:107373. [PMID: 38310039 PMCID: PMC10921235 DOI: 10.1016/j.cct.2023.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Affiliation(s)
- S M Nyenhuis
- Section of Allergy and Immunology, University of Chicago, Chicago, IL, USA
| | - A E Dixon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont, Burlington, VT, USA
| | - L Wood
- University of Newcastle, Newcastle, Australia
| | - N Lv
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - N E Wittels
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - C R Ronneberg
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - L Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - S Dosala
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Marroquin
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Barve
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - W Harmon
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - M E Poynter
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - A Parikh
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - C A Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
| | - J Ma
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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Ishigami J, Jaar BG, Charleston JB, Lash JP, Brown J, Chen J, Mills KT, Taliercio JJ, Kansal S, Crews DC, Riekert KA, Dowdy DW, Appel LJ, Matsushita K. Factors Associated With Non-vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024; 83:196-207.e1. [PMID: 37717847 PMCID: PMC10872850 DOI: 10.1053/j.ajkd.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 09/19/2023]
Abstract
RATIONALE & OBJECTIVE Vaccination for influenza is strongly recommended for people with chronic kidney disease (CKD) due to their immunocompromised state. Identifying risk factors for not receiving an influenza vaccine (non-vaccination) could inform strategies for improving vaccine uptake in this high-risk population. STUDY DESIGN Longitudinal observational study. SETTING & PARTICIPANTS 3,692 Chronic Renal Insufficiency Cohort Study (CRIC) participants. EXPOSURE Demographic factors, social determinants of health, clinical conditions, and health behaviors. OUTCOME Influenza non-vaccination, which was assessed based on a receipt of influenza vaccine ascertained during annual clinic visits in a subset of participants who were under nephrology care. ANALYTICAL APPROACH Mixed-effects Poisson models to estimate adjusted prevalence ratios (APRs). RESULTS Between 2009 and 2020, the pooled mean vaccine uptake was 72% (mean age, 66 years; 44% female; 44% Black race). In multivariable models, factors significantly associated with influenza non-vaccination were younger age (APR, 2.16 [95% CI, 1.85-2.52] for<50 vs≥75 years), Black race (APR, 1.58 [95% CI, 1.43-1.75] vs White race), lower education (APR, 1.20 [95% CI, 1.04-1.39 for less than high school vs college graduate]), lower annual household income (APR, 1.26 [95% CI, 1.06-1.49] for <$20,000 vs >$100,000), formerly married status (APR, 1.22 [95% CI, 1.09-1.35] vs currently married), and nonemployed status (APR, 1.13 [95% CI, 1.02-1.24] vs employed). In contrast, participants with diabetes (APR, 0.80 [95% CI, 0.73-0.87] vs no diabetes), chronic obstructive pulmonary disease (COPD) (APR, 0.80 [95% CI, 0.70-0.92] vs no COPD), end-stage kidney disease (APR, 0.64 [0.56 to 0.76] vs estimated glomerular filtration rate≥60mL/min/1.73m2), frailty (APR, 0.86 [95% CI, 0.74-0.99] vs no frailty), and ideal physical activity (APR, 0.90 [95% CI, 0.82-0.99] vs. physically inactive) were less likely to have non-vaccination status. LIMITATIONS Possible residual confounding. CONCLUSIONS Among adults with CKD receiving nephrology care, younger adults, Black individuals, and those with adverse social determinants of health were more likely to have the influenza non-vaccination status. Strategies are needed to address these disparities and reduce barriers to vaccination. PLAIN-LANGUAGE SUMMARY Identifying risk factors for not receiving an influenza vaccine ("non-vaccination") in people living with kidney disease, who are at risk of influenza and its complications, could inform strategies for improving vaccine uptake. In this study, we examined whether demographic factors, social determinants of health, and clinical conditions were linked to the status of not receiving an influenza vaccine among people living with kidney disease and receiving nephrology care. We found that younger adults, Black individuals, and those with adverse social determinants of health were more likely to not receive the influenza vaccine. These findings suggest the need for strategies to address these disparities and reduce barriers to vaccination in people living with kidney disease.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jeanne B Charleston
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James P Lash
- Division of Nephrology, College of Medicine, University of Illinois, Chicago, Illinois
| | - Julia Brown
- Division of Nephrology, College of Medicine, University of Illinois, Chicago, Illinois
| | - Jing Chen
- Division of Nephrology, School of Medicine, Tulane University New Orleans, Louisiana
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University New Orleans, Louisiana
| | | | - Sheru Kansal
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David W Dowdy
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Chen TK, Estrella MM, Appel LJ, Surapaneni AL, Köttgen A, Obeid W, Parikh CR, Grams ME. Associations of Baseline and Longitudinal Serum Uromodulin With Kidney Failure and Mortality: Results From the African American Study of Kidney Disease and Hypertension (AASK) Trial. Am J Kidney Dis 2024; 83:71-78. [PMID: 37690632 DOI: 10.1053/j.ajkd.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 09/12/2023]
Abstract
RATIONALE & OBJECTIVE Uromodulin (UMOD) is the most abundant protein found in urine and has emerged as a promising biomarker of tubule health. Circulating UMOD is also detectable, but at lower levels. We evaluated whether serum UMOD levels were associated with the risks of incident kidney failure with replacement therapy (KFRT) and mortality. STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS Participants in AASK (the African American Study of Kidney Disease and Hypertension) with available stored serum samples from the 0-, 12-, and 24-month visits for biomarker measurement. PREDICTORS Baseline log-transformed UMOD and change in UMOD over 2 years. OUTCOMES KFRT and mortality. ANALYTICAL APPROACH Cox proportional hazards and mixed-effects models. RESULTS Among 500 participants with baseline serum UMOD levels (mean age, 54y; 37% female), 161 KFRT events occurred during a median of 8.5 years. After adjusting for baseline demographic factors, clinical factors, glomerular filtration rate, log-transformed urine protein-creatinine ratio, and randomized treatment groups, a 50% lower baseline UMOD level was independently associated with a 35% higher risk of KFRT (adjusted HR, 1.35; 95% CI, 1.07-1.70). For annual UMOD change, each 1-standard deviation lower change was associated with a 67% higher risk of KFRT (adjusted HR, 1.67; 95% CI, 1.41-1.99). Baseline UMOD and UMOD change were not associated with mortality. UMOD levels declined more steeply for metoprolol versus ramipril (P<0.001) as well as for intensive versus standard blood pressure goals (P = 0.002). LIMITATIONS Small sample size and limited generalizability. CONCLUSIONS Lower UMOD levels at baseline and steeper declines in UMOD over time were associated with a higher risk of subsequent KFRT in a cohort of African American adults with chronic kidney disease and hypertension. PLAIN-LANGUAGE SUMMARY Prior studies of uromodulin (UMOD), the most abundant protein in urine, and kidney disease have focused primarily on urinary UMOD levels. The present study evaluated associations of serum UMOD levels with the risks of kidney failure with replacement therapy (KFRT) and mortality in a cohort of African American adults with hypertension and chronic kidney disease. It found that participants with lower levels of UMOD at baseline were more likely to experience KFRT even after accounting for baseline kidney measures. Similarly, participants who experienced steeper annual declines in UMOD also had a heightened risk of kidney failure. Neither baseline nor annual change in UMOD was associated with mortality. Serum UMOD is a promising biomarker of kidney health.
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Affiliation(s)
- Teresa K Chen
- Kidney Health Research Collaborative and Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco VA Health Care System, San Francisco, California; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Michelle M Estrella
- Kidney Health Research Collaborative and Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California; San Francisco VA Health Care System, San Francisco, California
| | - Lawrence J Appel
- General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aditya L Surapaneni
- Department of Medicine, New York University Langone School of Medicine, New York, New York
| | - Anna Köttgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Wassim Obeid
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine, New York University Langone School of Medicine, New York, New York
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15
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Park HS, Yin A, Barranta C, Lee JS, Caputo CA, Sachithanandham J, Li M, Yoon S, Sitaras I, Jedlicka A, Eby Y, Ram M, Fernandez RE, Baker OR, Shenoy AG, Mosnaim GS, Fukuta Y, Patel B, Heath SL, Levine AC, Meisenberg BR, Spivak ES, Anjan S, Huaman MA, Blair JE, Currier JS, Paxton JH, Gerber JM, Petrini JR, Broderick PB, Rausch W, Cordisco ME, Hammel J, Greenblatt B, Cluzet VC, Cruser D, Oei K, Abinante M, Hammitt LL, Sutcliffe CG, Forthal DN, Zand MS, Cachay ER, Raval JS, Kassaye SG, Marshall CE, Yarava A, Lane K, McBee NA, Gawad AL, Karlen N, Singh A, Ford DE, Jabs DA, Appel LJ, Shade DM, Lau B, Ehrhardt S, Baksh SN, Shapiro JR, Ou J, Na YB, Knoll MD, Ornelas-Gatdula E, Arroyo-Curras N, Gniadek TJ, Caturegli P, Wu J, Ndahiro N, Betenbaugh MJ, Ziman A, Hanley DF, Casadevall A, Shoham S, Bloch EM, Gebo KA, Tobian AAR, Laeyendecker O, Pekosz A, Klein SL, Sullivan DJ. Outpatient COVID-19 convalescent plasma recipient antibody thresholds correlated to reduced hospitalizations within a randomized trial. medRxiv 2023:2023.04.13.23288353. [PMID: 37131659 PMCID: PMC10153328 DOI: 10.1101/2023.04.13.23288353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 convalescent plasma (CCP) viral specific antibody levels that translate into recipient post-transfusion antibody levels sufficient to prevent disease progression is not defined. METHODS This secondary analysis correlated donor and recipient antibody levels to hospitalization risk among unvaccinated, seronegative CCP recipients within the outpatient, double blind, randomized clinical trial that compared CCP to control plasma. The majority of COVID-19 CCP arm hospitalizations (15/17, 88%) occurred in this unvaccinated, seronegative subgroup. A functional cutoff to delineate recipient high versus low post-transfusion antibody levels was established by two methods: 1) analyzing virus neutralization-equivalent anti-S-RBD IgG responses in donors or 2) receiver operating characteristic (ROC) analysis. RESULTS SARS-CoV-2 anti-S-RBD IgG antibody was diluted by a factor of 21.3 into post-transfusion seronegative recipients from matched donor units. Viral specific antibody delivered approximated 1.2 mg. The high antibody recipients transfused early (symptom onset within 5 days) had no hospitalizations. A CCP recipient analysis for antibody thresholds correlated to reduced hospitalizations found a significant association with Fisher's exact test between early and high antibodies versus all other CCP recipients (or control plasma) with antibody cutoffs established by both methods-donor virus neutralization-based cutoff: (0/85; 0% versus 15/276; 5.6%) p=0.03 or ROC based cutoff: (0/94; 0% versus 15/267; 5.4%) p=0.01. CONCLUSION In unvaccinated, seronegative CCP recipients, early transfusion of plasma units corresponding to the upper 30% of all study donors reduced outpatient hospitalizations. These high antibody level plasma units, given early, should be reserved for therapeutic use.Trial registration: NCT04373460. FUNDING Defense Health Agency and others.
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Affiliation(s)
- Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Yin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caelan Barranta
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John S Lee
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher A Caputo
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maggie Li
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steve Yoon
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ioannis Sitaras
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Jedlicka
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Reinaldo E Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Owen R Baker
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarthi G Shenoy
- Department of Medicine, Division of Hematology and Oncology, MedStar Washington Hospital Center, Washington DC, USA
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Bela Patel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Sonya L Heath
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA
| | | | - Emily S Spivak
- Department of Medicine, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Moises A Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, OH, USA
| | - Janis E Blair
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Judith S Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, CA, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jonathan M Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | | | - Jean Hammel
- Nuvance Health Norwalk Hospital, Norwalk, CT, USA
| | | | - Valerie C Cluzet
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Daniel Cruser
- Nuvance Health Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | | | | | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donald N Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, CA, USA
| | - Martin S Zand
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center Washington DC, USA
| | - Christi E Marshall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anusha Yarava
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nichol A McBee
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy L Gawad
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicky Karlen
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atika Singh
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel E Ford
- Institute for Clinical and Translational Research Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas A Jabs
- Department of Ophthalmology Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Shade
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheriza N Baksh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janna R Shapiro
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jiangda Ou
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yu Bin Na
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria D Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elysse Ornelas-Gatdula
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore MD, USA
| | - Netzahualcoyotl Arroyo-Curras
- Chemistry-Biology Interface Program, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore MD, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas J Gniadek
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jinke Wu
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Nelson Ndahiro
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniel F Hanley
- Department of Neurology, Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arturo Casadevall
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly A Gebo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David J Sullivan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Petriceks AH, Appel LJ, Miller ER, Mitchell CM, Schrack JA, Mukamal KJ, Lipsitz LA, Wanigatunga AA, Plante TB, Michos ED, Juraschek SP. Timing of orthostatic hypotension and its relationship with falls in older adults. J Am Geriatr Soc 2023; 71:3711-3720. [PMID: 37668347 PMCID: PMC10842425 DOI: 10.1111/jgs.18573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND There is inconsistent evidence on the optimal time after standing to assess for orthostatic hypotension. We determined the prevalence of orthostatic hypotension at different time points after standing in a population of older adults, as well as fall risk and symptoms associated with orthostatic hypotension. METHODS We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized clinical trial funded by the National Institute on Aging, testing the effect of differing vitamin D3 doses on fall risk in older adults. STURDY occurred between July 2015 and May 2019. Secondary analysis occurred in 2022. Participants were community-dwelling adults, 70 years or older. In the orthostatic hypotension assessment, participants stood upright from supine position and underwent six standing blood pressure measurements (M1-M6) in two clusters of three measurements (immediately and 3 min after standing). Cox proportional hazard models were used to examine the relationship between orthostatic hypotension at each measurement and subsequent falls. Participants were followed until the earlier of their 24-month visit or study completion. RESULTS Orthostatic hypotension occurred in 32% of assessments at M1, and only 16% at M5 and M6. Orthostatic hypotension from average immediate (M1-3) and average delayed (M4-6) measurements, respectively, predicted higher fall risk (M1-3 = 1.65 [1.08, 2.52]; M4-6 = 1.73 [1.03, 2.91]) (hazard ratio [95% confidence interval]). However, among individual measurements, only orthostatic hypotension at M5 (1.84 [1.16, 2.93]) and M6 (1.85 [1.17, 2.91]) predicted higher fall risk. Participants with orthostatic hypotension at M1 (3.07 [1.48, 6.38]) and M2 (3.72 [1.72, 8.03]) were more likely to have reported orthostatic symptoms. CONCLUSIONS Orthostatic hypotension was most prevalent and symptomatic immediately within 1-2 min after standing, but more informative for fall risk after 4.5 min. Clinicians may consider both intervals when assessing for orthostatic hypotension.
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Affiliation(s)
- Aldis H. Petriceks
- Harvard Medical School, Boston, Massachusetts, USA
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lawrence J. Appel
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edgar R. Miller
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine M. Mitchell
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A. Schrack
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth J. Mukamal
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis A. Lipsitz
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Amal A. Wanigatunga
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Timothy B. Plante
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Erin D. Michos
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P. Juraschek
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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17
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Juraschek SP, Hu JR, Cluett JL, Ishak AM, Mita C, Lipsitz LA, Appel LJ, Beckett NS, Coleman RL, Cushman WC, Davis BR, Grandits G, Holman RR, Miller ER, Peters R, Staessen JA, Taylor AA, Thijs L, Wright JT, Mukamal KJ. Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease: An Individual Participant Meta-Analysis. JAMA 2023; 330:1459-1471. [PMID: 37847274 PMCID: PMC10582789 DOI: 10.1001/jama.2023.18497] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Abstract
Importance There are ongoing concerns about the benefits of intensive vs standard blood pressure (BP) treatment among adults with orthostatic hypotension or standing hypotension. Objective To determine the effect of a lower BP treatment goal or active therapy vs a standard BP treatment goal or placebo on cardiovascular disease (CVD) or all-cause mortality in strata of baseline orthostatic hypotension or baseline standing hypotension. Data Sources Individual participant data meta-analysis based on a systematic review of MEDLINE, EMBASE, and CENTRAL databases through May 13, 2022. Study Selection Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) with orthostatic hypotension assessments. Data Extraction and Synthesis Individual participant data meta-analysis extracted following PRISMA guidelines. Effects were determined using Cox proportional hazard models using a single-stage approach. Main Outcomes and Measures Main outcomes were CVD or all-cause mortality. Orthostatic hypotension was defined as a decrease in systolic BP of at least 20 mm Hg and/or diastolic BP of at least 10 mm Hg after changing position from sitting to standing. Standing hypotension was defined as a standing systolic BP of 110 mm Hg or less or standing diastolic BP of 60 mm Hg or less. Results The 9 trials included 29 235 participants followed up for a median of 4 years (mean age, 69.0 [SD, 10.9] years; 48% women). There were 9% with orthostatic hypotension and 5% with standing hypotension at baseline. More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline orthostatic hypotension (hazard ratio [HR], 0.81; 95% CI, 0.76-0.86) similarly to those with baseline orthostatic hypotension (HR, 0.83; 95% CI, 0.70-1.00; P = .68 for interaction of treatment with baseline orthostatic hypotension). More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline standing hypotension (HR, 0.80; 95% CI, 0.75-0.85), and nonsignificantly among those with baseline standing hypotension (HR, 0.94; 95% CI, 0.75-1.18). Effects did not differ by baseline standing hypotension (P = .16 for interaction of treatment with baseline standing hypotension). Conclusions and Relevance In this population of hypertension trial participants, intensive therapy reduced risk of CVD or all-cause mortality regardless of orthostatic hypotension without evidence for different effects among those with standing hypotension.
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Affiliation(s)
- Stephen P. Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer L. Cluett
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anthony M. Ishak
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Healthcare Associates, Beth Israel–Lahey Health System, Boston, Massachusetts
| | - Carol Mita
- Countway Library, Harvard University, Boston, Massachusetts
| | - Lewis A. Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research and Harvard Medical School, Boston, Massachusetts
| | | | | | - Ruth L. Coleman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, England
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Barry R. Davis
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston
| | - Greg Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Rury R. Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, England
| | | | - Ruth Peters
- The George Institute for Global Health, Sydney, Australia
- Department of Biomedical Sciences, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, England
| | | | - Addison A. Taylor
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
| | | | - Jackson T. Wright
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kenneth J. Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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18
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Grams ME, Coresh J, Matsushita K, Ballew SH, Sang Y, Surapaneni A, Alencar de Pinho N, Anderson A, Appel LJ, Ärnlöv J, Azizi F, Bansal N, Bell S, Bilo HJG, Brunskill NJ, Carrero JJ, Chadban S, Chalmers J, Chen J, Ciemins E, Cirillo M, Ebert N, Evans M, Ferreiro A, Fu EL, Fukagawa M, Green JA, Gutierrez OM, Herrington WG, Hwang SJ, Inker LA, Iseki K, Jafar T, Jassal SK, Jha V, Kadota A, Katz R, Köttgen A, Konta T, Kronenberg F, Lee BJ, Lees J, Levin A, Looker HC, Major R, Melzer Cohen C, Mieno M, Miyazaki M, Moranne O, Muraki I, Naimark D, Nitsch D, Oh W, Pena M, Purnell TS, Sabanayagam C, Satoh M, Sawhney S, Schaeffner E, Schöttker B, Shen JI, Shlipak MG, Sinha S, Stengel B, Sumida K, Tonelli M, Valdivielso JM, van Zuilen AD, Visseren FLJ, Wang AYM, Wen CP, Wheeler DC, Yatsuya H, Yamagata K, Yang JW, Young A, Zhang H, Zhang L, Levey AS, Gansevoort RT. Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis. JAMA 2023; 330:1266-1277. [PMID: 37787795 PMCID: PMC10548311 DOI: 10.1001/jama.2023.17002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/15/2023] [Indexed: 10/04/2023]
Abstract
Importance Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. Objective To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. Design, Setting, and Participants Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. Exposures The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). Main Outcomes and Measures The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. Results Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). Conclusions and Relevance In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.
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Affiliation(s)
- Morgan E Grams
- Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shoshana H Ballew
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Yingying Sang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Aditya Surapaneni
- Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Amanda Anderson
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Lawrence J Appel
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences, and Society, Family Medicine and Primary Care Unit, Karolinska Institutet, Huddinge, Sweden
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, Scotland
| | - Henk J G Bilo
- Diabetes Centre and Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, University of Leicester, and John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and Department of Clinical Science, Danderyd Hospital, Stockholm, Sweden
| | - Steve Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - John Chalmers
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College, London, England
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jing Chen
- Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Massimo Cirillo
- Department Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marie Evans
- Department of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Alejandro Ferreiro
- Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, School of Medicine, Tokai University, Isehara, Japan
| | - Jamie A Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
- Center for Kidney Health Research, Geisinger, Danville, Pennsylvania
| | | | - William G Herrington
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, England
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, England
| | - Shih-Jen Hwang
- Framingham Heart Study, Framingham, Massachusetts
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | | | - Tazeen Jafar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Simerjot K Jassal
- University of California-San Diego, La Jolla
- San Diego VA Health Care System, San Diego, California
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- George Institute for Global Health, School of Public Health, Imperial College, London, England
| | - Aya Kadota
- Department of Public Health, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Brian J Lee
- Kaiser Permanente, Hawaii Region, and Moanalua Medical Center, Honolulu, Hawai'i
| | - Jennifer Lees
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Helen C Looker
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Rupert Major
- Department of Cardiovascular Sciences, University of Leicester, and John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Cheli Melzer Cohen
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Mariko Miyazaki
- Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Olivier Moranne
- Service de Néphrologie Dialyse Aphérèse, Nîmes Hôpital Universitaire, Nîmes, France
- IDESP, UMR-INSERM, Universite de Montpellier, Montpellier, France
| | - Isao Muraki
- Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| | - David Naimark
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, England
| | - Wonsuk Oh
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle Pena
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tanjala S Purnell
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Division of Transplantation, Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Michihiro Satoh
- Division of Public Health, Hygiene, and Epidemiology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, Scotland
- NHS Grampian, Aberdeen, Scotland
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Jenny I Shen
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco
- General Internal Medicine Division, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Smeeta Sinha
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, England
| | - Benedicte Stengel
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jose M Valdivielso
- Vascular and Renal Translational Research Group, Biomedical Research Institute of Lleida, IRBLleida and University of Lleida, Lleida, Spain
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Chi-Pang Wen
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan/China Medical University Hospital, Taichung, Taiwan
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, England
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Jae Won Yang
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Ann Young
- Division of Nephrology, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- ICES Western, London, Ontario, Canada
| | - Haitao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Luxia Zhang
- Peking University First Hospital, Beijing, China
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Castilla‐Ojo N, Turkson‐Ocran R, Conlin PR, Appel LJ, Miller ER, Juraschek SP. Effects of the DASH diet and losartan on serum urate among adults with hypertension: Results of a randomized trial. J Clin Hypertens (Greenwich) 2023; 25:915-922. [PMID: 37695134 PMCID: PMC10560966 DOI: 10.1111/jch.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
Serum urate is a risk factor for hypertension and gout. The DASH diet and losartan independently lower blood pressure (BP); however, their effects on serum urate are understudied. We performed a post-hoc analysis of the DASH-losartan trial, which randomized participants with hypertension in parallel fashion to the DASH diet or a standard American diet (control) and in crossover fashion to 4-week losartan or placebo. Serum urate was measured at baseline and after each 4-week period. Diets were designed to maintain weight constant. We examined the effects of DASH (vs control) and/or losartan (vs placebo) on serum urate, overall and among those with baseline serum urate ≥6 mg/dL, using generalized estimating equations. Of 55 participants (mean age 52 years, 58% women, 64% Black), mean (±SD) baseline ambulatory SBP/DBP was 146±12/91±9 and mean (±SD) serum urate was 5.2±1.2 mg/dL. The DASH diet did not significantly reduce urate levels overall (mean difference -0.05 mg/dL; 95%CI: -0.39, 0.28), but did decrease levels among participants with baseline hyperuricemia (-0.33 mg/dL; 95%CI: -0.87, 0.21; P-interaction=0.007 across hyperuricemia groups). Losartan significantly decreased serum urate (-0.23 mg/dL; 95%CI: -0.40, -0.05) with greater effects on serum urate among adults <60 years old versus adults ≥60 years old (-0.33 mg/dL vs 0.16 mg/dL, P interaction = 0.003). In summary, the DASH diet significantly decreased serum urate among participants with higher urate at baseline, while losartan significantly reduced serum urate, especially among younger adults. Future research should examine the effects of these interventions in patients with hyperuricemia or gout.
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Affiliation(s)
- Noelle Castilla‐Ojo
- Harvard Medical SchoolBostonMassachusettsUSA
- Beth Israel Deaconess Medical Center/Harvard Medical SchoolDivision of General MedicineBostonMassachusettsUSA
| | | | - Paul R. Conlin
- Harvard Medical SchoolBostonMassachusettsUSA
- VA Boston Healthcare SystemWest RoxburyMassachusettsUSA
| | - Lawrence J. Appel
- Johns Hopkins UniversitySchool of MedicineDepartment of MedicineDivision of General Internal MedicineBaltimoreMarylandUSA
| | - Edgar R. Miller
- Johns Hopkins UniversitySchool of MedicineDepartment of MedicineDivision of General Internal MedicineBaltimoreMarylandUSA
| | - Stephen P. Juraschek
- Harvard Medical SchoolBostonMassachusettsUSA
- Beth Israel Deaconess Medical Center/Harvard Medical SchoolDivision of General MedicineBostonMassachusettsUSA
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20
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Johnson Curtis C, Marklund M, Saxena A, Goyena E, P Desnacido J, Koon AD, Warren B, Cobb LK, E Henry M, Appel LJ, Angeles-Agdeppa I. Considerations for modelling a broad food tax in the Philippines and other low-income and middle-income countries. BMJ Glob Health 2023; 8:e012068. [PMID: 37813445 PMCID: PMC10565299 DOI: 10.1136/bmjgh-2023-012068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 10/13/2023] Open
Abstract
Fiscal policies to improve diet are a promising strategy to address the increasing burden of non-communicable disease, the leading cause of death globally. Sugar-sweetened beverage taxes are the most implemented type of fiscal policy to improve diet. Yet taxes on food, if appropriately structured and applied across the food supply, may support a larger population-level shift towards a healthier diet. Designing these policies and guiding them through the legislative process requires evidence. Equity-oriented cost-effectiveness analyses that estimate the distribution of potential health and economic gains can provide this critical evidence. Taxes on less healthy foods are rarely modelled in low-income and middle-income countries.We describe considerations for modelling the effect of a food tax, which can provide guidance for food tax policy design. This includes describing issues related to the availability, reliability and level of detail of national data on dietary habits, the nutrient content of foods and food prices; the structure of the nutrient profile model; type of tax; tax rate; pass-through rate and price elasticity. Using the Philippines as an example, we discuss considerations for using existing data to model the potential effect of a tax, while also taking into account the political and food policy context. In this way, we provide a modelling framework that can help guide policy-makers and advocates in designing a food policy to improve the health and well-being of future generations in the Philippines and elsewhere.
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Affiliation(s)
| | - Matti Marklund
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Akshar Saxena
- School of Social Sciences, Economics, Nanyang Technological University, Singapore
| | - Eva Goyena
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Josie P Desnacido
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
| | - Adam D Koon
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Megan E Henry
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Manila, Philippines
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Ishigami J, Charleston J, Miller ER, Matsushita K, Appel LJ, Brady TM. Effects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med 2023; 183:1061-1068. [PMID: 37548984 PMCID: PMC10407761 DOI: 10.1001/jamainternmed.2023.3264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/07/2023] [Indexed: 08/08/2023]
Abstract
Importance Clinical practice guidelines recommend selecting an appropriately sized cuff based on mid-arm circumference prior to measuring blood pressure (BP). To our knowledge, the effect of miscuffing on BP measurement when using an automated BP device has not been quantified. Objective To determine the effect of using a regular BP cuff vs an appropriately sized BP cuff on automated BP readings. Design, Setting, and Participants This randomized crossover trial of community-dwelling adults with a wide range of mid-arm circumferences took place between March 16 and October 25, 2021, in Baltimore, Maryland. Participants were recruited via BP screening events at a public food market and a senior housing facility, targeted mailings to prior research participants, placement of study brochures in hypertension clinics at Johns Hopkins University, and referrals from physicians providing hypertension care to adults. Interventions Participants underwent 4 sets of triplicate BP measurements, with the initial 3 sets using an appropriate, too-small, or too-large BP cuff in random order; the fourth set of triplicate measurements was always completed with an appropriate BP cuff. Main Outcomes and Measures The primary outcome was the difference in mean BP when measured with a regular BP cuff compared with an appropriate BP cuff. The secondary outcome was the difference in BP when using too-small or too-large BP cuffs vs an appropriate BP cuff across all cuff sizes. Results were also stratified by systolic BP (≥130 mm Hg vs <130 mm Hg) and body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30 vs <30). Results A total of 195 adults (mean [SD] age, 54 [16] years; 67 [34%] male; 132 [68%] Black; 100 [51%] with hypertension) were randomized for inclusion. Among individuals requiring a small BP cuff, use of a regular BP cuff resulted in a statistically significant lower BP reading (mean systolic BP difference, -3.6 [95% CI, -5.6 to -1.7] mm Hg). In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in a statistically significant higher BP reading (mean systolic BP difference, 4.8 [95% CI, 3.0-6.6] mm Hg and 19.5 [95% CI, 16.1-22.9] mm Hg, respectively). For the secondary outcome, BP differences with overcuffing and undercuffing by 1 and 2 cuff sizes were greater among those requiring larger BP cuffs. The results were consistent in stratified analyses by systolic BP and body mass index. Conclusions and Relevance In this randomized crossover trial, miscuffing resulted in strikingly inaccurate BP measurements. This is particularly concerning for settings where 1 regular BP cuff size is routinely used in all individuals, regardless of arm size. A renewed emphasis on individualized BP cuff selection is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT04610775.
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Affiliation(s)
- Junichi Ishigami
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne Charleston
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Edgar R. Miller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J. Appel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tammy M. Brady
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Daumit GL, Evins AE, Cather C, Dalcin AT, Dickerson FB, Miller ER, Appel LJ, Jerome GJ, McCann U, Ford DE, Charleston JB, Young DR, Gennusa JV, Goldsholl S, Cook C, Fink T, Wang NY. Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:895-904. [PMID: 37378972 PMCID: PMC10308301 DOI: 10.1001/jamapsychiatry.2023.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
Importance Tobacco smoking drives markedly elevated cardiovascular disease risk and preventable death in persons with serious mental illness, and these risks are compounded by the high prevalence of overweight/obesity that smoking cessation can exacerbate. Guideline-concordant combined pharmacotherapy and behavioral smoking cessation treatment improves abstinence but is not routinely offered in community settings, particularly to those not seeking to quit smoking immediately. Objective To determine the effectiveness of an 18-month pharmacotherapy and behavioral smoking cessation intervention incorporating weight management and support for physical activity in adults with serious mental illness interested in quitting smoking within 1 or 6 months. Design, Setting, and Participants This was a randomized clinical trial conducted from July 25, 2016, to March 20, 2020, at 4 community health programs. Adults with serious mental illness who smoked tobacco daily were included in the study. Participants were randomly assigned to intervention or control, stratified by willingness to try to quit immediately (within 1 month) or within 6 months. Assessors were masked to group assignment. Interventions Pharmacotherapy, primarily varenicline, dual-form nicotine replacement, or their combination; tailored individual and group counseling for motivational enhancement; smoking cessation and relapse prevention; weight management counseling; and support for physical activity. Controls received quitline referrals. Main Outcome and Measures The primary outcome was biochemically validated, 7-day point-prevalence tobacco abstinence at 18 months. Results Of the 298 individuals screened for study inclusion, 192 enrolled (mean [SD] age, 49.6 [11.7] years; 97 women [50.5%]) and were randomly assigned to intervention (97 [50.5%]) or control (95 [49.5%]) groups. Participants self-identified with the following race and ethnicity categories: 93 Black or African American (48.4%), 6 Hispanic or Latino (3.1%), 90 White (46.9%), and 9 other (4.7%). A total of 82 participants (42.7%) had a schizophrenia spectrum disorder, 62 (32.3%) had bipolar disorder, and 48 (25.0%) had major depressive disorder; 119 participants (62%) reported interest in quitting immediately (within 1 month). Primary outcome data were collected in 183 participants (95.3%). At 18 months, 26.4% of participants (observed count, 27 of 97 [27.8%]) in the intervention group and 5.7% of participants (observed count, 6 of 95 [6.3%]) in the control group achieved abstinence (adjusted odds ratio [OR], 5.9; 95% CI, 2.3-15.4; P < .001). Readiness to quit within 1 month did not statistically significantly modify the intervention's effect on abstinence. The intervention group did not have significantly greater weight gain than the control group (mean weight change difference, 1.6 kg; 95% CI, -1.5 to 4.7 kg). Conclusions and Relevance Findings of this randomized clinical trial showed that in persons with serious mental illness who are interested in quitting smoking within 6 months, an 18-month intervention with first-line pharmacotherapy and tailored behavioral support for smoking cessation and weight management increased tobacco abstinence without significant weight gain. Trial Registration ClinicalTrials.gov Identifier: NCT02424188.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- College of Health Professions, Towson University, Towson, Maryland
| | - Una McCann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel E. Ford
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tyler Fink
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Sullivan VK, Appel LJ, Anderson CAM, Kim H, Unruh ML, Lash JP, Trego M, Sondheimer J, Dobre M, Pradhan N, Rao PS, Chen J, He J, Rebholz CM. Ultraprocessed Foods and Kidney Disease Progression, Mortality, and Cardiovascular Disease Risk in the CRIC Study. Am J Kidney Dis 2023; 82:202-212. [PMID: 37028638 PMCID: PMC10524102 DOI: 10.1053/j.ajkd.2023.01.452] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/22/2023] [Indexed: 04/09/2023]
Abstract
RATIONALE & OBJECTIVE Ultraprocessed foods are widely consumed in the United States and are associated with cardiovascular disease (CVD), mortality, and kidney function decline in the general population. We investigated associations between ultraprocessed food intake and chronic kidney disease (CKD) progression, all-cause mortality, and incident CVD in adults with chronic kidney disease (CKD). STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Chronic Renal Insufficiency Cohort Study participants who completed baseline dietary questionnaires. EXPOSURE Ultraprocessed food intake (in servings per day) classified according to the NOVA system. OUTCOMES CKD progression (≥50% decrease in estimated glomerular filtration rate [eGFR] or initiation of kidney replacement therapy), all-cause mortality, and incident CVD (myocardial infarction, congestive heart failure, or stroke). ANALYTICAL APPROACH Cox proportional hazards models adjusted for demographic, lifestyle, and health covariates. RESULTS There were 1,047 CKD progression events observed during a median follow-up of 7 years. Greater ultraprocessed food intake was associated with higher risk of CKD progression (tertile 3 vs tertile 1, HR, 1.22; 95% CI, 1.04-1.42; P=0.01 for trend). The association differed by baseline kidney function, such that greater intake was associated with higher risk among people with CKD stages 1/2 (eGFR≥60mL/min/1.73m2; tertile 3 vs tertile 1, HR, 2.61; 95% CI, 1.32-5.18) but not stages 3a-5 (eGFR<60mL/min/1.73m2; P=0.003 for interaction). There were 1,104 deaths observed during a median follow-up of 14 years. Greater ultraprocessed food intake was associated with higher risk of mortality (tertile 3 vs tertile 1, HR, 1.21; 95% CI, 1.04-1.40; P=0.004 for trend). LIMITATIONS Self-reported diet. CONCLUSIONS Greater ultraprocessed food intake may be associated with CKD progression in earlier stages of CKD and is associated with higher risk of all-cause mortality in adults with CKD. PLAIN LANGUAGE SUMMARY Ultraprocessed foods are industrial formulations produced using ingredients and processes that are not commonly used in culinary preparations and contain few, if any, intact unprocessed foods. Ultraprocessed foods are widely consumed in the United States, and high intakes of such foods have been linked to cardiovascular disease, kidney disease, and mortality in the general population. In this study, we found that greater intake of ultraprocessed foods was associated with higher risk of kidney disease progression and mortality in adults with chronic kidney disease. Our findings suggest that patients with kidney disease may benefit from greater consumption of fresh, whole, and homemade or hand-prepared foods and fewer highly processed foods.
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Affiliation(s)
- Valerie K Sullivan
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark L Unruh
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
| | - James P Lash
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, IL
| | - Marsha Trego
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James Sondheimer
- Division of Nephrology and Hypertension, School of Medicine, Wayne State University, Detroit, MI
| | - Mirela Dobre
- Department of Medicine (Nephrology), Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Nishigandha Pradhan
- Department of Medicine (Nephrology), Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ishigami J, Kansal M, Mehta R, Srivastava A, Rahman M, Dobre M, Al-Kindi SG, Go AS, Navaneethan SD, Chen J, He J, Bhat ZY, Jaar BG, Appel LJ, Matsushita K. Cardiac Structure and Function and Subsequent Kidney Disease Progression in Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2023; 82:225-236. [PMID: 36935072 PMCID: PMC10440229 DOI: 10.1053/j.ajkd.2023.01.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/05/2023] [Indexed: 03/19/2023]
Abstract
RATIONALE & OBJECTIVE Heart-kidney crosstalk is recognized as the cardiorenal syndrome. We examined the association of cardiac function and structure with the risk of kidney failure with replacement therapy (KFRT) in a chronic kidney disease (CKD) population. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 3,027 participants from the Chronic Renal Insufficiency Cohort Study. EXPOSURE Five preselected variables that assess different aspects of cardiac structure and function: left ventricular mass index (LVMI), LV volume, left atrial (LA) area, peak tricuspid regurgitation (TR) velocity, and left ventricular ejection fraction (EF) as assessed by echocardiography. OUTCOME Incident KFRT (primary outcome), and annual estimated glomerular filtration rate (eGFR) slope (secondary outcome). ANALYTICAL APPROACH Multivariable Cox models and mixed-effects models. RESULTS The mean age of the participants was 59±11 SD years, 54% were men, and mean eGFR was 43±17mL/min/1.73m2. Between 2003 and 2018 (median follow-up, 9.9 years), 883 participants developed KFRT. Higher LVMI, LV volume, LA area, peak TR velocity, and lower EF were each statistically significantly associated with an increased risk of KFRT, with corresponding HRs for the highest versus lowest quartiles (lowest vs highest for EF) of 1.70 (95% CI, 1.27-2.26), 1.50 (95% CI, 1.19-1.90), 1.43 (95% CI, 1.11-1.84), 1.45 (95% CI, 1.06-1.96), and 1.26 (95% CI, 1.03-1.56), respectively. For the secondary outcome, participants in the highest versus lowest quartiles (lowest vs highest for EF) had a statistically significantly faster eGFR decline, except for LA area (ΔeGFR slope per year, -0.57 [95% CI, -0.68 to-0.46] mL/min/1.73m2 for LVMI, -0.25 [95% CI, -0.35 to-0.15] mL/min/1.73m2 for LV volume, -0.01 [95% CI, -0.12 to-0.01] mL/min/1.73m2 for LA area, -0.42 [95% CI, -0.56 to-0.28] mL/min/1.73m2 for peak TR velocity, and -0.11 [95% CI, -0.20 to-0.01] mL/min/1.73m2 for EF, respectively). LIMITATIONS The possibility of residual confounding. CONCLUSIONS Multiple aspects of cardiac structure and function were statistically significantly associated with the risk of KFRT. These findings suggest that cardiac abnormalities and incidence of KFRT are potentially on the same causal pathway related to the interaction between hypertension, heart failure, and coronary artery diseases. PLAIN-LANGUAGE SUMMARY Heart disease and kidney disease are known to interact with each other. In this study, we examined whether cardiac abnormalities, as assessed by echocardiography, were linked to the subsequent progression of kidney disease among people living with chronic kidney disease (CKD). We found that people with abnormalities in heart structure and function had a greater risk of progression to advanced CKD that required kidney replacement therapy and had a faster rate of decline in kidney function. Our study indicates the potential role of abnormal heart structure and function in the progression of kidney disease among people living with CKD.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
| | - Mayank Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Anand Srivastava
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mahboob Rahman
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio; Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology, Biostatistics and Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | | | - Jing Chen
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | | | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Ogungbe O, Cazabon D, Moran AE, Neupane D, Himmelfarb CD, Edward A, Pariyo GW, Appel LJ, Matsushita K, Hongwei Z, Tong L, Dessie GA, Worku A, Choudhury SR, Jubayer S, Bhuiyan MR, Islam S, Osi K, Odu J, Obagha EC, Ojji D, Huffman MD, Commodore-Mensah Y. Landscape of team-based care to manage hypertension: results from two surveys in low/middle-income countries. BMJ Open 2023; 13:e072192. [PMID: 37487684 PMCID: PMC10373743 DOI: 10.1136/bmjopen-2023-072192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Team-based care is essential for improving hypertension outcomes in low-resource settings. We assessed perceptions of country representatives and healthcare workers (HCWs) on team-based hypertension care in low/middle-income countries. DESIGN Two cross-sectional surveys. SETTING The first survey (Country Profile Survey) was conducted in 17 countries and eight in-country regions: Algeria, Bangladesh, Burundi, Chile, China (Beijing, Henan, Shandong), Cuba, Ethiopia, India (Kerala, Madhya Pradesh, Maharashtra, Punjab, Telangana), Nepal, Nigeria, Philippines, Saint Lucia, Sri Lanka, Thailand, Turkey, Uganda and Vietnam. The second survey (HCW Survey) was conducted in four countries: Bangladesh, China, Ethiopia and Nigeria. PARTICIPANTS Using convenience sampling, participants for the Country Profile Survey were representatives from 17 countries and eight in-country regions, and the HCW Survey was administered to HCWs in Bangladesh, China, Ethiopia and Nigeria. OUTCOME MEASURES Country-level use of team-based hypertension care framework, comprising administrative, basic and advanced clinical tasks. Current practices of different HCW cadres, perspectives on team-based management of hypertension, barriers and facilitators. RESULTS In the Country Profile Survey, all (23/23, 100%) countries/regions surveyed integrated team-based care for basic clinical hypertension management tasks, less for advanced tasks (7/23, 30%). In the HCW Survey, 854 HCWs participated, 47% of whom worked in rural settings. Most HCWs in the sample acknowledged the value of team-based hypertension care. Although there were slight variations by country in the study sample, overall, barriers to team-based hypertension care were identified as inadequate training (83%); regulatory issues (76%); resistance by patients (56%), physicians (42%) and nurses (40%). Facilitators identified were use of treatment algorithms (94%), telehealth/m-health technology (92%) and adequate compensation for HCWs (80%). CONCLUSIONS Our findings revealed key lessons for health systems and governments regarding team-based care implementation. Specifically, policies to facilitate additional training, optimise HCWs' roles within care teams, use of hypertension treatment protocols and telehealth/m-health technology will be essential to promote team-based care.
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Affiliation(s)
| | | | - Andrew E Moran
- Resolve to Saves Lives, New York, New York, USA
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kunihiro Matsushita
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Shamim Jubayer
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
- Dental Public Health, University Dental College and Hospital, Dhaka, Bangladesh
| | | | - Shahinul Islam
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
| | - Kufor Osi
- Resolve to Saves Lives, New York, New York, USA
| | - Joseph Odu
- Resolve to Saves Lives, New York, New York, USA
| | | | - Dike Ojji
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark D Huffman
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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26
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Edward A, Kalyesubula R, Pariyo G, Kyazze AP, Hu X, Appel LJ, Matsushita K. Self-paced online learning to improve knowledge competencies for hypertension among medical students in Uganda: A pre-post study. PLOS Glob Public Health 2023; 3:e0001609. [PMID: 37459296 PMCID: PMC10351720 DOI: 10.1371/journal.pgph.0001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
The growing burden of hypertension (HT) is projected to reach 1.56 billion globally by 2025 and is an increasing public health concern, even for low- and middle-income countries (LMIC) like Uganda, where the prevalence of HT is 31.5%. The objective of this study was to test the effectiveness of a freely available HT online course on knowledge competencies for medical students in Uganda. The online course was developed by a multidisciplinary team at Johns Hopkins University to address HT control in resource-constrained healthcare settings. Students in the 3rd, 4th, and 5th years of medical school were randomly selected to participate in the online course. Pre and post knowledge tests were administered using an online survey system. Of the 201 invited students, 121 (60.2%) completed the study. Significant improvements in mean knowledge scores were evident following the online course completion for Module 1, Fundamentals of HT (21.9±2.5 to 23.7±2.5, p<0.001), and Module 2, Basics of HT Management (14.9±3.3 to 18.5±4.3, p<0.001). No statistically significant differences were evident by gender or school year. Students who took a shorter duration to complete the course had significantly higher mean score improvement between pre- and post-test (mean score improvement 7.0 if <4 weeks, 3.6 if 4-8 weeks, and 3.7 if >8 weeks, p<0.003). Students recognized information on blood pressure measurement (32.2%) and HT management (22.3%) as the most important concept addressed in the course. A self-paced online course, complementing medical school training, improved knowledge on HT burden and management in Uganda.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert Kalyesubula
- Departments of Medicine and Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Peter Kyazze
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Xiao Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lawrence J. Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kim H, Lichtenstein AH, Ganz P, Miller ER, Coresh J, Appel LJ, Rebholz CM. Associations of circulating proteins with lipoprotein profiles: proteomic analyses from the OmniHeart randomized trial and the Atherosclerosis Risk in Communities (ARIC) Study. Clin Proteomics 2023; 20:27. [PMID: 37400771 PMCID: PMC10316599 DOI: 10.1186/s12014-023-09416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Within healthy dietary patterns, manipulation of the proportion of macronutrient can reduce CVD risk. However, the biological pathways underlying healthy diet-disease associations are poorly understood. Using an untargeted, large-scale proteomic profiling, we aimed to (1) identify proteins mediating the association between healthy dietary patterns varying in the proportion of macronutrient and lipoproteins, and (2) validate the associations between diet-related proteins and lipoproteins in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS In 140 adults from the OmniHeart trial, a randomized, cross-over, controlled feeding study with 3 intervention periods (carbohydrate-rich; protein-rich; unsaturated fat-rich dietary patterns), 4,958 proteins were quantified at the end of each diet intervention period using an aptamer assay (SomaLogic). We assessed differences in log2-transformed proteins in 3 between-diet comparisons using paired t-tests, examined the associations between diet-related proteins and lipoproteins using linear regression, and identified proteins mediating these associations using a causal mediation analysis. Levels of diet-related proteins and lipoprotein associations were validated in the ARIC study (n = 11,201) using multivariable linear regression models, adjusting for important confounders. RESULTS Three between-diet comparisons identified 497 significantly different proteins (protein-rich vs. carbohydrate-rich = 18; unsaturated fat-rich vs. carbohydrate-rich = 335; protein-rich vs. unsaturated fat-rich dietary patterns = 398). Of these, 9 proteins [apolipoprotein M, afamin, collagen alpha-3(VI) chain, chitinase-3-like protein 1, inhibin beta A chain, palmitoleoyl-protein carboxylesterase NOTUM, cathelicidin antimicrobial peptide, guanylate-binding protein 2, COP9 signalosome complex subunit 7b] were positively associated with lipoproteins [high-density lipoprotein (HDL)-cholesterol (C) = 2; triglyceride = 5; non-HDL-C = 3; total cholesterol to HDL-C ratio = 1]. Another protein, sodium-coupled monocarboxylate transporter 1, was inversely associated with HDL-C and positively associated with total cholesterol to HDL-C ratio. The proportion of the association between diet and lipoproteins mediated by these 10 proteins ranged from 21 to 98%. All of the associations between diet-related proteins and lipoproteins were significant in the ARIC study, except for afamin. CONCLUSIONS We identified proteins that mediate the association between healthy dietary patterns varying in macronutrients and lipoproteins in a randomized feeding study and an observational study. TRIAL REGISTRATION NCT00051350 at clinicaltrials.gov.
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Affiliation(s)
- Hyunju Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD USA
| | - Alice H. Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA USA
| | - Peter Ganz
- Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Edgar R. Miller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA
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Schrack JA, Cai Y, Urbanek JK, Wanigatunga AA, Mitchell CM, Miller ER, Guralnik JM, Juraschek SP, Michos ED, Roth DL, Appel LJ. The association of vitamin D supplementation and serum vitamin D levels with physical activity in older adults: Results from a randomized trial. J Am Geriatr Soc 2023; 71:2208-2218. [PMID: 36821761 PMCID: PMC10363216 DOI: 10.1111/jgs.18290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND To assess whether vitamin D3 supplementation attenuates the decline in daily physical activity in low-functioning adults at risk for falls. METHODS Secondary data analyses of STURDY (Study to Understand Fall Reduction and Vitamin D in You), a response-adaptive randomized clinical trial. Participants included 571 adults aged 70 years and older with baseline serum 25(OH)D levels of 10-29 ng/mL and elevated fall risk, who wore a wrist accelerometer at baseline and at least one follow-up visit and were randomized to receive: 200 IU/day (control), 1000, 2000, or 4000 IU/day of vitamin D3 . Objective physical activity quantities and patterns (total daily activity counts, active minutes/day, and activity fragmentation) were measured for 7-days, 24-h/day, in the free-living environment using the Actigraph GT9x over up to 24-months of follow-up. RESULTS In adjusted models, physical activity quantities declined (p < 0.001) and became more fragmented, or "broken up", (p = 0.017) over time. Supplementation with vitamin D3 did not attenuate this decline. Changes in physical activity were more rapid among those with baseline serum 25(OH)D <20 ng/mL compared to those with baseline 25(OH)D levels of 20-29 ng/mL (time*baseline 25(OH)D, p < 0.05). CONCLUSION In low-functioning older adults with serum 25(OH)D levels 10-29 ng/mL, vitamin D3 supplementation of 1000 IU/day or higher did not attenuate declines in physical activity compared with 200 IU/day. Those with baseline 25(OH)D <20 ng/mL showed accelerated declines in physical activity. Alternative interventions to supplementation are needed to curb declines in physical activity in older adults with low serum 25(OH)D.
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Affiliation(s)
- Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
| | - Yurun Cai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Jacek K. Urbanek
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amal A. Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
| | - Christine M. Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
| | - Edgar R. Miller
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jack M. Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, Massachusetts, USA
| | - Erin D. Michos
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - David L. Roth
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Kim H, Appel LJ, Lichtenstein AH, Wong KE, Chatterjee N, Rhee EP, Rebholz CM. Metabolomic Profiles Associated With Blood Pressure Reduction in Response to the DASH and DASH-Sodium Dietary Interventions. Hypertension 2023; 80:1494-1506. [PMID: 37161796 PMCID: PMC10262995 DOI: 10.1161/hypertensionaha.123.20901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The DASH (Dietary Approaches to Stop Hypertension) diets reduced blood pressure (BP) in the DASH and DASH-Sodium trials, but the underlying mechanisms are unclear. We identified metabolites associated with systolic BP or diastolic BP (DBP) changes induced by dietary interventions (DASH versus control arms) in 2 randomized controlled feeding studies-the DASH and DASH-Sodium trials. METHODS Metabolomic profiling was conducted in serum and urine samples collected at the end of diet interventions: DASH (n=219) and DASH-Sodium (n=395). Using multivariable linear regression models, associations were examined between metabolites and change in systolic BP and DBP. Tested for interactions between diet interventions and metabolites were the following comparisons: (1) DASH versus control diets in the DASH trial (serum), (2) DASH high-sodium versus control high-sodium diets in the DASH-Sodium trial (urine), and (3) DASH low-sodium versus control high-sodium diets in the DASH-Sodium trial (urine). RESULTS Sixty-five significant interactions were identified (DASH trial [serum], 12; DASH high sodium [urine], 35; DASH low sodium [urine], 18) between metabolites and systolic BP or DBP. In the DASH trial, serum tryptophan betaine was associated with reductions in DBP in participants consuming the DASH diets but not control diets (P interaction, 0.023). In the DASH-Sodium trial, urine levels of N-methylglutamate and proline derivatives (eg, stachydrine, 3-hydroxystachydrine, N-methylproline, and N-methylhydroxyproline) were associated with reductions in systolic BP or DBP in participants consuming the DASH diets but not control diets (P interaction, <0.05 for all tests). CONCLUSIONS We identified metabolites that were associated with BP lowering in response to dietary interventions. REGISTRATION URL: https://www. CLINICALTRIALS gov/ct2/show/NCT03403166; Unique identifier: NCT03403166 (DASH trial). URL: https://www. CLINICALTRIALS gov/ct2/show/NCT00000608; Unique identifier: NCT00000608 (DASH-Sodium trial).
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Affiliation(s)
- Hyunju Kim
- Department of Epidemiology (H.K., L.J.A., C.M.R.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (H.K., L.J.A., C.M.R.)
| | - Lawrence J. Appel
- Department of Epidemiology (H.K., L.J.A., C.M.R.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (L.J.A., C.M.R.)
| | - Alice H. Lichtenstein
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (H.K., L.J.A., C.M.R.)
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L.)
| | - Kari E. Wong
- Metabolon, Research Triangle Park, Morrisville, NC (K.E.W.)
| | - Nilanjan Chatterjee
- Department of Biostatistics (N.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Eugene P. Rhee
- Nephrology Division and Endocrine Unit, Massachusetts General Hospital, Boston, MA (E.P.R.)
| | - Casey M. Rebholz
- Department of Epidemiology (H.K., L.J.A., C.M.R.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (H.K., L.J.A., C.M.R.)
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30
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Mueller NT, Differding MK, Sun H, Wang J, Levy S, Deopujari V, Appel LJ, Blaser MJ, Kundu T, Shah AA, Dominguez Bello MG, Hourigan SK. Maternal Bacterial Engraftment in Multiple Body Sites of Cesarean Section Born Neonates after Vaginal Seeding-a Randomized Controlled Trial. mBio 2023; 14:e0049123. [PMID: 37074174 PMCID: PMC10294643 DOI: 10.1128/mbio.00491-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
Children delivered by elective, prelabor Cesarean section (C-section) are not exposed to the birth canal microbiota and, in relation to vaginally delivered children, show altered microbiota development. Perturbed microbial colonization during critical early-life windows of development alters metabolic and immune programming and is associated with an increased risk of immune and metabolic diseases. In nonrandomized studies, vaginal seeding of C-section-born neonates partially restores their microbiota colonization to that of their vaginally delivered counterparts, but without randomization, confounding factors cannot be excluded. In a double-blind, randomized, placebo-controlled trial, we determined the effect of vaginal seeding versus placebo seeding (control arm) on the skin and stool microbiota of elective, prelabor C-section-born neonates (n = 20) at 1 day and 1 month after birth. We also examined whether there were between-arm differences in engraftment of maternal microbes in the neonatal microbiota. In relation to the control arm, vaginal seeding increased mother-to-neonate microbiota transmission and caused compositional changes and a reduction in alpha diversity (Shannon Index) of the skin and stool microbiota. The neonatal skin and stool microbiota alpha diversity when maternal vaginal microbiota is provided is intriguing and highlights the need of larger randomized studies to determine the ecological mechanisms and effects of vaginal seeding on clinical outcomes. IMPORTANCE Children delivered by elective C-section are not exposed to the birth canal and show altered microbiota development. Impairing microbial colonization during early life alters metabolic and immune programming and is associated with an increased risk of immune and metabolic diseases. In a double-blind, randomized, placebo-controlled trial, we determined the effect of vaginal seeding on the skin and stool microbiota of elective C-section born neonates and found that vaginal seeding increased mother-to-neonate microbiota transmission and caused compositional changes and a reduction in the skin and stool microbiota diversity. The reduction of neonatal skin and stool microbiota diversity when maternal vaginal microbiota is provided is intriguing and highlights the need of larger randomized studies to determine the ecological mechanisms and effects of vaginal seeding on clinical outcomes.
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Affiliation(s)
- Noel T. Mueller
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
| | - Moira K. Differding
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
| | - Haipeng Sun
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jincheng Wang
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Shira Levy
- Clinical Microbiome Unit (CMU), Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Inova Children’s Hospital, Inova Health System, Falls Church, Virginia, USA
| | - Varsha Deopujari
- Inova Children’s Hospital, Inova Health System, Falls Church, Virginia, USA
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
| | - Martin J. Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, New Jersey, USA
| | - Tanima Kundu
- Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, New Jersey, USA
| | - Ankit A. Shah
- Inova Women’s Hospital, Inova Health System, Falls Church, Virginia, USA
| | - Maria Gloria Dominguez Bello
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, New Jersey, USA
- Clinical Microbiome Unit (CMU), Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Anthropology, Rutgers University, New Brunswick, New Jersey, USA
- Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, New Jersey, USA
- Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario, Canada
| | - Suchitra K. Hourigan
- Clinical Microbiome Unit (CMU), Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Inova Children’s Hospital, Inova Health System, Falls Church, Virginia, USA
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Sullivan VK, Appel LJ, Anderson CAM, Tan TC, Brown J, Ricardo AC, Schrauben SJ, Hsu CY, Shah VO, Unruh M, Nelson RG, Sondheimer J, Chen J, He J, Charleston J, Rebholz CM. Changes in Diet Quality, Risk of CKD Progression, and All-Cause Mortality in the CRIC Study. Am J Kidney Dis 2023; 81:621-624. [PMID: 36455682 PMCID: PMC10228419 DOI: 10.1053/j.ajkd.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Valerie K Sullivan
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, California
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Julia Brown
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Ana C Ricardo
- Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, Illinois
| | - Sarah J Schrauben
- Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California San Francisco, San Francisco, California; Kaiser Permanente Division of Nephrology, Oakland, California
| | - Vallabh O Shah
- Departments of Internal Medicine and Biochemistry and Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mark Unruh
- Departments of Internal Medicine and Biochemistry and Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - James Sondheimer
- Division of Nephrology and Hypertension, School of Medicine, Wayne State University, Detroit, Michigan
| | - Jing Chen
- Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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White K, Wu B, Pilla SJ, Charleston J, Maw MTT, Appel LJ, Clark JM, Maruthur NM. Design and Implementation of a Time-Restricted Eating Intervention in a Randomized, Controlled Eating Study. Nutrients 2023; 15:nu15081978. [PMID: 37111198 PMCID: PMC10144293 DOI: 10.3390/nu15081978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The efficacy of time-restricted eating for weight loss has not been established, as prior studies were limited by a lack of controlled isocaloric designs. This study describes the design and implementation of interventions in a controlled eating study evaluating time-restricted eating. We designed a randomized, controlled, parallel-arm eating study comparing time-restricted eating (TRE) to a usual eating pattern (UEP) for the primary outcome of weight change. Participants were aged 21-69 years with prediabetes and obesity. TRE consumed 80% of calories by 1300 h (military time), and UEP consumed ≥ 50% of calories after 1700 h (military time). Both arms consumed identical macro- and micro-nutrients based on a healthy, palatable diet. We calculated individual calorie requirements, which were maintained throughout the intervention. The desired distribution of calories across eating windows in both arms was achieved, as were the weekly averages for macronutrients and micronutrients. We actively monitored participants and adapted diets to facilitate adherence. We provide the first report, to our knowledge, on the design and implementation of eating study interventions that isolated the effect of meal timing on weight while maintaining constant caloric intake and identical diets during the study period.
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Affiliation(s)
- Karen White
- ProHealth Clinical Research Unit, School of Medicine, Johns Hopkins University, Baltimore, MD 21207, USA
| | - Beiwen Wu
- ProHealth Clinical Research Unit, School of Medicine, Johns Hopkins University, Baltimore, MD 21207, USA
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3L9, Canada
| | - Scott J Pilla
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jeanne Charleston
- ProHealth Clinical Research Unit, School of Medicine, Johns Hopkins University, Baltimore, MD 21207, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - May Thu Thu Maw
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Lawrence J Appel
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jeanne M Clark
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Nisa M Maruthur
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Kim H, Lichtenstein AH, Ganz P, Du S, Tang O, Yu B, Chatterjee N, Appel LJ, Coresh J, Rebholz CM. Identification of Protein Biomarkers of the Dietary Approaches to Stop Hypertension Diet in Randomized Feeding Studies and Validation in an Observational Study. J Am Heart Assoc 2023; 12:e028821. [PMID: 36974735 PMCID: PMC10122905 DOI: 10.1161/jaha.122.028821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for cardiovascular disease prevention. We aimed to identify protein biomarkers of the DASH diet using data from 2 randomized feeding studies and validate them in an observational study, the ARIC (Atherosclerosis Risk in Communities) study. Methods and Results Large-scale proteomic profiling was conducted in serum specimens (SomaLogic) collected at the end of 8-week and 4-week DASH diet interventions in multicenter, randomized controlled feeding studies of the DASH trial (N=215) and the DASH-Sodium trial (N=396), respectively. Multivariable linear regression models were used to compare the relative abundance of 7241 proteins between the DASH and control diet interventions. Estimates from the 2 trials were meta-analyzed using fixed-effects models. We validated significant proteins in the ARIC study (N=10 490) using the DASH diet score. At a false discovery rate <0.05, there were 71 proteins that were different between the DASH diet and control diet in the DASH and DASH-Sodium trials. Nineteen proteins were validated in the ARIC study. The 19 proteins collectively improved the prediction of the DASH diet intervention in the feeding studies (range of difference in C statistics, 0.267-0.313; P<0.001 for both tests) and the DASH diet score in the ARIC study (difference in C statistics, 0.017; P<0.001) beyond participant characteristics. Conclusions We identified 19 proteins robustly associated with the DASH diet in 3 studies, which may serve as biomarkers of the DASH diet. These results suggest potential pathways that are impacted by consumption of the DASH diet. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03403166, NCT00000608.
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Affiliation(s)
- Hyunju Kim
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University Boston MA
| | - Peter Ganz
- Cardiovascular Division, Zuckerberg San Francisco General Hospital University of California, San Francisco San Francisco CA
| | - Shutong Du
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
| | - Olive Tang
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
| | - Bing Yu
- Department of Epidemiology, Human Genetics & Environmental Sciences University of Texas Health Sciences Center at Houston School of Public Health Houston TX
| | - Nilanjan Chatterjee
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Lawrence J Appel
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
- Division of Nephrology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD
| | - Josef Coresh
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
- Division of Nephrology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD
| | - Casey M Rebholz
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD
- Division of Nephrology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD
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Marklund M, Cherukupalli R, Pathak P, Neupane D, Krishna A, Wu JH, Neal B, Kaur P, Moran AE, Appel LJ, Matsushita K. Hypertension treatment capacity in India by increased workforce, greater task-sharing, and extended prescription period: a modelling study. Lancet Reg Health Southeast Asia 2023; 10:100124. [PMID: 37383361 PMCID: PMC10306017 DOI: 10.1016/j.lansea.2022.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 06/30/2023]
Abstract
Background The worldwide control rate for hypertension is dismal. An inadequate number of physicians to treat patients with hypertension is one key obstacle. Innovative health system approaches such as delegation of basic tasks to non-physician health workers (task-sharing) might alleviate this problem. Massive scale up of population-wide hypertension management is especially important for low- and middle-income countries such as India. Methods Using constrained optimization models, we estimated the hypertension treatment capacity and salary costs of staff involved in hypertension care within the public health system of India and simulated the potential effects of (1) an increased workforce, (2) greater task-sharing among health workers, and (3) extended average prescription periods that reduce treatment visit frequency (e.g., quarterly instead of monthly). Findings Currently, only an estimated 8% (95% uncertainty interval 7%-10%) of ∼245 million adults with hypertension can be treated by physician-led services in the Indian public health system (assuming the current number of health workers, no greater task-sharing, and monthly visits for prescriptions). Without task-sharing and with continued monthly visits for prescriptions, the least costly workforce expansion to treat 70% of adults with hypertension would require ∼1.6 (1.0-2.5) million additional staff (all non-physicians), with ∼INR 200 billion (≈USD 2.7 billion) in additional annual salary costs. Implementing task-sharing among health workers (without increasing the overall time on hypertension care) or allowing a 3-month prescription period was estimated to allow the current workforce to treat ∼25% of patients. Joint implementation of task-sharing and a longer prescription period could treat ∼70% of patients with hypertension in India. Interpretation The combination of greater task-sharing and extended prescription periods could substantially increase the hypertension treatment capacity in India without any expansion of the current workforce in the public health system. By contrast, workforce expansion alone would require considerable, additional human and financial resources. Funding Resolve to Save Lives, an initiative of Vital Strategies, was funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners (funded with support from the Chan Zuckerberg Foundation).
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Affiliation(s)
- Matti Marklund
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Priya Pathak
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dinesh Neupane
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jason H.Y. Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Imperial College London, London, UK
| | - Prabhdeep Kaur
- National Institute of Epidemiology, The Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Andrew E. Moran
- Resolve to Save Lives, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Lawrence J. Appel
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Morales-Alvarez MC, Nissaisorakarn V, Appel LJ, Miller ER, Christenson RH, Rebuck H, Rosas SE, William JH, Juraschek SP. Abstract P387: Effects of Reduced Dietary Sodium and the Dash Diet on Glomerular Filtration Rate: Results From the Dash-Sodium Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background:
While prior studies demonstrated that a low-sodium, DASH diet reduced blood pressure, the effects of sodium reduction, alone or in combination with the DASH diet, on kidney function are still unknown.
Objective:
We measured cystatin C in stored specimens of the DASH-Na trial, to determine the effects of sodium reduction and the DASH diet, alone or combined, on kidney function assessed by eGFR.
Methods:
DASH-Sodium was a controlled, feeding study in adults with pre- or stage 1 hypertension, who were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4-weeks following a 2-week run-in period where all consumed a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes included eGFR by cystatin C (CKD-EPI 2021 equation) at baseline and at the end of each feeding period.
Results:
Cystatin C was measured in 409 of the original 412 participants, 207 were assigned the DASH diet, and 202 were assigned the control diet. The mean age was 48 years; 56% were women, and 56% were Black. The mean baseline BP was 135/86 mm Hg and BMI was 29.2 kg/m
2
. Compared with control, the DASH diet did not affect eGFR (β=-0.96 mL/min per 1.73 m
2
; 95% CI: -2.74, 0.83) (
Figure
). In contrast, low versus high sodium intake decreased eGFR (β=-2.36 mL/min per 1.73 m
2
; 95% CI: -3.64, -1.07). Together, compared to the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 mL/min per 1.73 m
2
(95% CI: -5.46, -0.73).
Conclusions:
A combined low sodium-DASH diet reduced eGFR over a 4-week feeding period. Whether these effects are reno-protective long-term represent an important clinical inquiry for subsequent research.
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Kim H, Appel LJ, Lichtenstein AH, Wong K, Chatterjee N, Rhee EP, Rebholz CM. Abstract P208: Metabolomic Profiles Associated With Blood Pressure Reduction in Response to the DASH and DASH-Sodium Trials. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
The Dietary Approaches to Stop Hypertension (DASH) diet significantly reduced blood pressure (BP) in the DASH and DASH-Sodium trials, but the underlying mechanisms are unclear.
Hypothesis:
We hypothesized that certain metabolites will be associated with BP reductions.
Methods:
Metabolomic profiling was conducted at the end of the diet interventions for participants randomly assigned to the DASH or control diet in multicenter, controlled feeding studies: DASH (N=219) and DASH-Sodium trials (N=395). Using multivariable linear regression models to examine the association between metabolites and BP change, we tested for interactions between diet and metabolites for the following comparisons: 1) DASH vs. control diets in the DASH trial, 2) DASH-high sodium vs. control-high sodium diets in the DASH-Sodium trial, and 3) DASH-low sodium vs. control-high sodium diets in the DASH-Sodium trial. Pathway overrepresentation analysis was constructed for significant metabolites.
Results:
Identified were 65 significant interactions [DASH=12; DASH-high sodium=35; DASH-low sodium=18]. Most amino acids (16/19), cofactors and vitamins (15/15), xenobiotics (9/13), peptides (4/5), and a nucleotide (1/1) were higher in participants consuming the DASH diets vs. the control diets. These metabolites were associated with BP reductions in participants consuming the DASH diets, but not control diets (
Figure
). Many lipid metabolites (10/12) were lower in participants consuming the DASH vs. the control diets. Lipid concentrations were associated with BP elevations in participants consuming the DASH diets and with BP reductions in participants consuming the control diets. Metabolites associated with tocopherol metabolism, ceramides, and pantothenate and CoA metabolism were overrepresented.
Conclusions:
Using data from randomized feeding studies, we identified metabolites that were associated with BP lowering. These metabolites highlight the pathways through which DASH diet reduced BP.
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Kwon S, Juraschek SP, Wanigatunga AA, Mitchell CM, Michos ED, Miller ER, Appel LJ, Schrack JA. Abstract P436: Objective Physical Activity and Orthostatic Hypotension in Older Adults: The STURDY Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Orthostatic hypotension (OH) is prevalent in older adults and associated with poor health outcomes. Physical activity (PA) may attenuate the risk of OH, but evidence of the association between daily volume and patterns of objectively measured PA and OH is lacking.
Hypothesis:
Lower daily volume and higher fragmentation of PA are associated with greater risk of OH.
Methods:
We included 196 participants (age ≥70) of the Study To Understand Fall Reduction and Vitamin D in You (STURDY) trial who wore an accelerometer for 7 days at their baseline visit and completed a supine-to-standing OH assessment at 2-year follow-up. We defined OH as a 20 mm Hg drop in systolic blood pressure or 10 mm Hg drop in diastolic blood pressure 3 minutes after changing from supine to standing position. Using accelerometry, daily total activity counts (TAC; counts/day) and time spent active (mins/day) were used to measure volume of daily PA. Active-to-sedentary transition probability (ASTP) was calculated as the reciprocal of the average PA bout duration to measure PA fragmentation. Multivariable robust Poisson regression estimated the risk ratio between baseline PA and OH after 2-years of follow up.
Results:
Among 196 participants, 12.2% of participants had OH after 2-years of follow up; 62.2% were male, and mean baseline age was 76.4 (SD=5.2). In this prospective analyses, lower daily activity (lowest vs highest tertile of TAC: RR = 6.49, 95% CI: 2.15-19.58; lowest vs highest tertile of time spent active: RR= 4.30, 95% CI:1.55-11.92) and higher fragmentation (highest vs lowest tertile of ASTP: RR = 5.36, 95% CI: 1.57-18.34) of PA were associated with higher risk of OH after 2 years
(Figure)
.
Conclusions:
Both lower daily activity volume and higher fragmentation of PA were associated with increased risk of OH in older adults over follow-up. Longitudinal studies to assess whether changes in PA volume or fragmentation alter the risk of OH should be explored.
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Affiliation(s)
- Sohyeon Kwon
- Johns Hopkins Bloomberg Sch of Public Health, Baltimore, MD
| | | | | | | | | | | | | | | |
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38
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Earle W, Rainer K, Appel LJ, Miller ER, Michos ED, Schrack J, Wanigatunga A, Mitchell C, Rebuck H, Christenson RH, Juraschek SP. Abstract 49: The Effects of Vitamin D Supplementation on Subclinical Cardiovascular Disease: Results From the Sturdy Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background:
In observational studies, older adults with insufficient or deficient serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have failed to demonstrate reduction in CVD risk from vitamin D supplementation. This is possibly because the doses of vitamin D supplements tested were too low.
Objective:
To determine if higher doses of vitamin D supplementation lower high sensitivity cardiac troponin level (hs-cTnI) and N-terminal pro b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD.
Methods:
The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, and 4000 IU/day) on fall risk in adults aged ≥70 years old with low serum 25-hydroxyvitamin D levels (10-29 ng/ml). Hs-cTnI and NT-proBNP levels were measured at baseline and at 3-, 12- and 24-month follow-up visits. For analysis, participants were divided into low (200 IU/day) and high dose (1000+ IU/day) vitamin D treatment groups. The effects of vitamin D dose on hs-cTnI and NT-proBNP were assessed via mixed effects tobit models.
Results:
Among 688 participants (mean age of 77 ± 5 years, 44% were women, and 18% were Black), 50.7% were in the high-dose treatment group (1000+ IU/day). Hs-cTnI increased in both the low and high dose groups by 5.1% and 5.8%, respectively; likewise, NT-proBNP increased in both groups by 11.3% and 9.3%, respectively (
Figure).
Compared to the low-dose group, high-dose vitamin D treatment did not affect hs-cTnI (1.7 % difference; 95% CI: -5.3, 9.3) or NT-proBNP (-1.8 % difference; 95% CI: -9.3, 6.3).
Conclusions:
Compared to low dose vitamin D supplementation, a higher dose did not affect markers of subclinical CVD in older adults with low serum vitamin D levels. These findings do not support higher doses of vitamin D as an intervention to reduce the risk of CVD in this population.
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Yeh HC, Jerome GJ, Wang NY, Dalcin A, Bunyard L, Durkin N, Charleston J, Kanarek N, Carducci M, Appel LJ. Abstract P139: Behavioral Weight Loss Programs for Cancer Survivors: A Non-Randomized Clinical Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background:
Clinical trials for weight loss in cancer survivors have been shown to be safe and effective. Pragmatic approaches are needed to facilitate broader adoption. The ASPIRE study evaluates real-world, lifestyle weight loss programs in Maryland on reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes. Here we report 6-month data on weight change.
Methods:
Participants were adults with overweight or obesity, who had a history of solid malignant tumors and completed curative intent treatment. The exclusion criteria were minimized to increase generalizability. Participants self-selected 1 of 3 programs: the Self-Directed (SD) Program provided evidence-based, written materials; the App-Directed (AD) Program additionally provided a commercially available, free smartphone app and weekly diet and exercise tips; and the Coach-Directed (CD) Program additionally included 1-on-1 telephonic coaching. SD and AD had versions with and without weight tracking; CD required weight tracking. Weights were transmitted to the study team using cellular technology with the scales provided and collected at baseline, 3, 6, and 12 months.
Results:
5,644 cancer survivors were invited, mostly via electronic health records; 9% expressed interest. Of these, 67% enrolled (total n=340; n=240 in weight tracking programs; 54% black, 74% women.) Participants in CD were younger, more likely to be women, less likely to have bachelor’s degree, and weighed more than those in SD. At 6m, weights were obtained from 97.5% of participants. Within-program weight reduction was most significant in CD. In the adjusted mixed-effects models, compared with SD participants, CD participants achieved significant weight reduction (see Table)
Conclusion:
Remotely delivered weight loss programs are desirable and can be broad- reach. Intervention with remote coaching was effective. While selected by many participants, app-directed program with weight tracking but without coaching led to small weight reduction.
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40
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Wang X, Ma H, Heianza Y, Appel LJ, Sacks FM, Qi L. Abstract MP09: Diets Varying in Glycemic Index and Carbohydrates With Meal-Timing Specific 12-hour Postprandial Metabolic Changes: The Omnicarb Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.mp09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background:
Both the glycemic index (GI) and amounts of carbohydrates are important determinants of postprandial glucose changes. Recent studies suggest the effects of carbohydrate intake on postprandial glucose metabolism may differ according to meal timing, showing circadian patterns.
Hypothesis:
We investigated whether the relations of altering both GI levels and the carbohydrate amount with postprandial response of glucose, insulin, and c-peptide differed by meal timing (breakfast, lunch, and dinner), in overweight and obese adults.
Methods:
The OmniCarb trial was a randomized trial with a crossover design in which participants were given 4 diets varying in GI levels and carbohydrate content. We included 61 participants attended the 12-h postprandial study and completed at least two diets. Area under the curve increment (AUCi) of glucose, insulin, and c-peptide after breakfast (180 min), lunch (240 min), and dinner (120 min), was calculated as outcome.
Results:
After consuming each diet for 5 weeks, we observed that the diet replacing effects on the postprandial responses in glucose, insulin and c-peptide significantly differed by meal timing. For postprandial glucose response to breakfast, the beneficial effects (lowered AUCi) of replacing high- by low-GI in high-carb diet, replacing high- by low-carb in high-GI diet, and replacing high-GI/high-carb by low-GI/low-carb diet were consistently observed. Such beneficial effects were less significant for lunch and dinner (Figure). For the response of insulin, the beneficial effects of the corresponding diet replacements were more consistently observed in dinner, followed by breakfast. For the response of C-peptide, similar beneficial effects of the corresponding diet replacements were observed for breakfast and dinner, but not lunch.
Conclusion:
Our results indicate that the beneficial effects of replacing high-GI and/or high-carbohydrate diets by low-GI and/or low-carbohydrate diets on postprandial metabolic changes may differ according to meal timing.
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Affiliation(s)
| | - Hao Ma
- Tulane university, New Orleans, LA
| | | | | | | | - Lu Qi
- TULANE UNIVERSITY, New Orleans, LA
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41
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Ogungbe OV, Cazabon D, Moran AE, Neupane D, Dennison Himmelfarb CR, Edward A, Pariyo G, Appel LJ, Matsushita K, ZHANG H, Tong LIU, Girma D, Worku A, Reza Choudhury S, Jubayer S, Rahman Bhuiyan M, Islam S, Osi K, Odu J, Chijioke Emmanuel O, Dike O, Huffman MD, Commodore-Mensah Y. Abstract P557: A Landscape Analysis of Team-Based Care for Hypertension Control in Low-and Middle-Income Countries. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
A team-based care approach to hypertension care in low-resource settings is an effective strategy for improving hypertension control.
Objective:
In this multi-country survey, we assessed the extent to which team-based care is operationalized for hypertension care in low- and middle-income countries (LMICs), and the perception of hypertension program experts and health care workers (HCWs).
Methods:
Two surveys were administered; the first survey (Country Profile Survey), administered in 25 countries, sought to identify the current tasks of HCWs from perspectives of national representatives involved in public health programming. The second survey (HCW Survey), administered among HCWs in four LMICs; Bangladesh, China, Ethiopia, and Nigeria, aimed to understand current practices of HCWs, perspectives on team-based management of hypertension, and barriers and facilitators.
Results:
In the Country Profile Survey, all countries surveyed allowed team-based care for basic clinical hypertension management tasks, but less for advanced tasks (9/25, 36%). In the HCW survey, 854 HCWs from four countries participated: 47% (401/854) work in rural settings. Although there were slight variations by country, overall, barriers to team-based hypertension care were similar, including: inadequate training of HCWs (83%), regulatory issues (76%), resistance by patients (56%), and opposition by physicians (42%) and nurses (40%). Perceived facilitators of team-based hypertension care were use of treatment algorithms (94%), telehealth/m-health technology (92%), and adequate compensation for HCWs (80%) (
Figure A-B
).
Conclusions:
These surveys revealed key targets for health systems and governments to facilitate team-based care implementation. Specifically, policies to provide additional training, optimize HCWs roles within the care team, and establish hypertension treatment protocols and telehealth/m-health are essential.
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Affiliation(s)
| | | | - Andrew E Moran
- Resolve to Save Lives; Columbia Univ Irving Med Cntr, Columbia Univ, New York, NY
| | | | | | | | | | | | | | | | | | | | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Shamim Jubayer
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
| | | | - Shahinul Islam
- National Heart Foundation of Bangladesh, Dhaka, Bangladesh
| | | | | | | | | | | | | |
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42
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Mills KT, Chen J, Nguyen B, He H, Dorans KS, Uwaifo GI, Kumbala D, Appel LJ, Whelton PK, He J. Abstract 20: Effect of Dietary Sodium Reduction in Chronic Kidney Disease Patients With Albuminuria: Results of a Randomized Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
Albuminuria, an early marker of kidney damage, is a risk factor for chronic kidney disease (CKD) progression, cardiovascular disease (CVD), and death. Dietary sodium is a risk factor for elevated blood pressure, CVD, and all cause-mortality. It is particularly important in patients with CKD due to increased salt-sensitivity. It is unclear if dietary sodium reduction is associated with reduced albuminuria.
Hypothesis:
A low sodium diet will reduce albuminuria in patients with CKD.
Methods:
The Sodium Lowering and Urinary Protein Reduction (SUPER) Trial was a randomized, parallel trial testing the effect of a 24-week dietary sodium reduction intervention compared to usual diet on albuminuria in 151 CKD patients with albuminuria. Participants were eligible if they had an estimated glomerular filtration rate (eGFR) of 30-90 mL/min/1.73 m
2
and an albumin-to-creatinine ratio (ACR) of 30-1,500 mg/g. Intervention group participants received a dietician-led behavioral change intervention targeting sodium intake <2,300 mg/day and those in the control group received no dietary intervention. Twenty-four hour urine samples and dietary recalls, blood pressure, weight, and questionnaire data was collected at baseline, 12 weeks and 24 weeks. Mixed effects models were used to examine the intervention effect.
Results:
Study participants were an average of 65.6 years old, 72% African American, and 48% women. Median baseline ACR was 180.3 mg/g in the intervention and 157.4 mg/g in the control group, respectively. Urinary sodium excretion was reduced by 15.5% and 0.0% in the intervention and control groups, respectively. Results for the primary and key secondary outcomes are presented in the Table.
Conclusions:
The dietician-led dietary sodium reduction intervention succeeded in significantly reducing dietary sodium and BP in patients with CKD and albuminuria. However, no significant differences were observed in ACR, albuminuria, or eGFR between treatment groups.
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Affiliation(s)
| | | | | | - Hua He
- Tulane Univ, New Orleans, LA
| | | | | | | | | | | | | |
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43
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Heianza Y, Wang X, Ma H, Appel LJ, Sacks FM, Qi L. Abstract MP61: Starch Digestion-Related Amylase Genetic Variants, Dietary Carbohydrates, and Changes in Glucose Tolerance: Results From the OmniCarb Trial. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.mp61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Salivary amylase, encoded by the
AMY1
gene, plays a pivotal role in carbohydrate digestion, and genetic adaptation of carbohydrate digestion has been implicated in impaired glucose tolerance, type 2 diabetes, and cardiometabolic diseases.
Hypothesis:
We investigated whether
AMY1
genetic variations are associated with β-cell function and glycemic responses during 2-h oral glucose tolerance tests (OGTTs) and tested whether
AMY1
variations were related to changes in glucose tolerance in a randomized controlled trial testing effects of diets varying in glycemic index (GI) levels and carbohydrate (Carb) amount.
Methods:
The study included participants (n=146) from the OmniCarb trial, a randomized crossover-controlled feeding trial, in which overweight or obese adults were given 4 diets that differed in composition by GI and Carb amount. Each diet was consumed for 5 weeks, followed by a 2-week washout. Genetic risk score (GRS) was calculated using eight
AMY1
SNPs, with higher GRS indicating higher activity of salivary amylase. The primary outcomes were glycemic and insulin responses during OGTTs.
Results:
At baseline, lower GRS was related to a larger area under the curve of glucose (AUC-glucose) and β-cell dysfunction assessed by the insulinogenic index and disposition index (
p
<0.05 for all). After consuming either a high-Carb and low-GI diet or a low-Carb and high-GI diet for 5 weeks, participants with low GRS (tertile 1) showed impaired glycemic responses at 30, 60, and 90 min after OGTTs, as compared to those with high GRS (tertile 3); there was no significant difference according to GRS after eating a low-Carb/low-GI diet. After consuming a high-Carb and high-GI diet for 5 weeks, the participants with low GRS showed a mean 21 (SE 10) mg/dl higher glucose concentrations at 60 min after OGTT, as compared to those with high GRS (
p
=0.038). The effect of increasing GI at low Carb amount for glucose levels at 60 min (
P
interaction
= 0.024) and AUC-glucose (
P
interaction
=0.016) significantly interacted with the GRS. Also, we found a significant interaction between GRS and the effect of increasing Carb amount at high GI for 60-min post-load glucose levels (
P
interaction
= 0.016).
Conclusions:
The
AMY1
genetic variations were associated with β-cell function and impaired glucose tolerance. Effects of changing the amount or quality of carbohydrates on glucose tolerance may be partly determined by individual genetic adaptation of carbohydrate digestion.
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Affiliation(s)
- Yoriko Heianza
- Sch of Public Health and Tropical Medicine, Tulane Univ, New Orleans, LA
| | - Xuan Wang
- Sch of Public Health and Tropical Medicine, Tulane Univ, New Orleans, LA
| | - Hao Ma
- Tulane university, New Orleans, LA
| | | | | | - Lu Qi
- TULANE UNIVERSITY, New Orleans, LA
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44
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Juraschek SP, Appel LJ, Lipsitz LA, Miller ER. Reply to: Comment on: Comparison of supine and seated orthostatic hypotension assessments and their association with falls and orthostatic symptoms. J Am Geriatr Soc 2023; 71:674-676. [PMID: 36356235 PMCID: PMC10189164 DOI: 10.1111/jgs.18113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022]
Abstract
This letter comments on the letter by Baker et al.
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Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, Massachusetts
| | | | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, Massachusetts
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for
Aging Research and Harvard Medical School, Boston, MA
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45
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Luo S, Surapaneni A, Rebholz CM, Appel LJ, Coresh J, Grams ME. Circulating Branched-Chain Amino Acids, Incident Cardiovascular Disease, and Mortality in the African American Study of Kidney Disease and Hypertension. Circ Genom Precis Med 2023; 16:e003729. [PMID: 36716198 PMCID: PMC9974782 DOI: 10.1161/circgen.122.003729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Shengyuan Luo
- Department of Internal Medicine, Rush University, Chicago, IL
| | - Aditya Surapaneni
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Precision Medicine, Department of Medicine, New York University, New York, NY
| | - Casey M. Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Neprhology, Department of Medicine, Johns Hopkins University
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E. Grams
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Precision Medicine, Department of Medicine, New York University, New York, NY
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46
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Wanigatunga AA, Chiu V, Cai Y, Urbanek JK, Mitchell CM, Miller ER, Christenson RH, Rebuck H, Michos ED, Juraschek SP, Walston J, Xue QL, Bandeen-Roche K, Appel LJ, Schrack JA. Patterns of Daily Physical Movement, Chronic Inflammation, and Frailty Incidence. Med Sci Sports Exerc 2023; 55:281-288. [PMID: 36170549 PMCID: PMC9840658 DOI: 10.1249/mss.0000000000003048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Low physical activity is a criterion of phenotypic frailty defined as an increased state of vulnerability to adverse health outcomes. Whether disengagement from daily all-purpose physical activity is prospectively associated with frailty and possibly modified by chronic inflammation-a pathway often underlying frailty-remains unexplored. METHODS Using the Study to Understand Fall Reduction and Vitamin D in You data from 477 robust/prefrail adults (mean age = 76 ± 5 yr; 42% women), we examined whether accelerometer patterns (activity counts per day, active minutes per day, and activity fragmentation [broken accumulation]) were associated with incident frailty using Cox proportional hazard regression. Baseline interactions between each accelerometer metric and markers of inflammation that include interleukin-6, C-reactive protein, and tumor necrosis factor-alpha receptor 1 were also examined. RESULTS Over an average of 1.3 yr, 42 participants (9%) developed frailty. In Cox regression models adjusted for demographics, medical conditions, and device wear days, every 30 min·d -1 higher baseline active time, 100,000 more activity counts per day, and 1% lower activity fragmentation was associated with a 16% ( P = 0.003), 13% ( P = 0.001), and 8% ( P < 0.001) lower risk of frailty, respectively. No interactions between accelerometer metrics and baseline interleukin-6, C-reactive protein, or tumor necrosis factor-alpha receptor 1 were detected (interaction P > 0.06 for all). CONCLUSIONS Among older adults who are either robust or prefrail, constricted patterns of daily physical activity (i.e., lower total activity minutes and counts, and higher activity fragmentation) were prospectively associated with higher risk of frailty but not modified by frailty-related chronic inflammation. Additional studies, particularly trials, are needed to understand if this association is causal.
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Affiliation(s)
- Amal A. Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Venus Chiu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yurun Cai
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | | | - Christine M. Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Edgar R. Miller
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Heather Rebuck
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Erin D. Michos
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, MA
| | - Jeremy Walston
- Division of Geriatric Medicine, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of Geriatric Medicine, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of Geriatric Medicine, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
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47
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Jeong SY, Wee CC, Kovell LC, Plante TB, Miller ER, Appel LJ, Mukamal KJ, Juraschek SP. Effects of Diet on 10-Year Atherosclerotic Cardiovascular Disease Risk (from the DASH Trial). Am J Cardiol 2023; 187:10-17. [PMID: 36459731 PMCID: PMC10122756 DOI: 10.1016/j.amjcard.2022.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 12/02/2022]
Abstract
Although modern risk estimators, such as the American College of Cardiology/American Heart Association Pooled Cohort Equation, play a central role in the decisions of patients to start pharmacologic therapy to prevent atherosclerotic cardiovascular disease (ASCVD), there is limited evidence to inform expectations for 10-year ASCVD risk reduction from established lifestyle interventions. Using data from the original DASH (Dietary Approaches to Stop Hypertension) trial, we determined the effects of adopting the DASH diet on 10-year ASCVD risk compared with adopting a control or a fruits and vegetables (F/V) diet. The DASH trial included 459 adults aged 22 to 75 years without CVD and not taking antihypertensive or diabetes mellitus medications, who were randomized to controlled feeding of a control diet, an F/V diet, or the DASH diet for 8 weeks. We determined 10-year ASCVD risk with the American College of Cardiology/American Heart Association Pooled Cohort Equation based on blood pressure and lipids measured before and after the 8-week intervention. Compared with the control diet, the DASH and F/V diets changed 10-year ASCVD risk by -10.3% (95% confidence interval [CI] -14.4 to -5.9) and -9.9% (95% CI -14.0 to -5.5) respectively; these effects were more pronounced in women and Black adults. There was no difference between the DASH and F/V diets (-0.4%, 95% CI -6.9 to 6.5). ASCVD reductions attributable to the difference in systolic blood pressure alone were -14.6% (-17.3 to -11.7) with the DASH diet and -7.9% (-10.9 to -4.8) with the F/V diet, a net relative advantage of 7.2% greater relative reduction from DASH compared with F/V. This was offset by the effects on high-density lipoprotein of the DASH diet, which increased 10-year ASCVD by 8.8% (5.5 to 12.3) compared with the more neutral effect of the F/V diet of -1.9% (-5.0 to 1.2). In conclusion, compared with a typical American diet, the DASH and F/V diets reduced 10-year ASCVD risk scores by about 10% over 8 weeks. These findings are informative for counseling patients on both choices of diet and expectations for 10-year ASCVD risk reduction.
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Affiliation(s)
- Sun Young Jeong
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christina C Wee
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Kenneth J Mukamal
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen P Juraschek
- Department of Medicine, American College of Physicians, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Belanger MJ, Kovell LC, Turkson‐Ocran R, Mukamal KJ, Liu X, Appel LJ, Miller ER, Sacks FM, Christenson RH, Rebuck H, Chang AR, Juraschek SP. Effects of the Dietary Approaches to Stop Hypertension Diet on Change in Cardiac Biomarkers Over Time: Results From the DASH-Sodium Trial. J Am Heart Assoc 2023; 12:e026684. [PMID: 36628985 PMCID: PMC9939071 DOI: 10.1161/jaha.122.026684] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce biomarkers of cardiovascular disease. We aimed to characterize the time course of change in biomarkers of cardiac injury (high-sensitivity cardiac troponin I), cardiac strain (NT-proBNP [N-terminal pro-B-type natriuretic peptide]), and inflammation (hs-CRP [high-sensitivity C-reactive protein]) while consuming the DASH diet. Methods and Results The DASH-Sodium trial was a randomized controlled trial of 412 adults with elevated blood pressure or hypertension. Participants were randomly assigned to 12 weeks of the DASH diet or a typical American diet. Energy intake was adjusted to maintain body weight. Measurements of high-sensitivity cardiac troponin I, NT-proBNP, and hs-CRP were performed in stored serum specimens, collected at baseline and ≈4, 8, and 12 weeks after randomization. In both the control diet and DASH diet, levels of NT-proBNP decreased; however, there was no difference between diets (P-trend compared with control=0.22). On the DASH diet versus control, levels of high-sensitivity cardiac troponin I decreased progressively during follow-up (P-trend compared with control=0.025), but a statistically significant between-diet difference in change from baseline levels was not observed until week 12 (% difference, 17.78% [95% CI, -29.51% to -4.09%]). A similar pattern was evident for hs-CRP (P-trend compared with control=0.01; % difference at week 12, 19.97% [95% CI, -31.94% to -5.89%]). Conclusions In comparison with a typical American diet, the DASH diet reduced high-sensitivity cardiac troponin I and hs-CRP progressively over 12 weeks. These results suggest that the DASH diet has cumulative benefits over time on biomarkers of subclinical cardiac injury and inflammation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000608.
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Affiliation(s)
- Matthew J. Belanger
- Division of Cardiology, Department of MedicineJohns Hopkins Medical InstitutionsBaltimoreMD
| | - Lara C. Kovell
- Division of CardiologyUniversity of Massachusetts Chan Medical SchoolWorcesterMA
| | | | | | - Xiaoran Liu
- Harvard T.H. Chan School of Public Health, Harvard Medical SchoolBrigham and Women’s HospitalBostonMA
| | - Lawrence J. Appel
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMD
| | - Edgar R. Miller
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMD
| | - Frank M. Sacks
- Harvard T.H. Chan School of Public Health, Harvard Medical SchoolBrigham and Women’s HospitalBostonMA
| | | | - Heather Rebuck
- Department of PathologyUniversity of Maryland School of MedicineBaltimoreMD
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49
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Zhang M, Brady TM, Buckley JP, Appel LJ, Hong X, Wang G, Liang L, Wang X, Mueller NT. Metabolome-Wide Association Study of Cord Blood Metabolites With Blood Pressure in Childhood and Adolescence. Hypertension 2022; 79:2806-2820. [PMID: 36111548 PMCID: PMC9649875 DOI: 10.1161/hypertensionaha.122.20139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/28/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND No studies have examined whether the cord blood metabolome-a reflection of in utero metabolism-influences blood pressure (BP) in children. OBJECTIVES To examine prospective associations of cord blood metabolites with systolic BP (SBP), diastolic BP (DBP), and risk of elevated BP in childhood and adolescence. METHODS In the Boston Birth Cohort, we measured metabolites in cord blood plasma, and SBP and DBP at clinic visits between 3 and 18 years. We examined associations of cord metabolites with SBP and DBP percentiles using linear mixed models and with elevated BP using mixed-effects Poisson regression. RESULTS Our study included 902 mother-child dyads (60% Black, 23% Hispanic, 45% female). Children were followed for a median of 9.2 (interquartile range, 6.7-11.7) years, and the median number of BP observations per child was 7 (interquartile range, 4-11). After false discovery rate correction, 3 metabolites were associated with SBP, 96 with DBP, and 24 with elevated BP; 2 metabolites (1-methylnicotinamide, dimethylguanidino valeric acid) were associated with all 3 outcomes, and 21 metabolites were associated with both DBP and elevated BP. After multivariable adjustment, 48 metabolites remained significantly associated with DBP. Metabolites that showed the strongest associations with SBP, DBP, and elevated BP included nucleotides (eg, xanthosine, hypoxanthine, xanthine) and acylcarnitines (eg, C6 and C7 carnitines), which represent fatty acid oxidation and purine metabolism pathways. CONCLUSIONS In our urban and predominantly racial/ethnic minority cohort, we provide evidence that metabolomic alterations in utero, in particular, acylcarnitine- and purine-metabolism metabolites, may be involved in the early life origins of hypertension.
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Affiliation(s)
- Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Tammy M Brady
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jessie P Buckley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Johns Hopkins University, Baltimore, MD
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Johns Hopkins University, Baltimore, MD
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Xiaobin Wang
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Center on the Early Life Origins of Disease, Johns Hopkins University, Baltimore, MD
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
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50
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Dorans KS, Bazzano LA, Qi L, He H, Chen J, Appel LJ, Chen CS, Hsieh MH, Hu FB, Mills KT, Nguyen BT, O’Brien MJ, Samet JM, Uwaifo GI, He J. Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2238645. [PMID: 36287562 PMCID: PMC9606840 DOI: 10.1001/jamanetworkopen.2022.38645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Low-carbohydrate diets decrease hemoglobin A1c (HbA1c) among patients with type 2 diabetes at least as much as low-fat diets. However, evidence on the effects of low-carbohydrate diets on HbA1c among individuals with HbA1c in the range of prediabetes to diabetes not treated by diabetes medications is limited. OBJECTIVE To study the effect of a behavioral intervention promoting a low-carbohydrate diet compared with usual diet on 6-month changes in HbA1c among individuals with elevated untreated HbA1c. DESIGN, SETTING, AND PARTICIPANTS This 6-month randomized clinical trial with 2 parallel groups was conducted from September 2018 to June 2021 at an academic medical center in New Orleans, Louisiana. Laboratory analysts were blinded to assignment. Participants were aged 40 to 70 years with untreated HbA1c of 6.0% to 6.9% (42-52 mmol/mol). Data analysis was performed from November 2021 to September 2022. INTERVENTIONS Participants were randomized to a low-carbohydrate diet intervention (target <40 net grams of carbohydrates during the first 3 months; <60 net grams for months 3 to 6) or usual diet. The low-carbohydrate diet group received dietary counseling. MAIN OUTCOMES AND MEASURES Six-month change in HbA1c was the primary outcome. Outcomes were measured at 0, 3, and 6 months. RESULTS Of 2722 prescreened participants, 962 underwent screening, and 150 were enrolled (mean [SD] age, 58.9 [7.9] years; 108 women [72%]; 88 Black participants [59%]) and randomized to either the low-carbohydrate diet intervention (75 participants) or usual diet (75 participants) group. Six-month data were collected on 142 participants (95%). Mean (SD) HbA1c was 6.16% (0.30%) at baseline. Compared with the usual diet group, the low-carbohydrate diet intervention group had significantly greater 6-month reductions in HbA1c (net difference, -0.23%; 95% CI, -0.32% to -0.14%; P < .001), fasting plasma glucose (-10.3 mg/dL; 95% CI, -15.6 to -4.9 mg/dL; P < .001), and body weight (-5.9 kg; 95% CI, -7.4 to -4.4 kg; P < .001). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, a low-carbohydrate dietary intervention led to improvements in glycemia in individuals with elevated HbA1c not taking glucose-lowering medication, but the study was unable to evaluate its effects independently of weight loss. This diet, if sustained, might be a useful dietary approach for preventing and treating type 2 diabetes, but more research is needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03675360.
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Affiliation(s)
- Kirsten S. Dorans
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Lu Qi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Ming-Hui Hsieh
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine T. Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Bernadette T. Nguyen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Matthew J. O’Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan M. Samet
- Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Colorado School of Public Health, Aurora
| | - Gabriel I. Uwaifo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Endocrinology, Diabetes, Metabolism, and Weight Management, Ochsner Medical Center, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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