Cross sectional analysis of the effect of alcohol on pulmonary function in a cohort of men and women living with HIV

People living with HIV (PLWH) are at increased risk for noncommunicable diseases such as lung disease in part due to opportunistic infections including pneumonia. HIV infection is associated with increased prevalence of impaired lung function and abnormal gas exchange. Alcohol use disorder (AUD) is exceedingly common in PLWH and is associated with higher risk of pneumonia in PLWH. Alcohol use may lead to lung damage through several mechanisms. Data on the long-term effect of AUD on pulmonary function in PLWH are sparse and conflicting. To evaluate this relationship, we conducted a cross-sectional analysis of adult PLWH in care in Louisiana. We hypothesized that chronic alcohol use would be associated with subsequent pulmonary dysfunction in a dose-dependent fashion. All participants performed standardized spirometry on study entry. In total, 350 participants with acceptable spirometry were included in this analysis. Thirty-one percent of participants were female. Women reported less lifetime alcohol use and less smoking; however, they reported more chronic respiratory symptoms. In adjusted models, total lifetime alcohol use was not associated with spirometry measures of pulmonary function. HIV-related variables (CD4 count and viral load) were also not associated with measures of pulmonary function. We then conducted sex-stratified analyses to eliminate residual confounding of sex and similarly found no association of total lifetime alcohol use and pulmonary function. We found no association of AUDIT score or early life alcohol use and pulmonary function. In latent class factor analysis, current heavy alcohol use was associated with lower measures of pulmonary function as compared to former heavy alcohol use. In summary, in this cohort of New Orleanian men and women living with HIV with robust measures of alcohol use, though total lifetime alcohol use and early life alcohol use were not associated with pulmonary function, current heavy alcohol use was associated with impaired pulmonary function.

Alcohol use and dysglycemia among people living with human immunodeficiency virus (HIV) in the Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions (ALIVE-Ex) study

BACKGROUND

At-risk alcohol use is a common and costly form of substance misuse that is highly prevalent among people living with HIV (PLWH). The goal of the current analysis was to test the hypothesis that PLWH with at-risk alcohol use are more likely to meet the clinical criteria for prediabetes/diabetes than PLWH with low-risk alcohol use.

METHODS

A cross-sectional analysis was performed on measures of alcohol and glycemic control in adult PLWH (n = 105) enrolled in a prospective, interventional study (the ALIVE-Ex Study (NCT03299205)) that investigated the effects of aerobic exercise on metabolic dysregulation in PLWH with at-risk alcohol use. The Alcohol Use Disorders Identification Test (AUDIT), Timeline Followback, and phosphatidylethanol (PEth) level were used to measure alcohol use. Participants were stratified into low-risk (AUDIT score < 5) and at-risk alcohol use (AUDIT  score ≥ 5). All participants underwent an oral glucose tolerance test and measures of glycemic control- the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Matsuda Index - were correlated with alcohol measures and compared by AUDIT score group using mixed-effects linear and logistic regression models, adjusting for age, sex, race, body mass index (BMI), and viral load.

RESULTS

In response to the glucose challenge, participants with at-risk alcohol use (n = 46) had higher glucose levels and were five times more likely to meet criteria for prediabetes/diabetes (OR: 5.3 (1.8, 15.9)) than participants with an AUDIT score < 5. Two-hour glucose values were positively associated with AUDIT score and PEth level and a higher percentage of PLWH with at-risk alcohol use had glucose values ≥140 mg/dl than those with low-risk alcohol use (34.8% vs. 10.2%, respectively).

CONCLUSION

In this cohort of PLWH, at-risk alcohol use increased the likelihood of meeting the clinical criteria for prediabetes/diabetes (2-h glucose level ≥140 mg/dl). Established determinants of metabolic dysfunction (e.g., BMI, waist-hip ratio) were not associated with greater alcohol use and dysglycemia, suggesting that other mechanisms may contribute to the impaired glycemic control observed in this cohort.

Prevalence of Insulin Resistance in Adults Living with HIV: Implications of Alcohol Use

Unhealthy alcohol use is prevalent among persons living with HIV (PLWH). Aging and increased survival of PLWH on antiretroviral therapy (ART) are complicated by metabolic dysregulation and increased risk of insulin resistance (IR) and diabetes mellitus. The objective of this study was to determine the prevalence and association of IR with unhealthy alcohol use in adult in-care PLWH. A cross-sectional analysis of metabolic parameters and alcohol use characteristics was conducted in adult PLWH enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. IR was estimated using homeostatic model assessment (HOMA-IR), triglyceride index, and McAuley index and beta cell function (HOMA-β). Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT)-C, 30-day timeline followback (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) measures. A total of 351 participants, with a mean age [±standard deviation (SD)] of 48.1 ± 10.4 years, were included (69.6% male). Of these, 57% had an AUDIT-C score of 4 or greater, indicating unhealthy alcohol use. Mean body mass index (BMI) was 27.2 ± 7.0 kg/m², 36.4% met criteria for metabolic syndrome, and 14% were diagnosed with diabetes. After adjusting for education, race, BMI, smoking status, viral load, CD4 count, use of protease inhibitors, statins, or metformin; physical activity and diabetes diagnosis, HOMA-IR, and McAuley index were negatively associated with AUDIT-C, and HOMA-β cell function was negatively associated with AUDIT-C, PEth, and TLFB. Cross-sectional analysis of NOAH participants indicates that alcohol use is associated with decreased HOMA-β cell function, suggesting dysregulation of endocrine pancreatic function.

Alcohol Use Is Associated With Intestinal Dysbiosis and Dysfunctional CD8+ T-Cell Phenotypes in Persons With Human Immunodeficiency Virus

BACKGROUND

Inflammation persists among persons with human immunodeficiency virus (PWH) despite effective antiretroviral therapy and may contribute to T-cell dysfunction. Alcohol use is prevalent among PWH and promotes intestinal leak, dysbiosis, and a proinflammatory milieu. Whether alcohol use is associated with T-cell late differentiation remains to be investigated.

METHODS

Data and samples from PWH (N = 359 of 365) enrolled in the New Orleans Alcohol Use in HIV Study were used. Alcohol use was assessed by self-report (Alcohol Use Disorders Identification Test; lifetime alcohol exposure; 30-day Alcohol Timeline Followback) and phosphatidylethanol (PEth) quantitation. In a subset of participants, fecal bacterial content was assessed by ribosomal 16S marker gene deep sequencing and quantitative polymerase chain reaction. Intestinal leak was assessed by fecal-to-plasma α-1-antitrypsin (A1AT) enzyme-linked immunosorbent assay ratio. Peripheral T-cell populations were quantified by flow cytometry.

RESULTS

Alcohol Use Disorder Identification Test scores were positively associated with activated-senescent, exhausted, and terminal effector memory CD45RA+CD8+ but not CD4+ T cells (cells/μL) after confounder adjustment (P < .050). Phosphatidylethanol was positively associated with A1AT (P < .050). The PEth and activated-senescent CD8+ were associated with bacterial β-diversity (P < .050) and positively associated with the relative abundance of coabundant Prevotellaceae members (q < .100).

CONCLUSIONS

Alcohol use among PWH is associated with CD8+ T-cell late differentiation, intestinal leak, and dysbiosis. Alcohol-associated dysbiosis is implicated in CD8+ T-cell senescence.

The Women and Their Children's Health (WaTCH) study: methods and design of a prospective cohort study in Louisiana to examine the health effects from the BP oil spill

PURPOSE

The Deepwater Horizon Oil Spill is the largest marine oil spill in US history. Few studies have evaluated the potential health effects of this spill on the Gulf Coast community. The Women and Their Children's Health (WaTCH) study is a prospective cohort designed to investigate the midterm to long-term physical, mental and behavioural health effects of exposure to the oil spill.

PARTICIPANTS

Women were recruited by telephone from pre-existing lists of individuals and households using an address-based sampling frame between 2012 and 2014. Baseline interviews obtained information on oil spill exposure, demographics, physical and mental health, and health behaviours. Women were also asked to provide a household roster, from which a child between 10 and 17 years was randomly selected and recruited into a child substudy. Telephone respondents were invited to participate in a home visit in which blood samples, anthropometrics and neighbourhood characteristics were measured. A follow-up interview was completed between 2014 and 2016.

FINDINGS TO DATE

2852 women completed the baseline interview, 1231 of whom participated in the home visit, and 628 children participated in the child's health substudy. The follow-up interview successfully reinterviewed 2030 women and 454 children.

FUTURE PLANS

WaTCH continues to conduct follow-up surveys, with a third wave of interviews planned in 2017. Also, we are looking to enhance the collection of spatially related environmental data to facilitate assessment of health risks in the study population. In addition, opportunities to participate in behavioural interventions for subsets of the cohort have been initiated. There are ongoing studies that examine the relationship between genetic and immunological markers with mental health.

Abstract A93: Treatment and survival after head and neck cancer diagnosis by race in Louisiana's public hospital system

Incidence and survival rates of head and neck cancer (HNC) vary by demographic characteristics, with significant disparities for men and African Americans. Depending on tumor site and stage, treatments options vary, albeit most often are a combination of surgery, radiotherapy and chemotherapy. The objectives of this study are to examine the effect of race on HNC treatment and survival in Louisiana public hospitals from 2000 to 2010. Cases of HNC were identified using Louisiana Health Care Services Division ICON database, which is composed of diagnostic and billing data for all patients undergoing primary treatment in the facilities. This data was subsequently linked to the Louisiana Tumor Registry (LTR) database. Survival rates by, race, sub-site and stage were calculated. Data were analyzed using SAS Version 9.3. Chi-square statistics were used to calculate difference in proportions while log adjusted mixed models were implemented to evaluate the impact of time to first course treatment between groups. Finally, Cox regression models were performed to estimate hazard ratios. A total of 1,168 HNC cases were diagnosed with from 2000 to 2010. Blacks initiated first course treatment after diagnosis 5.7 days (p=0.002) later than whites, adjusted for site, age and stage. While there was no age difference at the time of diagnosis, blacks were significantly more likely to be diagnosed with a late stage HNC compared to whites (p=0.003). In addition it does not appear that treatment type varied by race. Survival functions by stage and tumor site consistently demonstrated poorer survival among blacks compared to whites. The current study suggests that survival differences between blacks and whites in Louisiana are more likely to be influenced by time to treatment and stage rather than any specific treatment differences.

Citation Format: Edward S. Peters, Meghan M. Brashear, Tekeda F. Ferguson. Treatment and survival after head and neck cancer diagnosis by race in Louisiana's public hospital system. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A93.

Five-Year Medical and Pharmacy Costs after a Medically Supervised Intensive Treatment Program for Obesity

Purpose.

The financial impact of intensive medical interventions for weight loss has not been fully studied.

Design.

A randomized pragmatic clinical trial.

Setting.

Seven primary care clinics and one research center in Louisiana.

Subjects.

Severely obese individuals (body mass index 40–60 kg/m2) randomized to usual care (n = 190) or intensive medical management (n = 200). Forty-seven percent of participants completed year 2 follow-up and were included in the analyses.

Intervention.

Physician-monitored intervention with recommendations for 12 weeks of liquid diet followed by 4 months of group behavioral therapy, structured diet, and option of pharmacotherapy, and an additional 16 months of maintenance strategies. Measures. Two-year preintervention and 5-year postintervention measures were computed from claims data and included (1) medical costs excluding pharmacy, (2) pharmacy costs only, (3) total medical and pharmacy costs, and (4) medical and pharmacy subcategory costs.

Analysis.

Differential categories for preintervention and postintervention were created using total sample 75th percentiles. Chi-square tests were employed to compare the intervention groups both preintervention and postintervention with respect to the proportion of subjects above the 75th percentile for each of the cost categories.

Results.

Medical costs excluding pharmacy did not differ between groups. The intensive medical intervention group had a significantly smaller percentage of subjects above the 75th percentile for pharmacy costs only (p = .0125), and for antidiabetic agents (p = .0464), antihypertensives (p = .0075), and dyslipidemic subcategories (p = .0197).

Conclusion.

An intensive medical intervention may reduce pharmaceutical expenditures in severely obese individuals. These results must be viewed with caution given the high attrition of study participants.

Neighborhood environments and obesity among Afro-Caribbean, African American, and Non-Hispanic white adults in the United States: results from the National Survey of American Life

OBJECTIVE

To examine possible associations between perceived neighborhood environments and obesity among a U.S. nationally representative sample of Afro-Caribbean, African American, and Non-Hispanic white adults.

METHODS

Data was used from the 2001-2003 National Survey of American Life (NSAL). All measures including neighborhood characteristics, height, and weight were self-reported. Multivariate logistic regression was used to compute odds ratios (ORs) of obesity (body mass index (BMI) ≥ 30 kg/m(2)) based on perceived neighborhood physical and social characteristics.

RESULTS

The odds of obesity were significantly lower for adults who reported involvement in clubs, associations, or help groups (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.44, 0.85) and perceived that they had a park, playground, or open space in their neighborhood (odds ratio (OR): 0.68; 95% confidence interval (CI): 0.47, 0.98). These associations remained significant after adjusting for leisure-time physical activity. Race/ethnicity appeared to modify the association between involvement in clubs, associations, or help groups and obesity.

CONCLUSIONS

Providing parks, playgrounds, or open space or increasing the perception of those amenities may assist in the prevention of obesity, especially in ethnically diverse neighborhoods in the United States. More research is needed to investigate how perceptions of the neighborhood environment influence obesity and whether perceptions of the neighborhood environment differ between individuals within the same neighborhoods.

Exercise training and quality of life in individuals with type 2 diabetes: a randomized controlled trial

OBJECTIVE

To establish whether exercise improves quality of life (QOL) in individuals with type 2 diabetes and which exercise modalities are involved.

RESEARCH DESIGN AND METHODS

Health Benefits of Aerobic and Resistance Training in individuals with type 2 Diabetes (HART-D; n = 262) was a 9-month exercise study comparing the effects of aerobic training, resistance training, or a combination of resistance and aerobic training versus a nonexercise control group on hemoglobin A1c (HbA1c) in sedentary individuals with type 2 diabetes. This study is an ancillary analysis that examined changes in QOL after exercise training using the Short Form-36 Health Survey questionnaire compared across treatment groups and with U.S. national norms.

RESULTS

The ancillary sample (n = 173) had high baseline QOL compared with U.S. national norms. The QOL physical component subscale (PCS) and the general health (GH) subscale were improved by all three exercise training conditions compared with the control group condition (resistance: PCS, P = 0.005; GH, P = 0.003; aerobic: PCS, P = 0.001; GH, P = 0.024; combined: PCS, P = 0.015; GH, P = 0.024). The resistance training group had the most beneficial changes in bodily pain (P = 0.026), whereas physical functioning was most improved in the aerobic and combined condition groups (P = 0.025 and P = 0.03, respectively). The changes in the mental component score did not differ between the control group and any of the exercise groups (all P > 0.05). The combined training condition group had greater gains than the aerobic training condition group in the mental component score (P = 0.004), vitality (P = 0.031), and mental health (P = 0.008) and greater gains in vitality compared with the control group (P = 0.021).

CONCLUSIONS

Exercise improves QOL in individuals with type 2 diabetes. Combined aerobic/resistance exercise produces greater benefit in some QOL domains.

Abstract 353: Variations in Implantable Cardioverter Defibrillator (ICD) Utilization in the Louisiana Health System

The emergence of implantable cardiac device technology has rapidly changed the way in which patients with chronic ventricular dysfunction are evaluated and medically treated. Effectiveness of cardioverter defibrillator (ICD) devices across patient subgroups such as age needs more evaluation. Several clinical variables have been associated with lack of survival benefit despite the overall 5-7% mortality rate over a period of 2- 4 years.

The overall objective of this Quality Improvement Initiative is to investigate the prevalence and variation in ICD utilization by hospital characteristics, income, or cardiovascular risk factor prevalence, as well as the related survival outcome among heart failure patients in the Louisiana State University health system.

All patients diagnosed with chronic heart failure between 1999 through June 30, 2012 within Louisiana State University Health Care Services Division (LSUHCSD) were selected from the Disease Management Evaluation Database (DMED). Seven hospitals in Louisiana contribute to the patient population. Prevalence was calculated for heart failure and ICD utilization; chi square test were used to explore the variation of ICD utilization by hospital characteristics and multiple cardiovascular risk factors.

There have been approximately 39,830 patients diagnosed with heart failure in the LSUHCSD hospitals over the last 13 years. Among heart failure patients identified, 3.6% have an ICD. There is slightly higher proportion of females than males with heart failure in the population; however, ICDs are higher among men (p-value <0.001). African-Americans have a higher rate of heart failure in the population and receipt of ICD than Whites (p-value = 0.005). Approximately 67% of the population has 2 or more listed comorbidities, with 12% having 5 or more comorbidities. The incidence of heart failure patients in LSU HCSD has decreased; however, the rate of ICD has increased over the last decade. The facility with the most heart failure and ICD patients identified is the largest facility, the Public Hospital in New Orleans, LA. However, the rate of ICD among heart failure patients is highest at the Medical Center, in Bogalusa, LA (17.3% compared to 12.4%). This facility has the highest proportion of Medicare patients.

Underutilization of ICDs can be identified in the LSUHCSD system. Variability for medical care including interventions can have multiple causes including market factors that reflect hospital attributes such as the type of cardiac services provided, managed care penetration, socioeconomic status and disease burden including risk factors such as those for cardiovascular disease (like obesity and tobacco use). This area holds much potential for gaining an understanding about allocation of resources in Louisiana in heart failure care and as a consequence to policy development for standardized patient treatment and improved care.

Predisease conditions and serum vitamin D levels in healthy Mexican American adults

AIMS

To elucidate the relationship between low circulating serum vitamin D levels and predisease conditions (ie, prediabetes and prehypertension) in healthy Mexican American adults.

METHODS

Analyses were conducted using data from the United States National Health and Nutrition Examination Survey (NHANES) from 2001 through 2006. Free-living (ie, community-dwelling, nonimprisoned) adult Mexican American subjects (N = 788; men, n = 443; women, n = 345) who had provided written informed consent and had no history of diabetes, hypertension, dyslipidemia, metabolic syndrome, and/or cardiovascular disease were included in this report. Participants were not ingesting any prescription medications, nor did they exhibit any evidence of malabsorption. Participants were determined to be disease free.

RESULTS

The mean serum vitamin D level for Mexican American adults (N = 788) of 50.5 nmol/L was significantly higher (P < 0.0001) than the mean of 35.9 nmol/L for non-Hispanic black adults (n = 621), and significantly lower (P < 0.0001) than the mean of 65.0 nmol/L for non-Hispanic white adults (n = 1711). Although age, sex, and body mass index were all significantly associated with prehypertension and prediabetes, no such association was found for serum vitamin D levels.

CONCLUSION

A successive, incremental shift of approximately 15 nmol/L in vitamin D distribution was seen in the transition from the dark-skinned non-Hispanic black population to the brown-skinned Mexican American population, and from the brown-skinned Mexican American population to the non-Hispanic white population. In contrast to the non-Hispanic black and non-Hispanic white populations, wherein previous studies found that serum vitamin D levels below the 75th percentile were associated with prediabetes and prehypertension, no such association was detected among the Mexican American population. The reason for this lack of association among the Mexican American population is unclear.

Low vitamin D levels, prediabetes and prehypertension in healthy African American adults

AIMS

To determine if customary lower serum vitamin D concentrations in healthy African American (AA) adults are associated with modest elevations in fasting plasma glucose (FPG) and/or resting blood pressure (BP). Numerous health disparities between African American (AA) and Caucasian American (CA) adults, especially those which increase cardiovascular morbidity and mortality, have been attributed to lower serum vitamin D concentrations in the AA. Prediabetes (PreDM) and prehypertension (PreHTN) are significantly more prevalent in healthy disease free CA adults with serum vitamin D concentrations below the 75th percentile for the Caucasian cohort. We hypothesized that despite overall lower serum vitamin D concentrations in AA, an increase in the prevalence for PreDM and PreHTN would be seen in those with low vitamin D levels.

METHODS AND RESULTS

Disease free AA adults in the National Health and Nutrition Examination Survey 2001-2006 were assessed. PreDM and PreHTN were diagnosed using the ADA and JNC 7 criteria: (FPG) 100-125 mg/dL and resting systolic (SBP) 120-139 and/or diastolic (DBP) 80-89 mm Hg, respectively. Logistic regression was employed to assess effects of low vitamin D concentrations on the odds for PreDM and PreHTN (n = 621). Age, gender and BMI adjusted odds ratio for co-morbid PreDM and PreHTN in AA men (n = 343) and women (n = 278) with vitamin D levels ≤45.4 versus >45.4 nmol/L was 2.02 (1.11, 3.68), (p < 0.021).

CONCLUSIONS

Evaluating serum vitamin D levels, with consideration for supplementation in seemingly healthy AA adults with prediabetes, prehypertension, or co-existing prediabetes and prehypertension, has merit.

Predicting doubly labeled water energy expenditure from ambulatory activity

The purpose of this study was to evaluate the potential for using accelerometer-determined ambulatory activity indicators (steps per day and cadence) to predict total energy expenditure (TEE) and physical activity energy expenditure (PAEE) derived from doubly labeled water (DLW). Twenty men and 34 women (20-36 years of age) provided complete anthropometric, accelerometer, resting metabolic rate (RMR), and DLW data. TEE and PAEE were determined for the same week that accelerometers were worn during waking hours. Accelerometer data included mean steps per day, peak 30-min cadence (average steps per minute for the highest 30 min of the day), and time spent in each incremental cadence band: 0 (nonmovement), 1-19 (incidental movement), 20-39 (sporadic movement), 40-59 (purposeful steps), 60-79 (slow walking), 80-99 (medium walking), 100-119 (brisk walking), and 120+ steps·min(-1) (indicative of all faster ambulatory activities). Regression analyses were employed to develop sex-specific equations for predicting TEE and PAEE. The final model predicting TEE included body weight, steps per day, and time in incremental cadence bands and explained 79% (men) and 65% (women) of the variability. The final model predicting PAEE included peak 30-min cadence, steps per day, and time in cadence bands and explained 76% (men) and 46% (women) of the variability. Time in cadence bands alone explained 39%-73% of the variability in TEE and 30%-63% of the variability in PAEE. Prediction models were stronger for men than for women.

Reducing the glycemic index or carbohydrate content of mixed meals reduces postprandial glycemia and insulinemia over the entire day but does not affect satiety

OBJECTIVE

We evaluated the effects of mixed meals differing in glycemic index (GI) and carbohydrate content on postprandial serum glucose and insulin response, hunger, and satiety over the course of a 12-h day.

RESEARCH DESIGN AND METHODS

In this randomized crossover trial, 26 overweight or obese adults received four diets in random order (high GI, high carbohydrate [HGI-HC]; high GI, low carbohydrate [HGI-LC]; low GI, high carbohydrate [LGI-HC]; and low GI, low carbohydrate [LGI-LC]). All meals were prepared by a metabolic kitchen. Participants received breakfast, lunch, and dinner over the course of a 12-h day. Primary outcomes were postprandial serum glucose and insulin quantified as area under the curve. Hunger, fullness, and satiety were assessed by visual analog scale.

RESULTS

The HGI-LC, LGI-HC, and LGI-LC diets significantly reduced glucose and insulin area under the curve compared with the HGI-HC diet (P < 0.001 for all comparisons). There were no significant differences in ratings of hunger, fullness, or satiety between the different dietary treatments.

CONCLUSIONS

Reducing the GI or carbohydrate content of mixed meals reduces postprandial glycemia and insulinemia, and these changes can be sustained over the course of an entire day. However, there were no differences in subjective hunger and satiety ratings between the diets. These results demonstrate that maintaining a low GI or glycemic load diet is an effective method of controlling serum glucose and insulin levels.

Incremental weight loss improves cardiometabolic risk in extremely obese adults

OBJECTIVE

Excessively obese adults often acquire many metabolic disorders that put them at high risk for developing type 2 diabetes mellitus and cardiovascular disease. We investigated the hypothesis that cardiometabolic risk in a primary care cohort of 208 excessively obese adults (body mass index 40-60 kg/m(2), 48 with type 2 diabetes mellitus) would deteriorate with additional weight gain and improve incrementally beginning with 5% weight reduction.

METHODS

Further analysis of the Louisiana Obese Subjects Study of excessively obese patients enrolled and followed during 2005-2008 is reported.

RESULTS

Weight loss correlated significantly with improvements in fasting plasma glucose, triglycerides, high- and low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, lactate dehydrogenase, and high-sensitivity C-reactive protein. Most parameters deteriorated with weight gain and progressively improved with 5% or more weight loss. Except for low-density lipoprotein cholesterol, all risk factors significantly improved with ≥ 20% loss of body weight. Among patients who had not been diagnosed with type 2 diabetes mellitus and had normoglycemia at baseline, median fasting plasma glucose increased significantly (13%) with stable or gained weight at 1 year, but did not change significantly with reduced weight. Although glucose levels did not change significantly in patients with type 2 diabetes mellitus who gained weight, a decline beginning after 5% weight reduction culminated in 25% glucose reduction with ≥ 20% weight loss. Resting blood pressure declined independently of weight change.

CONCLUSION

Very obese adults can improve their cardiometabolic risk under primary care weight management. Incremental success may help motivate further therapeutic weight reduction.

Prediabetes and prehypertension in healthy adults are associated with low vitamin D levels

OBJECTIVE

To determine whether modest elevations of fasting serum glucose (FSG) and resting blood pressure (BP) in healthy adults are associated with differential serum vitamin D concentrations.

RESEARCH DESIGN AND METHODS

Disease-free adults in the National Health and Nutrition Examination Survey 2001-2006 were assessed. Prediabetes (PreDM) and prehypertension (PreHTN) were diagnosed using American Diabetes Association and Seventh Report of the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure criteria: FSG 100-125 mg/dL and systolic BP 120-139 mmHg and/or diastolic BP 80-89 mmHg. Logistic regression was used to assess the effects of low vitamin D levels on the odds for PreDM and PreHTN in asymptomatic adults (n = 1,711).

RESULTS

The odds ratio for comorbid PreDM and PreHTN in Caucasian men (n = 898) and women (n = 813) was 2.41 (P < 0.0001) with vitamin D levels ≤ 76.3 versus >76.3 nmol/L after adjusting for age, sex, and BMI.

CONCLUSIONS

This study strengthens the plausibility that low serum vitamin D levels elevate the risk for early-stage diabetes (PreDM) and hypertension (PreHTN).

Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women

Background

The 2005-2006 National Health and Nutrition Examination Survey (NHANES) is used to describe an accelerometer-derived physical activity/inactivity profile in normal weight (BMI < 25 kg/m²), overweight (25 ≤ BMI < 30 kg/m²), and obese (BMI ≥ 30 kg/m²) U.S. adults.

Methods

We computed physical activity volume indicators (activity counts/day, uncensored and censored steps/day), rate indicators (e.g., steps/minute), time indicators (employing NHANES activity counts/minute cut points to infer time in non-wear, sedentary, low, light, moderate, and vigorous intensities), the number of breaks in sedentary time (occasions when activity counts rose from < 100 activity/counts in one minute to ≥ 100 activity counts in the subsequent minute), achievement of public health guidelines, and classification by step-defined physical activity levels. Data were examined for evidence of consistent and significant gradients across BMI-defined categories.

Results

In 2005-2006, U.S adults averaged 6,564 ± SE 107 censored steps/day, and after considering non-wear time, they spent approximately 56.8% of the rest of the waking day in sedentary time, 23.7% in low intensity, 16.7% in light intensity, 2.6% in moderate intensity, and 0.2% in vigorous intensity. Overall, approximately 3.2% of U.S. adults achieved public health guidelines. The normal weight category took 7,190 ± SE 157 steps/day, and spent 25.7 ± 0.9 minutes/day in moderate intensity and 7.3 ± 0.4 minutes/day in vigorous intensity physical activity. The corresponding numbers for the overweight category were 6,879 ± 140 steps/day, 25.3 ± 0.9 minutes/day, and 5.3 ± 0.5 minutes/day and for the obese category 5,784 ± 124 steps/day, 17.3 ± 0.7 minutes/day and 3.2 ± 0.4 minutes/day. Across BMI categories, increasing gradients and significant trends were apparent in males for sedentary time and decreasing gradients and significant trends were evident in time spent in light intensity, moderate intensity, and vigorous intensity. For females, there were only consistent gradients and significant trends apparent for decreasing amounts of time spent in moderate and vigorous intensity.

Conclusions

Simple indicators of physical activity volume (i.e., steps/day) and time in light, moderate or vigorous intensity physical activity differ across BMI categories for both sexes, suggesting that these should continue to be targets for surveillance.