The causal associations between interoception, self-regulation, non-purposeful eating behaviors, and weight status in college women: a longitudinal cross-lagged model analysis

AIMS

Excessive weight gain has led to increased obesity and mortality risk among college students. Issues with maintaining a healthy weight may be attributed to poor internal awareness and unhealthy eating behaviors. The study's purpose was to determine the longitudinal effects among interoception, self-regulation, nonpurposeful eating behaviors, and weight status (BMI) among college women.

METHODS

Data from 103 females were collected via Qualtrics over 3 timepoints (T1, T2, T3) during an academic semester. Repeated measures ANOVA and cross-lagged model analyses were used. Significant changes were found in interoceptive responsiveness, external, and uncontrolled eating throughout 3 timepoints.

RESULTS

Longitudinally, significant causal effects were found among the study measures. Among all models, higher interoceptive responsiveness (T1) predicted increased self-regulation (T2). Higher non-purposeful eating behaviors (T1) predicted reduced self-regulation (T2). Higher BMI (T1) predicted reduced non-purposeful eating behaviors (T2), however higher BMI (T2) predicted increased non-purposeful eating (T3) and reduced interoceptive responsiveness (T3). Significant causal effects were found within each non-purposeful eating behavior models.

CONCLUSION

Overall, the research study provided foundational evidence of the importance of self-regulatory skills to help prevent unhealthy eating behaviors and increased weight status in college women. Future interventions educating college women to become more internally aware and better self-regulate are needed.

Label-free electrochemical biosensor for direct detection of Oncostatin M (OSM) inflammatory bowel diseases (IBD) biomarker in human serum

Oncostatin M (OSM) is an interleukin-6 (IL-6) member family cytokine implicated in the pathogenesis of chronic diseases including inflammatory bowel disease (IBD). OSM is a novel diagnostic biomarker over-expressed in the serum of IBD patients. This paper reports on the first electrochemical OSM immunosensor, developed using a multistep fabrication process aimed at covalently immobilizing OSM antibodies on a mixed self-assembled monolayer coated gold working electrode. Cyclic voltammetry, atomic force microscopy (AFM), IR spectroscopy and optical characterizations were used to validate the sensor functionalization protocol. Electrochemical impedance spectroscopy (EIS) measurements were performed to assess the reliability of the immunosensor preparation and to verify the antibody-antigen complexes formation. The label-free immunosensor showed high sensitivity identifying OSM at clinically relevant concentrations (37-1000 pg mL-1) with low detection limit of 2.86 pg mL-1. Both sensitivity and selectivity of the proposed immunosensor were also demonstrated in human serum in the presence of interfering biomarkers, making it an innovative potential platform for the OSM biomarker detection in IBD patients' serum.

Drug use and COVID-19 testing, vaccination, and infection among underserved, minority communities in Miami, Florida

The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49-0.81; p<0.001). PWUD presented with greater difficulties accessing COVID-19 testing, greater vaccine hesitancy, and lower odds of vaccination. Testing and immunization plans that are tailored to the needs of PWUD and consider access, trust-building campaigns, and education may be needed.

Disability and COVID-19: Challenges, testing, vaccination, and postponement and avoidance of medical care among minoritized communities

BACKGROUND

People with disabilities face heightened vulnerability to COVID-19.

OBJECTIVE

This study investigated (1) the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection and (2) predictors of loss of healthcare coverage and postponement and avoidance of medical care during the pandemic.

METHODS

This cross-sectional study was conducted in Miami, Florida, between March 2021 and February 2022 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations initiative. Disability was defined using a standard measure that assesses six universal functions. Participants reported sociodemographic data, COVID-19 testing, infection history, challenges, and healthcare history. Vaccinations were confirmed with medical records and COVID-19 positivity was assessed using real-time reverse transcription-polymerase chain reaction. Statistical analyses included multivariable logistic regression.

RESULTS

Among 1,689 participants with a median age of 57.0, 50.6% were male, and 48.9% were non-Hispanic Black. Disability was associated with greater odds of all assessed COVID-19 challenges: healthcare (aOR:1.60; 95% CI:1.23-2.07), housing (aOR:2.15; 95% CI:1.62-2.87), insufficient food (aOR:1.97; 95% CI:1.54-2.52), water scarcity (aOR:2.33; 95% CI:1.60-3.37), medications (aOR:2.04; 95% CI:1.51-2.77), and transportation (aOR:2.56; 95% CI:1.95-3.36). Those reporting employment disability were less likely to have received COVID-19 testing (81.1% vs. 85.3%, p = 0.026) or to have history of COVID-19 positivity (aOR:0.63; 95% CI:0.44-0.92). Disability predicted avoidance (aOR:2.76; 95% CI:1.95-3.91) and postponement (aOR: 2.24; 95% CI:1.72-2.91) of medical care.

CONCLUSIONS

Disability is associated with higher odds of COVID-19 challenges and postponement and avoidance of medical care. Those reporting employment disability had a lower likelihood of COVID-19 testing. Public health responses to healthcare crises should prioritize the special challenges of people living with disabilities.

Interoception and self-regulation of eating behaviors and weight status in college students

OBJECTIVE

To determine the associations between interoception, self-regulation, eating behaviors, and weight status among college students.

PARTICIPANTS

229 female undergraduates, predominantly classified as Juniors (51.1%) and identified as Hispanic/Latinx (75%) with a mean age of 23.4 (SD = 6.3), were examined.

METHODS

Cross-sectional data using baseline measures from a larger, longitudinal study, were examined. Confirmatory factor analyses and structural equation modeling were conducted to test hypotheses.

RESULTS

Interoception was directly associated to self-regulation. Interoception and self-regulation were inversely associated with non-purposeful eating. Non-purposeful eating was directly associated with weight status.

CONCLUSION

This study provided empirical evidence on the associations between interoception, self-regulation, eating behaviors, and weight status. Our results support the need for programs that target college students' cognitive skills to reduce unhealthy eating behaviors and optimize weight status. Future interventions are needed to enhance interoception and self-regulation skills so that college students can be more purposeful in their eating habits.

Diet Quality and Liver Health in People Living with HIV in the MASH Cohort: A Multi-Omic Analysis of the Fecal Microbiome and Metabolome

The gut-liver axis has been recognized as a potential pathway in which dietary factors may contribute to liver disease in people living with HIV (PLWH). The objective of this study was to explore associations between dietary quality, the fecal microbiome, the metabolome, and liver health in PLWH from the Miami Adult Studies on HIV (MASH) cohort. We performed a cross-sectional analysis of 50 PLWH from the MASH cohort and utilized the USDA Healthy Eating Index (HEI)-2015 to measure diet quality. A Fibrosis-4 Index (FIB-4) score < 1.45 was used as a strong indication that advanced liver fibrosis was not present. Stool samples and fasting blood plasma samples were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. Statistical analyses included biomarker identification using linear discriminant analysis effect size. Compared to participants with FIB-4 ≥ 1.45, participants with FIB-4 < 1.45 had higher intake of dairy (p = 0.006). Fibrosis-4 Index score was inversely correlated with seafood and plant protein HEI component score (r = -0.320, p = 0.022). The relative abundances of butyrate-producing taxa Ruminococcaceae, Roseburia, and Lachnospiraceae were higher in participants with FIB-4 < 1.45. Participants with FIB-4 < 1.45 also had higher levels of caffeine (p = 0.045) and related metabolites such as trigonelline (p = 0.008) and 1-methylurate (p = 0.023). Dietary components appear to be associated with the fecal microbiome and metabolome, and liver health in PLWH. Future studies should investigate whether targeting specific dietary components may reduce liver-related morbidity and mortality in PLWH.

Multiomic analysis reveals microbiome-related relationships between cocaine use and metabolites

OBJECTIVE

Over 19 million individuals globally have a cocaine use disorder, a significant public health crisis. Cocaine has also been associated with a pro-inflammatory state and recently with imbalances in the intestinal microbiota as compared to nonuse. The objective of this pilot study was to characterize the gut microbiota and plasma metabolites in people with HIV (PWH) who use cocaine compared with those who do not.

DESIGN

Cross-sectional study.

METHODS

A pilot study in PWH was conducted on 25 cocaine users and 25 cocaine nonusers from the Miami Adult Studies on HIV cohort. Stool samples and blood plasma were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry.

RESULTS

The relative abundances of the Lachnopspira genus, Oscillospira genus, Bifidobacterium adolescentis species, and Euryarchaeota phylum were significantly higher in the cocaine- using PWH compared to cocaine-nonusing PWH. Cocaine-use was associated with higher levels of several metabolites: products of dopamine catabolism (3-methoxytyrosine and 3-methoxytyramine sulfate), phenylacetate, benzoate, butyrate, and butyrylglycine.

CONCLUSIONS

Cocaine use was associated with higher abundances of taxa and metabolites known to be associated with pathogenic states that include gastrointestinal conditions. Understanding key intestinal bacterial functional pathways that are altered due to cocaine use in PWH will provide a better understanding of the relationships between the host intestinal microbiome and potentially provide novel treatments to improve health.

Effectiveness of a 6-Month Nutrition Intervention in People Living with HIV and Prediabetes Progressing through Stages of Change towards Positive Health Behavior

The prevalence of prediabetes in people living with human immunodeficiency virus (HIV) is two to three times higher than that of the general population. The aim of this study was to assess the effectiveness of an intervention in guiding low-income people living with HIV (PLWH) and prediabetes through the stages of change and promote self-efficacy of positive health behavior.

METHODS

A 6- month randomized, controlled intervention was conducted where participants (N = 38) were randomized into the intervention group (n = 20) or the control group (n = 18). The participants' stages of change, nutrition knowledge, and self-efficacy were assessed using questionnaires. Participants were recruited in August 2017-December 2018, were HIV seropositive, had undetectable viral load, were prediabetic, and not currently receiving glucose-altering medications. Participants randomized into the intervention group received medical nutrition therapy/counseling and nutrition education; participants randomized into the control group received educational material related to nutrition, HIV, and prediabetes at baseline. Primary outcome measures were progression through the stages of change as measured by the transtheoretical ("stages of change") model, improvements in nutrition knowledge, and self-efficacy of the participants.

RESULTS

Significant improvement in stage of behavioral change was observed in the intervention group for physical activity, fruit/vegetable intake, fiber intake as well as nutrition knowledge and self-efficacy; however, no significant changes were observed in the control group.

CONCLUSIONS

A nutrition intervention was effective in promoting positive health behavior by progressing participants through the stages of behavioral change in low-income people living with HIV and prediabetes.

Cocaine use associated gut permeability and microbial translocation in people living with HIV in the Miami Adult Study on HIV (MASH) cohort

OBJECTIVE

Determine if cocaine use impacts gut permeability, promotes microbial translocation and immune activation in people living with HIV (PLWH) using effective antiretroviral therapy (ART).

METHODS

Cross-sectional analysis of 100 PLWH (ART ≥6 months, HIV-RNA <200 copies/mL) from the Miami Adult Studies on HIV (MASH) cohort. Cocaine use was assessed by self-report, urine screen, and blood benzoylecgonine (BE). Blood samples were collected to assess gut permeability (intestinal fatty acid-binding protein, I-FABP), microbial translocation (lipopolysaccharide, LPS), immune activation (sCD14, sCD27, and sCD163) and markers of inflammation (hs-CRP, TNF-α and IL-6). Multiple linear regression models were used to analyze the relationships of cocaine use.

RESULTS

A total of 37 cocaine users and 63 cocaine non-users were evaluated. Cocaine users had higher levels of I-FABP (7.92±0.35 vs. 7.69±0.56 pg/mL, P = 0.029) and LPS (0.76±0.24 vs. 0.54±0.27 EU/mL, P<0.001) than cocaine non-users. Cocaine use was also associated with the levels of LPS (P<0.001), I-FABP (P = 0.033), and sCD163 (P = 0.010) after adjusting for covariates. Cocaine users had 5.15 times higher odds to exhibit higher LPS levels than non-users (OR: 5.15 95% CI: 1.89-13.9; P<0.001). Blood levels of BE were directly correlated with LPS (rho = 0.276, P = 0.028), sCD14 (rho = 0.274, P = 0.031), and sCD163 (rho = 0.250, P = 0.049).

CONCLUSIONS

Cocaine use was associated with markers of gut permeability, microbial translocation, and immune activation in virally suppressed PLWH. Mitigation of cocaine use may prevent further gastrointestinal damage and immune activation in PLWH.

Stress Increases the Association between Cigarette Smoking and Mental Disorders, as Measured by the COVID-19-Related Worry Scale, in the Miami Adult Studies on HIV (MASH) Cohort during the Pandemic

Background: Smoking has been associated with mental disorders (MD). People who smoke are at a higher risk of contracting COVID-19 and experiencing more severe symptoms of the illness. This study aimed to investigate the relationship between cigarette smoking and MD before and during the COVID-19 pandemic and whether it was influenced by COVID-19-related stress in the MASH cohort. Methods: An ambispective design was used with data collected during the pandemic (July/August 2020) by the COVID-19-Related Worry Scale, a parameter for stress, and data collected at the participants’ last cohort visit before the pandemic (December 2019). Results: In our sample of 314 participants, 58.6% were living with HIV, 39.2% had MD, 52.5% smoked before, and 47.8% smoked during the pandemic. Participants with MD were twice as likely to smoke cigarettes both before (aOR = 2.02, 95% CI: 1.21−3.37, p = 0.007) and during the pandemic (aOR = 2.10, 95% CI: 1.24−3.56, p = 0.006); and experienced higher levels of stress measured by the COVID-19-Related Worry Scale (8.59 [5.0−10.0] vs. 7.65 [5.0−10.0]; p = 0.026) compared to those without MD. Participants with MD and high levels of stress smoked more days per month (20.1 [0−30] days) than those with lower levels of stress (9.2 [0−30] days, p = 0.021), and more than those with high levels of stress, but no MD (2.6 [0−30] days, p < 0.001). Conclusions: Cigarette smoking decreased in the MASH cohort during the pandemic, but increased in participants with MD and higher levels of stress.

Relationships between Glycemic and Lipid Control and TSH in Euthyroid Latinx Adults- a Community-Based Study

Objectives

Thyroid hormone abnormalities are among the most common endocrine disorders comorbidly suffered alongside metabolic syndrome and type 2 diabetes mellitus (T2DM). Thyroid hormones and their regulating hormone, thyroid-stimulating hormone (TSH), play a role in metabolism, obesity, insulin resistance and other disorders that share similar mechanisms. The aim of this study was to examine the associations between TSH and clinical measures of chronic disease markers in a Latinx population receiving free health care services at a community clinic.

Methods

A needs assessment was conducted on euthyroid Latinx adult patients from a community clinic in south Florida. The medical records of 93 randomly selected patients were cross-sectionally reviewed to collect data on demographics, diagnoses of health conditions, and biomedical laboratory information. The cut-off point for high TSH was ≥2 mU/L and low TSH as &lt;2 mU/L. Statistical analyses included descriptive statistics, independent t-test, chi-squared test, logistic regressions.

Results

The mean age was 51.9 ± 11.8 years and 82.8% were female. There were no differences between low and high TSH groups on age, gender, BMI, hypertension, T2DM, CVD, or CVD risk factors. The low TSH group had significantly higher fasting glucose (194.0 mg/dL ± 86.2 vs 140 mg/dL ± 52.8, P = 0.046), hemoglobin A1c (9.6% ±2.8 vs 7.5% ±1.5, P = 0.018), and total cholesterol (200.5 mg/dL ± 32.8 vs 171.5 mg/dL ± 39.7, P = 0.034) compared with the high TSH group. Subgroup analysis of those with T2DM revealed that the low TSH group also had a greater proportion of patients with high fasting glucose (≥170 mg/dL) and high hemoglobin A1c (≥8.5%) compared with the high TSH group. Similarly, those with a low TSH had 6 times greater odds of having high fasting glucose (OR 6.66, 95% CI 1.31–33.69, P = 0.022) and high hemoglobin A1c (OR 6.11, 95% CI 1.19–31.16, P = 0.029).

Conclusions

In Latinx euthyroid patients receiving medical services at a community clinic, a relationship between low-normal TSH levels, fasting glucose and hemoglobin A1c was demonstrated. As the population ages and the risk of both obesity and multimorbidity increases, understanding how thyroid hormone dysfunction can influence chronic disease status may help address health disparities suffered in disadvantaged and vulnerable populations.

Funding Sources

FIU RCMI/NIMHD

Dietary Fiber Intake and Type 2 Diabetes Indicators by Sex and Ethnicity for the U.S. Adults: A Secondary Analysis of NHANES 2017–2018 Data

Objectives

The relationship between dietary fiber intake and fasting plasma glucose (FPG) (mg/dl) among U.S. adults aged 40 years and older were studied. 2017–2018 NHANES data (N = 3309) was used. Sex and ethnicity differences were studied.

Methods

Participants were included if they had data available for daily fiber intake during the first in-person interview and laboratory data for fasting plasma glucose levels. n = 1643 were males and n = 1666 were females. n = 402 were Mexican American, n = 308 were Other Hispanic, n = 1229 were Non- Hispanic White, n = 799 were Non- Hispanic Black, n = 416 were Non- Hispanic Asian, and n = 155 were other race- including Multi-Racial. The participants with diabetes, n = 409 were males, and n = 312 were females. Independent-Samples T test was used to compare means between dietary fiber intake and FPG levels by sex and ethnicity.

Results

Fiber intake was significantly different between sex and ethnic groups; Mexican American, Other Hispanic, Non- Hispanic White, Non- Hispanic Black, Non- Hispanic Asian, and other race- including Multi-Racial (p &lt; 0.001). Males had significantly higher fiber intake than females (p &lt; 0.001). Mexican American had significantly higher fiber intake than non-Hispanic White and non- Hispanic Black (p &lt; 0.001). FPG levels were significantly different between sex groups (p &lt; 0.001). Males had significantly lower FPG levels than females (p &lt; 0.001). FPG was significantly lower for those with high fiber intake (p &lt; 0.001).

Conclusions

Dietary fiber intake and fasting plasma glucose levels by sex and ethnicity need to be further studied in controlled clinical trials.

Funding Sources

Florida International University.

Associations of Vitamin B6 Intake and Plasma Pyridoxal 5'-Phosphate with Plasma Polyunsaturated Fatty Acids in US Older Adults: Findings from NHANES 2003-2004

Previous evidence suggests a potential dual impact of aging and vitamin B6 (B6) deficiency on polyunsaturated fatty acid (PUFA) metabolism; gender may influence PUFA biosynthesis. Perturbation of PUFA compositions during B6 deficiency could be linked to age-related health outcomes. However, little is known about the interrelationships between vitamin B6, PUFA, and gender in the older population. Therefore, we investigated whether gender-specific associations of B6 intake and plasma pyridoxal 5’-phosphate (PLP) concentration, respectively, with plasma PUFA concentrations and ratios (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), EPA + DHA, EPA/AA, and (EPA + DHA)/AA) existed in older adults. We further examined the relationships of adequate B6 status (PLP ≥ 20 nmol/L) with high (above median) plasma PUFA relative to deficient B6 status. This cross-sectional study analyzed 461 participants aged ≥60 years from NHANES 2003−2004. Nutrient intakes were assessed using two 24-h recalls and supplement questionnaires. PLP and PUFA concentrations were measured. Multivariate linear regression assessed the association of B6 intake and PLP with PUFA; multivariate logistic regression evaluated the relationship of adequate B6 status with high plasma PUFA, adjusting for demographic, socioeconomic, and dietary factors; physical activity; smoking; alcohol; medication; and BMI. There were interactions between gender and B6 intake on EPA (P-interaction = 0.008) and AA (P-interaction = 0.004) only, whereas no interaction existed between gender and PLP on PUFA. PLP was directly associated with EPA (β = 0.181, P = 0.002), DHA (β = 0.109, P = 0.005), EPA + DHA (β = 0.14, P = 0.002), EPA/AA (β = 0.186, P = 0.004), and (EPA + DHA)/AA (β = 0.13, P = 0.026). The odds of having high plasma EPA (adjusted (a) OR: 2.03, P = 0.049) and EPA/AA (aOR: 3.83, P < 0.0001) were greater in those with adequate B6 status compared to those with deficient B6 status. In conclusion, in US older adults, a higher PLP level was associated with a greater level of EPA, DHA, EPA + DHA, EPA/AA, and (EPA + DHA)/AA. Adequate B6 status was associated with high EPA and EPA/AA status. These findings suggest that sufficient vitamin B6 status may positively influence PUFA metabolism in older adults.

Resilience, Anxiety, Stress, and Substance Use Patterns During COVID-19 Pandemic in the Miami Adult Studies on HIV (MASH) Cohort

We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July-August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIV-uninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.

Community Engagement Practices at Research Centers in U.S. Minority Institutions: Priority Populations and Innovative Approaches to Advancing Health Disparities Research

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns.

Associations Between Vitamin B6 Status and Plasma Polyunsaturated Fatty Acids Among US Older Adults: NHANES 2003−2004

Objectives

Previous evidence suggests that vitamin B6 deficiency may have a deleterious impact on aging and the metabolism of polyunsaturated fatty acids (PUFA). However, the relationship of aging with vitamin B6 status and PUFA metabolism is poorly understood; population-based studies to assess the relationship between plasma pyridoxal 5′-phosphate (PLP; an active form of vitamin B6) and PUFA status for older adults are lacking. Thus, we examined the associations between plasma PLP concentration and plasma PUFA concentrations and ratios [eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), EPA + DHA, EPA/AA, and (EPA + DHA)/AA] among US older adults. We further investigated the association of adequate (PLP ≥ 20 nmol/L) versus deficient (PLP &lt; 20 nmol/L) vitamin B6 status in those participants with plasma PUFA concentration above the median.

Methods

A cross-sectional study analyzed 467 participants aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES) 2003−2004. Nutrient intake data were estimated from two 24-h recalls and from questionnaires on the use of supplements. Plasma PLP and PUFA concentrations were measured. We used multivariable linear regression for obtaining unstandardized (b) and standardized (β) coefficients; multivariable logistic regression for adjusted odds ratios. Covariates included demographic, socioeconomic, dietary variables, physical activity, smoking, alcohol consumption, prescription medication use, and BMI.

Results

Plasma PLP was directly associated with plasma EPA (β = 0.176, b = 0.101, P = 0.002), DHA (β = 0.109, b = 0.046, P = 0.004), EPA + DHA (β = 0.137, b = 0.060, P = 0.002), EPA/AA (β = 0.169, b = 0.089, P = 0.009). The odds of having plasma EPA/AA and (EPA + DHA)/AA concentration above the median were greater in those with adequate vitamin B6 compared with those who were deficient [adjusted OR (aOR): 1.32, 95% CI: 0.8−2.17, P = 0.0001; aOR: 2.08, 95% CI: 1.0−4.33, P = 0.049, respectively].

Conclusions

In US older adults, plasma PLP was directly associated with plasma EPA, DHA, EPA + DHA, EPA/AA. Adequate vitamin B6 status was associated with having above the median EPA/AA and (EPA + DHA)/AA. These findings suggest that adequate B6 status may positively influence PUFA metabolism in the older US population.

Funding Sources

No funding sources.

Framingham Heart Study (FHS) 10-Year Cardiovascular Risk Is Associated With Marijuana Use in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Illicit drug use can lead to adverse cardiovascular events; it is an additional risk factor for cardiovascular disease. Thus, we sought to determine the association between CVD and drug use in people living with HIV (PLWH) using the FHS 10-year risk.

Methods

Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasting blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Urine toxicology was used to determine current illicit drug use. Descriptive statistics were used to analyze demographics, HIV status, and VL (undetectable VL &lt; 50 copies/ml). CVD (10-year risk) score was calculated using a formula based on CVD risk factors. An independent sample t-test was used to compare the mean CVD risk score between drug users and non-users. Linear regression was used to find an association between drug users and CVD 10-year risk while controlling for sex and infection status.

Results

Participants’ mean age was 54.6 ± 7.9 years (n = 1034), 58% male and 63.8% Black. About 46.8% were PLWH and 90.9% had an undetectable VL. The average CVD 10-year risk of all participants was 15.1% and 49.6% of participants used illicit substances. A univariate linear regression showed a positive association between FHS 10-year risk and marijuana use (b = 2.260 SE = 1.036, 95% CI: 0.227–4.293; P = 0.029). After adjusting for sex and HIV status the association remained significant (b = 2.322 SE = 1.028, 95% CI: 0.304–4.340; P = 0.024). Comparing the mean 10-year risk between groups, a significant difference between marijuana users and non-users was seen regardless of infection status and age (95% CI: −4.293- −0.227; P = 0.029). Separating by sex, only males showed a significant difference in 10-year risk when comparing marijuana users to non-users irrespective of infection status and age (95% CI: −6.394- −0.8373; P = 0.011). No association was determined between 10-year risk and other substances, including cocaine, fentanyl, and amphetamines.

Conclusions

Marijuana use seems to be a strong predictor of CVD risk in minority populations. However, other substances of abuse did not exhibit a cardiovascular effect regardless of HIV status or sex. Further studies are needed to examine the relationship between the use of marijuana and CVD.

Funding Sources

National Institute on Drug Abuse.

Study Protocol: A Six-Session Mindfulness-Based Training to Support Weight Management in Hispanics Post Bariatric Surgery – Lessons Learned From a Pilot Study

Objectives

Objective: To evaluate the recruitment, retention, and acceptability of a mindfulness-based group intervention to support weight management in Hispanics after bariatric surgery. Background: Mindfulness-based approaches may support improvement of problematic eating behaviors post- bariatric surgery. Such approaches have been explored with promising results in Non-Hispanic; however their impact on bariatric clients of Hispanic origin has not been investigated. The purpose of this pilot study was to evaluate the feasibility of a six-session mindfulness-based training for bariatric clients of Hispanic origin.

Methods

This was an intervention-one group pre/post-test pilot study. Participants were Hispanics (≥ 21 years), who had surgery 12–36 months prior to baseline. Recruitment was over a one-month period, through flyers available in a dietetics practice and through snowball sampling. Interested individuals were screened via telephone. Group training was delivered over six consecutive weeks, participants were asked to complete four questionnaires including: Perceived Stress Questionnaire, Acceptance and Committed Action-II Questionnaire, Intuitive Eating Scale-2, and Short-Form Five Facet Mindfulness Questionnaire at baseline, week six, and ten. A group exit interview was conducted on week six. Incentives and refreshments were provided at each meeting, training was free of charge.

Results

For recruitment in the first cohort, 60 people screened, 55 (92%) were eligible and 7 (13%) consented, meeting the recruitment objective of 7–10 participants. Out of the eligible, 42 (76%) were willing but not able at this time. There was 100% participation in all sessions and assessment visits which exceeded the adherence criteria of attendance at 4/6 sessions. Three participants were recruited from flyers, four from snowball sampling.

Conclusions

This pilot study was feasible; Hispanics were willing to participate, retention and adherence was at a maximum. Multiple sources for recruitment could increase the efficacy of the recruitment.

Funding Sources

None.

A Six-Session Mindfulness-Based Training to Support Weight Management After Bariatric Surgery in Clients of Hispanic Origin

Objectives

Objective: To understand more about the impact of mindfulness training on perceived stress levels, dispositional mindfulness, intuitive eating, and psychological flexibility.in bariatric patients of Hispanic origin, 12–36 months post-bariatric surgery. Background: Mindfulness meditation has been proposed as an approach to reduce stress and increase awareness of physical sensations. The purpose of this study was to evaluate the impact of a six-session mindfulness-based training on dispositional mindfulness, perceived stress levels, intuitive eating, and psychological flexibility in bariatric patients of Hispanic origin 12–36 months post surgery.

Methods

The mindfulness group training was based on The Mindfulness Meditation/Acceptance Commitment Approach (MMACT) and focused on the following topics: mind body connection, stress management, intuitive eating, self-compassion, and acceptance & commitment. Participants were recruited from flyers posted in a private dietitian's practice and snowball sampling.

Results

For the first group, sixty potential participants were screened and seven (12%, 3 males and 4 females, mean age 50.6 ± 6, mean BMI 34.7 ± 6) agreed to participate. The mean scores at baseline, six, and ten weeks were: Five Factor Mindfulness Questionnaire (80.1 ± 8, 84 ± 11, 83 ± 14), Acceptance and Action Questionnaire-II (18 ± 8, 17 ± 10, 17 ± 11), Perceived Stress Questionnaire (0.4 ± 0.2, 0.4 ± 0.2, 0.3 ± 0.2), and Intuitive Eating Scale-2 (2.7 ± 0.3, 2.9 ± 0.4, 3.1 ± 0.5), this last one with significant difference (P &lt; 0.01) between baseline and week ten.

Conclusions

This research provides preliminary data on how mindfulness training may affect factors that influence weight stability post bariatric surgery in clients of Hispanic origin.

Funding Sources

None.

Impact of Mothers Participation in a Nutrition Education Intervention on Their Children Eating Behavior

Objectives

To determine whether mother's participation in a nutrition education program influence obese children's body weight and improving their health behavior. Additionally, this study evaluates changes in attitude toward food, and beliefs for children-mothers dyad participating in the Healthy Habits (HH) program.

Methods

Fourteen mothers were willing to participate in the intervention. The mother's intervention was offered to the mothers of children participating in the Healthy Habits group only. Mothers received “what's app” text messages and materials related to the nutrition education provided for all children in the Healthy Habits group during the 8-week period.

Results

After an 8-week intervention, children with maternal support showed significant (21% VS 100%, P.001), (45% VS 95%, P = 0.012) improvement in eating behavior and attitude compared with the other group in the intervention. Maternal eating behaviors, beliefs and attitudes were also significantly (12% VS 95%, P.001), (21% VS 82%, P.001) changed by their participation.

Conclusions

Maternal involvement in the Healthy Habits program showed positive effect on children eating behavior in addition to improvement in maternal behavior. Our findings suggest that actively involving mothers in programs to reduce childhood obesity, will magnify the potential effects of the program on children by changing the family dynamics and creating a supportive environment.

Funding Sources

N/A.

Immune activation: A link between food insecurity and chronic disease in people living with HIV

Persistent immune activation is a hallmark of HIV infection and thought to play a role on chronic diseases in people with HIV (PWH). Food insecurity is disproportionately prevalent in PWH and is associated with adverse health outcomes. We determined whether food insecurity was associated with increased plasma levels of sCD14, sCD27, and sCD163 in 323 antiretroviral -treated PWH from the Miami Adult Studies on HIV (MASH) Cohort. Nearly half (42.7%) of participants were food insecure and 85.5% were virally suppressed (<200 copies/mL). Food insecurity was independently associated with higher levels of sCD14 and sCD27. Very low food security was associated with increased sCD163 levels among those with lower CD4+ cell counts. Food insecurity may promote immune activation in PWH, suggesting a biological link between food insecurity and chronic disease among PWH. Improving financial security and access to high-quality diets could reduce the burden of disease in this highly vulnerable population.

Food Insecurity and Cognitive Impairment in the Miami Adult Studies on HIV (MASH) Cohort

BACKGROUND

Food insecurity is a social determinant of health associated with cognitive impairments in older adults and people living with HIV (PLWH). Few studies have examined this relation longitudinally, and no studies have explored how the frequency of food insecurity over time may impact cognitive impairment.

OBJECTIVE

This study aimed to examine the impact of food insecurity on cognitive impairment over a 2-y follow-up period in a cohort of people living with and without HIV.

METHODS

This was a 2-y longitudinal analysis of primarily economically disadvantaged, middle-aged, Black, and Hispanic participants from the Miami Adult Studies on HIV (MASH) cohort. Food insecurity was assessed with the USDA Household Food Security Module at baseline and 12- and 24-mo follow-ups. Food insecurity in all 3 assessments was considered persistent food insecurity. Cognitive impairment was assessed with the Mini-Mental State Examination. Statistical analyses consisted of logistic regressions.

RESULTS

A total of 394 participants (247 HIV positive) with 2-y follow-up data were included in this analysis. At baseline, 104 (26.4%) were food-insecure and 58 (14.7%) had cognitive impairment. Very low food security was associated with cognitive impairment at baseline (OR: 3.23; 95% CI: 1.08, 9.65). PLWH not virally suppressed had higher risk for cognitive impairment compared with HIV-uninfected participants (OR: 2.87; 95% CI: 1.15, 7.18). Additionally, baseline food insecurity (OR: 2.28; 95% CI: 1.08, 4.81) and the frequency of food insecurity over time (OR: 1.50 per year; 95% CI: 1.08, 2.10), particularly persistent food insecurity (OR: 3.69; 95% CI: 1.15, 11.83), were associated with cognitive impairment at 2-y follow-up; the results were consistent after excluding cognitively impaired participants at baseline.

CONCLUSIONS

Food insecurity is a significant risk factor for cognitive impairment, particularly among individuals who experience food insecurity frequently or persistently. Screening for food insecurity and interventions to secure access to sufficient, nutritious foods may help delay cognitive decline among socioeconomically disadvantaged individuals.

Polysubstance use and adherence to antiretroviral treatment in the Miami Adult Studies on HIV (MASH) cohort

Evidence for a relationship between polysubstance use, depression, and adherence to antiretroviral therapy (ART) is limited. The objectives of this study were to examine the associations of depression, illicit drug, and alcohol use with adherence to ART. People living with HIV (PLHIV) from the Miami Adult Studies on HIV cohort were asked about the number of doses of their ART medication missed to assess ART adherence. Harmful alcohol drinking was evaluated using the Alcohol Use Disorders Identification Test and illicit substance use assessed with self-report and urine screen. The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms. Of 391 PLHIV, 16.6% missed at least one dose (range:1-4) in the past four days. Cocaine/crack, opiate use, and depression were significantly independently associated with a greater mean number of doses missed. The mean number of doses missed was significantly greater among participants who used alcohol in combination with cocaine/crack, marijuana, and tobacco compared to non-users. In conclusion, polysubstance use increased the risk for poor ART adherence among PLHIV. The use of cocaine/crack or opiates individually and depressive symptoms also promote poor ART adherence. An integrated approach targeting substance disorders and depression may help achieve better ART adherence.

Heroin use is associated with liver fibrosis in the Miami Adult Studies on HIV (MASH) cohort

BACKGROUND

People who use opioids and people living with HIV (PLWH) are at increased risk for liver-related morbidity and mortality. Although animal models suggest that chronic opioid use may cause liver damage, research in humans is limited. We aimed to determine whether opioid use, particularly heroin, was associated with liver fibrosis.

METHODS

Cross-sectional analysis of 679 participants (295 HIV/HCV uninfected, 218 HIV mono-infected, 87 HCV mono-infected, 79 HIV/HCV coinfected) from the Miami Adult Studies on HIV (MASH) cohort. Liver fibrosis was assessed via magnetic resonance elastography (MRE) on a 3 T Siemens MAGNETOM Prisma scanner.

RESULTS

A total of 120 (17.7 %) participants used opioids. Liver fibrosis was present in 99 (14.6 %) participants and advanced liver fibrosis in 31 (4.6 %). Heroin use (N = 46, 6.8 %) was associated with HCV-seropositivity, smoking, misuse of prescription opioids, and polysubstance use. The use of heroin, but not misuse of prescription opioids, was significantly associated with liver fibrosis (OR = 2.77, 95 % CI: 1.18-6.50) compared to heroin non-users, after adjustment for confounders including excessive alcohol consumption, polysubstance use and HIV and HCV infections. Both HIV and HCV infections were associated with liver fibrosis, whether virally suppressed/undetectable or viremic.

CONCLUSIONS

Heroin use was independently associated with increased risk for liver fibrosis irrespective of the use of other substances and HIV or HCV infections. Both HIV and HCV were associated with higher risk for liver fibrosis, even among those with suppressed or undetectable viral loads. The exact mechanisms for opioid-induced liver fibrosis remain to be fully elucidated.

Gender Differences in the Associations of Plasma Pyridoxal 5'-Phosphate with Plasma Polyunsaturated Fatty Acids among US Young and Middle-Aged Adults: NHANES 2003-2004

Vitamin B6-restricted diets and low plasma pyridoxal 5'-phosphate (PLP) status altered plasma polyunsaturated fatty acids (PUFA) compositions. Evidence suggests the role of gender in the metabolism of vitamin B6 and PUFA. However, no epidemiologic study examined the impact of gender on the relationship between vitamin B6 and PUFA status in adults. Thus, we investigated whether there were gender differences in the association of vitamin B6 intake and plasma PLP concentration with plasma PUFA concentrations and ratios (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), EPA + DHA, EPA/AA, (EPA + DHA)/AA) in US young/middle-aged adults. In total, 864 participants (20-59 years; 484 men, 380 women) from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 were used for this cross-sectional study. Nutrient intakes were estimated from two 24 h recalls and supplement questionnaires; plasma PLP and PUFA were measured. Multivariate linear regression was utilized to obtain unstandardized (b) and standardized (β) coefficients. Covariates included demographic, socioeconomic, dietary variables, physical activity level, cigarette smoking status, alcohol consumption, prescription medication use, and BMI. There were significant interactions between gender and PLP on EPA (P-interaction = 0.004), DHA (P-interaction = 0.020), EPA + DHA (P-interaction = 0.010), EPA/AA (P-interaction = 0.002), (EPA + DHA)/AA (P-interaction = 0.004), whereas no interaction between gender and B6 intake existed. In gender-stratified analyses, in men, PLP was positively associated with EPA (β = 0.138, b = 0.104, p = 0.0004), DHA (β = 0.101, b = 0.058, p = 0.036), EPA + DHA (β = 0.125, b = 0.073, p = 0.005), EPA/AA (β = 0.144, b = 0.099, p = 0.0002), (EPA + DHA)/AA (β = 0.123, b = 0.068, p = 0.005). However, no associations between PLP and PUFA existed in women. In conclusion, gender differences were found in the relationships between plasma PLP and plasma EPA, DHA, EPA + DHA, EPA/AA, and (EPA + DHA)/AA, with significant direct associations in men only among US young/middle-aged adults.

Food insecurity is associated with magnetic resonance-determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD.

OBJECTIVES

To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults.

METHODS

We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals.

RESULTS

Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants.

CONCLUSIONS

Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.

A Randomized Controlled Trial of Interventions for Growth Suppression in Children With Attention-Deficit/Hyperactivity Disorder Treated With Central Nervous System Stimulants

OBJECTIVE

To examine the impact of central nervous system (CNS) stimulants on the growth of children with attention-deficit/hyperactivity disorder (ADHD), and to assess the efficacy and feasibility of weight recovery interventions on growth.

METHOD

A total of 230 children aged 5 to 12 years with ADHD with no history of chronic CNS stimulant use were randomly assigned to receive daily CNS stimulants (78%, primarily osmotic release oral system-methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >0.5 z-units were randomized to 1 of 3 weight recovery treatments (WRTs): monthly monitoring of height/weight (MON) plus continued daily medication; drug holidays (DH) with medication limited to school days; or daily caloric supplementation (CS) with a 150-kcal supplement plus daily medication.

RESULTS

Before WRT assignment, medication was associated with significant reductions in standardized weight and height (p values <.01). Adherence to CS and DH during WRT was high, with significant increases in daily caloric intake and decreases in weekly medication exposure (p values <.05). Across all WRT participants (n = 71), weight velocity increased significantly after WRT randomization (β₂ = 0.271, SE = 0.027, p < .001).When analyzed by what parents did (versus what they were assigned to), CS (p < .01) and DH (p < .05) increased weight velocity more than MON. No increase in height velocity was seen after randomization to any WRT. Over the entire study, WRT participants declined in standardized weight (-0.44 z-units) and height (-0.20 z-units).

CONCLUSION

Drug holidays, caloric supplementation, and increased monitoring all led to increased weight velocity in children taking CNS stimulants, but none led to increased height velocity.

CLINICAL TRIAL REGISTRATION INFORMATION

Novel Approach to Stimulant Induced Weight Suppression and Its Impact on Growth; https://clinicaltrials.gov/; NCT01109849.

Cognitive Impairment among People Who Use Heroin and Fentanyl: Findings from the Miami Adult Studies on HIV (MASH) Cohort

Background: Cognitive impairment is common in people living with HIV (PLWH). Opioid drugs exert direct and indirect effects on cognitive processes, which may contribute to cognitive dysfunction among PLWH. This study was designed to determine if opioid use is associated with cognitive impairment and whether the effect differs between PLWH and HIV-uninfected adults. Other neuropsychiatric symptoms, such as depression and apathy, were also examined. We conducted a cross-sectional analysis of 265 PLWH and 284 HIV-uninfected participants from the Miami Adult Studies on HIV (MASH) cohort. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment. Substance use was self-reported. Overall, 26.8% of PLWH and 15.1% of HIV-uninfected used opioids. Cognitive impairment was more frequent among people who used heroin and/or fentanyl than those who misused prescription opioids (31.6% vs. 10.5%, p = .005). The use of heroin/fentanyl was associated with increased odds for cognitive impairment (adjusted OR: 2.21, 95% CI 1.05-4.64, p = .036). Among PLWH only, the misuse of opioids was associated with a higher frequency of neuropsychiatric symptoms such as depression and apathy. A higher risk for cognitive impairment was seen among people who used heroin and fentanyl. PLWH who misuse opioids may be at an increased risk for neuropathology, but elucidation of mechanisms for opioid-induced cognitive deficits is needed.

Cocaine Use and Inflammation Is Associated with Diet Quality in People Living with HIV (PLWH) from the MASH Cohort

Objectives

Cocaine use is one of the most widely used illicit drugs in Miami, FL and especially among PLWH. Cocaine use is associated with greater systemic inflammation and poor dietary intake. Lifestyle factors such as diet may influence inflammation and further exacerbate the effects of substance use and HIV infection on systemic inflammation. This study examined the relationships of cocaine use, inflammation and diet quality in PLWH from the Miami Adult Studies on HIV (MASH) cohort.

Methods

After obtaining informed consent, data on demographics, socioeconomic status, substance use and parameters of HIV disease progression (CD4 cell count and HIV viral load) were collected from 50 participants enrolled in the MASH cohort in Miami, FL. A total of 4 to 5 24-hour recalls were collected for each participant. Diet quality was assessed using the USDA Healthy Eating Index (HEI)-2015. Interleukin 6 (IL-6) was measured using the Quantikine ELISA kit (R&D Systems, Minneapolis, MN). Statistical analyses used descriptive statistics, Spearman's correlations, Mann-Whitney U and logistic regression.

Results

The participants’ mean age was 55 ± 6.81, 58% were male, and 68% were African Americans. Overall the diet quality was low with a total median HEI-2015 score of 44.5 (IQR = 38.8–53.8), lower than the general US population score of 59 (P &lt; 0.001) and it was not significantly correlated with IL-6 scores (r = −0.212, P = 139). Cocaine users had significantly lower total median HEI scores [41 (IQR = 35–48) vs.45 (IQR = 41–57.50), P = 0.048] than cocaine non-users. Component HEI scores of whole fruit (r = −0.280, P = 0.049) and saturated fat (r = −0.341, P = 0.015) were correlated with IL-6. Moreover, lower saturated fat intake reduced odds of having IL-6 above the median (OR = 0.710, 95% CI: 0.544–0.928, P = 0.012), after controlling for age, sex, income, education, and cocaine use.

Conclusions

Diet quality was low for all the participants and significantly lower for those who used cocaine compared to non-users. Higher inflammation was associated with lower fruit and higher saturated fat intakes. Larger studies are needed to elucidate these relationships in order to develop appropriate interventions for PLWH. These results highlight the need for nutritional counseling for PLWH, especially if the condition is associated with cocaine use.

Funding Sources

NIDA and NIMHD.

Substance Abuse and BMI Are Associated with Increased Inflammation and Oxidative Stress in Participants of the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Inflammation and oxidative stress are considered important factors in the development of non-communicable diseases with aging. We determined associations between body mass index (BMI), oxidative stress (OS), and inflammation in people living with HIV (PLWH) and un-infected substance users.

Methods

Overweight/obesity (OW/OB) was defined as BMI ≥ 25 and normal weight (NW) as BMI ≤ 24.9 in participants of the MASH cohort. Cocaine use was assessed with questionnaires and urine toxicology. Smoking was assessed with questionnaires. Blood was collected to assess inflammation (high sensitivity C-reactive protein [hsCRP] &gt;3 m/L) by LabCorp, and OS with ARBOR ASSAYS (Ann Arbor, MI) glutathione colorimetric detection kit with %oxidized glutathione above median (&gt;2.33%) as elevated. HIV viral load (VL) was obtained from medical charts. Regressions compared substance-abusing PLWH and un-infected people and controlled for age, sex, HIV status, and BMI.

Results

Mean age of the 605 participants was 54.4 ± 7.4 years, 54.7% male, 70.1% Black; 76% were OW/OB; 73% used cocaine and smoked cigarettes. PLWH comprised 45.5% of the population and 75% had suppressed VL. Regardless of HIV status, OW/OB cocaine users had higher odds for inflammation (OR = 3.1, 95% CI: 1.7–5.6, P &lt; 0.001) and higher OS (OR = 2.0, 95% CI: 1.1–3.4, P = 0.018) than NW cocaine users. OW/OB cocaine + cigarette users also had higher odds for inflammation (OR = 2.6, 95% CI: 1.6–4.2, P = 0.001) and higher OS (OR = 1.9, 95% CI: 1.2–2.9, P = 0.006) than NW cocaine + cigarette users. There were no differences in inflammation or OS between OW/OB cocaine alone or with cigarette use and non-users (P = 0.707). HIV status was not independently associated with inflammation or high OS (P &gt; 0.33).

Conclusions

These results indicated that OW/OB is associated with higher levels of inflammation and oxidative stress than normal weight even when accompanied with cocaine use as well as cocaine + cigarette use. These findings suggest that the use of substances does not increase inflammation or OS beyond overweight/obesity. In addition, in this cohort, with largely suppressed VL, HIV status was not independently associated with greater inflammation or OS. OW/OB is prevalent among PLWH and healthy people and may play an important role in the development of non-communicable diseases.

Funding Sources

National Institute on Drug Abuse.

Dietary Components and Metabolites Are Associated with Liver Fibrosis in People Living with HIV (PLWH) in the MASH cohort

Objectives

Distinct dietary components and microbiome metabolites may affect liver disease progression, a common comorbidity among people living with HIV (PLWH). Similarly, diet composition, including micronutrients, have been associated with markers of HIV disease progression (CD4 cell count). The objective of this study was to investigate the associations between dietary components, plasma metabolites, and liver fibrosis in PLWH.

Methods

A cross-sectional pilot study that enrolled 50 PLWH on antiretroviral therapy from the Miami Adult Studies on HIV (MASH) cohort. Diet quality was measured with the USDA Healthy Eating Index (HEI) and liver fibrosis was measured via the Fibrosis-4 Index (FIB-4). Microbiome metabolites were measured from plasma samples via metabolomics-non-targeted gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry. Statistical analysis included T-test, Chi-square, Spearman correlation, and Partial Least Squares Discriminant Analysis (PLS-DA).

Results

The participants’ mean age was 55 ± 6.81, 58% were male, and 68% were African Americans. FIB-4 and HEI seafood/plant protein score were inversely correlated (rho = -0.320, P = 0.022). There were also trends towards significance between CD4 cell count and seafood/plant protein score (rho = 0.251; P = 0.078), and CD4 cell count and greens/beans HEI score (rho = 0.269; P = 0.059). Microbiome metabolites that differed between the high and the low FIB-4 group using PLS-DA included 3-methylhistidine and phosphatidylcholine (PC) metabolites, often associated with meat consumption.

Conclusions

Lower liver fibrosis and higher CD4 cell count, a measure of HIV disease progression, were associated with consumption of foods typically high in micronutrients and fiber (seafood, plant protein, greens, and beans) in PLWH. Additionally, higher levels of 3-methylhistidine and PC metabolites, biomarkers associated with higher meat intake, were associated with higher liver fibrosis scores. These relationships confirm similar findings in the literature. Higher meat and lower vegetable intake are known risk factors for liver disease. These findings may provide the basis for larger studies and potential targets for dietary intervention in this population.

Funding Sources

National Institute on Drug Abuse and National Institute on Minority Health and Health Disparities.

Sodium and Sugar Intake Comparison Among Participants of the USDA National School Lunch Program Versus Non-Participants Based on 2015–2016 NHANES Survey

Objectives

The National School Lunch Program (NSLP) surveys the overall health and well-being of participants nationwide. To address rising obesity rates in the US, the USDA implemented revisions in 2010 to the NSLP targeting sodium and sugar intake reduction. Our objective was to compare intake of sodium and sugar between NSLP participants and non-NSLP participants.

Methods

Data from 2015–2016 NHANES survey were analyzed, which is after the implementations of the USDA revisions. All children (4–15 years) with two 24-hr dietary recalls were included. Mean intake for sugar and sodium were computed between the 2 recalls. NSLP participants were those who reported 2–5 school lunches per week whereas those reporting one school lunch per week or none were considered as not participating. Analyses were stratified by the following ages groups: 4–8y; 9–13y; and 14–15y. ANCOVA, adjusted for gender, was used to compare normalized intakes of sugar and sodium.

Results

A total of 1370 children were included (49% were females). Sugar intake was similar between NSLP or non-NSLP participants in children 4–8y. In children 9–13y, sugar intake was higher in NSLP participants (101 ± 2.31 g/d) versus non-NSLP participants (95.2 ± 1.94 g/d; P = 0.010) but lower in children 14–15y in NSLP participants (95.7 ± 2.44 g/d) versus non-NSLP participants (106 ± 2.67 g/d; P = 0.022). Sodium intake was higher in NSLP participants (2731 ± 8.64 mg/d) versus non-NSLP participants (2583 ± 9.69 mg/d; P = 0.020) in children 4–8y and also in children 9–13y (NSLP participants 3097 ± 10.4 mg/d; non-NSLP participants 2852 ± 8.07; P &lt; 0.001) but only lower among NSLP participants (3102 ± 10.3 mg/d) versus non-NSLP participants (3240 ± 12.4 mg/d; P = 0.002) in children 14–15y.

Conclusions

The effects of the new NSLP recommendations are conflicting compared with children not participating in the program. Sugar and sodium intakes were generally higher among NSLP participants between the ages of 9–13 years old. This suggests that despite recommendations to reduce sodium and sugar intake among school children, these nutrients might still be of concern. In short, this study indicates that a greater investment on education is needed and that further research should assess the effect of changes on NSLP recommendations through time.

Funding Sources

Florida International University.

The Effects of Types of Residence and Nutrition Knowledge on Food Insecurity Status Among Syrian Refugees Residing in the State of Florida

Objectives

As a recently arrived vulnerable population, food insecurity might be associated with types of residence and nutrition knowledge among Syrian refugees residing in the State of Florida. We assessed the relationship between food insecurity status, types of residence and nutrition knowledge among Syrian refugees in Florida.

Methods

In one-on-one sessions, the assessments of nutrition knowledge and food insecurity were completed in 80 households (n = 80, 43 in rural area, 37 in urban area). The outcome measures included demographics, types of residence, food insecurity status, the levels of food insecurity, and nutrition knowledge.

Results

Of the 80 households, 20% were food secure while 80% of households experienced food insecurity at different levels. Fisher's exact test showed significant differences between the levels of food insecurity in rural and urban areas, P = 0.02. The mean nutrition knowledge score (42.0 ± 13.6) indicated that Syrian refugees had fair nutrition knowledge. Fisher's exact test showed marginal differences between the levels of food insecurity in households with different nutrition knowledge, P = 0.08. The results of our multivariate logistic regression model showed that types of residence had an inverse significant effect on food security, which remained significant after controlling for nutrition knowledge. Syrian refugees in rural areas had 78.4 greater odds of being food insecure compared with urban areas, odds ratio = 0.216, 95% CI: 0.06–0.777, P = 0.02.

Conclusions

Food insecurity was experienced by 80% of our participants. It was estimated that Syrian refugees had fair nutrition knowledge. Geographical location, types of residence, is a determinant for food insecurity status; Syrian refugees residing in rural areas are more likely to be food insecure compared with urban areas. Greater nutrition knowledge might increase the likelihood of food security among Syrian refugee households. Increasing sample size may be recommended to support our findings.

Funding Sources

Personal funding.

Comparison Between Total Energy Intake and Screen Time Among U.S Children Based on NHANES 2015–2016 Data

Objectives

Childhood obesity is a multifactorial condition related to energy intake and decreased energy expenditure. Increased screen time as television, computers, tablets, and video games may be contributing to the rates of overweight and obesity in the United States. The American Academy of Pediatrics and the Centers of Disease Control and Prevention recommend that children aged 3–5 years should spend up to 1 hour as screen time and older children up to 2 hours per day. Exceeding screen time recommendations may be related to overweight and obesity due to an increased consumption of sugar, fats, and highly advertised food products and to a lower energy expenditure. Our objectives were to compare total energy intake between children that comply or not with recommendations for screen time.

Methods

This was an analysis of data from NHANES 2015–2016. Responses on the average of hours spent daily as screen time from television (TV), video watching, and computer use were analyzed and compared with the mean energy intake obtained from two 24-h dietary recalls. The sample was divided into two age groups following the recommendations for screen time: 3–5 y and 6–14 y. Data were analyzed by one-way analysis of variance (ANOVA), with Bonferroni post-hoc stratified by gender only for 6–14 y.

Results

A total of 1936 participants aged 3–14 y had complete data and were included in the analysis. Reported mean screen time was 5.48 ± 3.91 h in children 3–5 y and 4.98 ± 3.48 h in 6–14 y. Most did not meet the recommendations for screen time (87.6% in 3–5 y and 71.2% in 6–14 y). Girls aged 6–14 y who met the recommended screen time (≤2 h) had significantly lower mean energy intake (1733 ± 534.18 kcal/d) compared to those that spent between 4–8 h (1908 ± 809 kcal/d; P &lt; 0.041). No significant differences in caloric intake were found in energy intake among boys aged 6–14 y or among children aged 3–5 y.

Conclusions

Most of the children did not meet the recommendations for screen time. In girls aged 6–14 years, the length of screen time was associated with total calories consumed. This association might be explained by the high frequency of high calorie-dense foods advertised on television and the internet, which may influence food choices or by less energy expenditure with the long hours of sedentary viewing. This needs to be confirmed in future studies.

Funding Sources

Internal funds from Florida International University.

Are Antidepressants Associated with Energy Intake and Obesity Among U.S. Adolescents and Young Adults

Objectives

Depression and use of antidepressants in U.S. adolescents and young adults are becoming more prevalent. Antidepressant use may lead to higher energy intake and obesity; however, the evidence is not clear. Our objective was to assess whether energy intake and obesity differ between U.S. adolescents and young adults on antidepressants and those who are not.

Methods

Data from the NHANES 2015–2016 on prescription medication use, energy intake and weight status were obtained for participants 10–34 years. Inclusion criteria were completion of two dietary recalls, not underweight and non-pregnant women. Energy intake between users and non-users of antidepressants was compared using ANCOVA, adjusting for age, gender, BMI, and use of weight loss or weight gain diets and for obesity prevalence, we used Chi-square.

Results

The sample consisted of 802 adolescents (10–17 years) and 1126 young adults (18–34 years), with 50.7% female and 32.4% Hispanic, 27.9% White, 22.6% Black, 22.4% Multi-racial/other and 11.7% Asian. Obesity was 15.7% in adolescents and 35.1% in young adults and use of antidepressants was 2.4% in adolescents and 4.3% in young adults. Energy intake was higher among antidepressants’ users (2208 ± 780 kcals) compared to non-users (1982 ± 718 kcals; P &lt; 0.001) after adjusting for age, gender, BMI, and weight loss/gain diet. In adolescents, energy intake was higher among antidepressants’ users (2145 ± 951 kcals) compared to non-users (1898 ± 676 kcals; P &lt; 0.001). In young adults, energy intake was higher among users of antidepressants (2233 ± 712 kcals vs. non-users 2044 ± 742 kcals; P &lt; 0.001). Obesity prevalence was higher among users (40.3% vs. non-users 26.5%, P = 0.038). When the two age groups were independently analyzed, obesity in young adults was significantly higher among users (47.9% vs. non-users 34.5%, P = 0.016), however, obesity in adolescents was not significantly different between groups (21.1% users vs.15.6% non-users, P = 0.682).

Conclusions

In this study, the use of antidepressants was associated with higher energy intake and higher prevalence of obesity, mainly in young adults. These results could be relevant when providing nutrition counseling to adolescents and young adults receiving pharmaceutical treatment for depression to help prevent excess energy intake and weight gain.

Funding Sources

FIU internal funds.

Impact of Eating Frequency and Snack Quality on Body Weight of WIC Preschool Children

Objectives

To understand the influence of eating frequency and snack quality on body weight of preschool children ages 3 up to 5 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC).

Methods

Cross-sectional data were collected from all 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data were extracted from the WIC data system. Centers for Disease Control and Prevention's BMI-for-age percentiles were used to classify children into weight categories that were combined into under/normal weight and overweight/obese. Snacks were categorized into nutrient-based food groups and assigned a quality score.

Results

A total of 197 participants [90 boys (45.7%) and 107 girls (54.3%)] were included. From those, 3.6% were underweight, 64.4% normal weight, 16.8% overweight and 15.2% were obese. Most children consumed 3 meals (97.5%) and between 2 (33%) to 3 (37.1%) snacks on average per day. Mean number of snacks on the weekend was significantly higher than on weekdays (2.78 ± 1.20 vs. 2.67 ± 1.08, P = 0.001). We found a tendency for a lower prevalence of overweight/obesity as the number of eating events increased, although it was not significant. The most frequently consumed snacks were milk, 100% fruit juice, and fresh fruits, consumed daily by more than 75% of the children, irrespective of weight category. There was an overall higher consumption of more nutritious snacks when compared to nutrient-poor snacks (66% vs. 33.5%), with under/normal weight children consuming nutritious snacks more frequently than overweight/obese children (P = 0.09).

Conclusions

Most children included in this study engaged in frequent eating events with a higher intake of the more nutritious snacks, which were both associated with a lower prevalence of overweight/obesity. Our findings suggest that in this age range, participation in the WIC program may foster positive eating behaviors.

Funding Sources

A.C. was supported by a NIH/NIGMS R25 grant. Support to conduct the study was provided by the FIU Dietetics and Nutrition research foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Predictors of Insulin Resistance and Liver Steatosis in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Immune activation is central to developing insulin resistance and is implicated in the pathophysiology of liver steatosis. People living with HIV (PLWH) have elevated biomarkers of immune activation, which may play a role in faster development of insulin resistance and liver steatosis. The objective of this study was to examine if HIV status and immune activation are related to insulin resistance and liver steatosis.

Methods

Demographic and anthropometric data on MASH cohort participants were obtained. Insulin resistance was estimated using the triglyceride-glucose (TyG) index from fasting blood. HIV status was abstracted from participants’ medical records. Immune activation biomarkers soluble CD163 (sCD163), sCD27, sCD14, and monocyte chemoattractant protein (MCP-1) measured with multiplex flow cytometry in Dr. Sherman's laboratory. High sensitivity C-Reactive Protein (hsCRP), measure of inflammation, was determined by LabCorp. Liver steatosis was defined as liver fat &gt;3.5% obtained with magnetic resonance elastography scans. Statistics included descriptive analysis, Mann-Whitney tests, multivariate linear, and logistic regressions, controlled for age, sex, and BMI.

Results

Of the 712 participants (age 54.24 ± 7.48 years), 336 were PLWH with suppressed viral load, and 376 were uninfected healthy participants. PLWH had higher levels of sCD27 (P = 0.003) and MCP-1 (P = 0.034) than uninfected participants. Multiple linear regressions showed HIV status and sCD163 were independently associated with higher insulin resistance (HIV status b = 0.130, P = 0.014, sCD163 Multiple logistic regressions showed higher levels of sCD163 (OR = 1.097, 95% CI: 1.01–1.19, P = 0.032) and insulin resistance (OR = 7.126, 95% CI: 2.59–19.58, P &lt; 0.001) were significant predictors of liver steatosis. HIV status, sCD14, sCD27, hsCRP, or MCP-1 were not related to liver steatosis.

Conclusions

These results indicate that HIV infection and sCD163, a marker of immune activation, are independent predictors of insulin resistance, and sCD163 was associated with greater odds of liver steatosis. Lifestyle interventions and anti-inflammatory agents aimed at reducing insulin resistance and immune activation in PLWH may help to reduce the risk of liver steatosis and other co-morbidities.

Funding Sources

Grant Number: U01DA040381.

Association of Polyunsaturated Fatty Acids and Vitamin B6 with Inflammation in Adults from the National Health and Nutrition Examination Survey (NHANES) 2003–2004

Objectives

Polyunsaturated fatty acids (PUFA) such as n-3 PUFA, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and n-6 PUFA, arachidonic acid (AA) may mediate inflammatory responses. Vitamin B6 deficiency has been shown to alter plasma PUFA levels. This perturbation of PUFA metabolism in vitamin B6 deficiency measured by pyridoxal-5’-phosphate (PLP) may contribute to inflammation. Thus, we aimed to examine the associations of 1) dietary EPA + DHA, and vitamin B6 with plasma ratio of AA/(EPA + DHA) by PLP level, 2) plasma AA/(EPA + DHA) and PLP with C-reactive protein (CRP), a marker for inflammation, and 3) dietary EPA + DHA, and vitamin B6 with CRP level, using NHANES.

Methods

NHANES datasets (2003–2004) with subjects ≥20 years were analyzed, accounting for survey design and sample weights (n = 4486). The significance level was P &lt; 0.05. Covariates were age, gender, ethnicity, BMI, smoking, alcohol, total energy, dietary supplements, physical activity, and NSAIDs, depending on analyses. Multiple linear regression assessed the association of dietary EPA + DHA, and vitamin B6 with plasma ratio of AA/(EPA + DHA) by PLP level (Low: &lt; 20 nmol/L, High: ≥20 nmol/L). Next, multivariate logistic regression predicted the associations of plasma AA/(EPA + DHA) and PLP with CRP level (Low: ≤3 mg/L, Moderate to High: &gt; 3 mg/L); then, dietary EPA + DHA, and B6 with CRP level.

Results

In the low PLP level, dietary EPA + DHA was negatively associated with plasma ratio of AA/(EPA + DHA) (B = ─5.29, SE = 0.84, P = &lt; .0001), but B6 intake was not, whereas, in the high PLP level, both dietary EPA + DHA (B = ─2.99, SE = 0.53, P = &lt; .0001) and dietary vitamin B6 (B = ─0.21, SE = 0.04, P = 0.0001) were inversely associated with plasma AA/(EPA + DHA). Further, low PLP level was associated with greater odds of moderate to high CRP level compared to high PLP level (adjusted OR (aOR): 2.8, 95% CI: 1.93–4.04, P = &lt; .0001), but plasma AA/(EPA + DHA) was not. In addition, both dietary EPA + DHA (aOR: 0.5, 95% CI: 0.23–0.98, P = 0.04) and vitamin B6 (aOR: 0.8, 95% CI: 0.68–0.95, P = 0.009) were inversely associated with moderate to high CRP level.

Conclusions

Our findings show that low plasma PLP level and low vitamin B6 intake are associated with inflammation, and the relationship may be through their effect on PUFA metabolism, suggesting that increased intake of vitamin B6 and EPA and DHA may protect against inflammation.

Funding Sources

N/A.

Obesity Is Associated with Higher Oxidative Stress Among PLWH and Healthy Men, But Not Women, in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Over-expression of oxidative stress leads to the development of obesity-related complications, including non-communicable diseases in healthy populations. We determined the association between obesity and oxidative stress in people living with HIV (PLWH) and un-infected, healthy individuals.

Methods

Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasted blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Oxidative stress was determined using ARBOR ASSAYS (Ann Arbor, MI) glutathione colorimetric detection kit. Descriptive statistics were used to analyze demographics, HIV status, VL (undetectable VL &lt; 50copies/ml), and obesity (BMI ≥30 kg/m2; body fat % &gt;25 Males and &gt;35 Females) status. Logistic regression was used to find an association between high oxidative stress (% oxidized glutathione [GSSG] defined as % GSSG above the median) and obesity (BMI) in the group of PLWH and the healthy group. Association between body fat %, and high % GSSG was also determined. Linear regression was used to find the association between % GSSG and BMI.

Results

Participants’ mean age was 54.4 ± 7.4 years (n = 738), 55.3% were male and 66.3% Black; 46.7% were PLWH; 90.9% had an undetectable viral load and 47.3% of all participants were obese. A univariate linear regression showed a positive association between BMI and % GSSG among the PLWH (b = 0.066 SE = 0.032, CI: 0.002–0.129; P = 0.043) but not in the healthy group. Logistic regression showed obesity to be a significant predictor for high % GSSG (OR = 1.42, 95% CI:1.06–1.92; P = 0.019) after controlling for age, gender and HIV status. However, when participants were separated by sex, obese male participants were 1.55 times more likely to have high % GSSG (OR = 1.55, 95% CI: 1.025–2.348; P = 0.038) than non-obese males after controlling for age and HIV status. Statistically significant associations were not observed in females, regardless of HIV status.

Conclusions

Obese PLWH and obese healthy participants were more likely to have high oxidative stress than non-obese participants. The increased oxidative stress in males but not in females may provide one of the mechanisms for increased risk for non-communicable diseases such as cardiovascular disease, in males.

Funding Sources

National Institute on Drug Abuse.

Validation and Refinement of Noninvasive Methods to Assess Hepatic Fibrosis: Magnetic Resonance Elastography Versus Enhanced Liver Fibrosis Index

BACKGROUND

Noninvasive fibrosis markers are routinely used in patients with liver disease. Magnetic resonance elastography (MRE) is recognized as a highly accurate methodology, but a reliable blood test for fibrosis would be useful. We examined performance characteristics of the Enhanced Liver Fibrosis (ELF) Index compared to MRE in a cohort including those with HCV, HIV, and HCV/HIV.

METHODS

Subjects enrolled in the Miami Adult Studies on HIV (MASH) cohort underwent MRE and blood sampling. The ELF Index was scored and receiver-operator curves constructed to determine optimal cutoff levels relative to performance characteristics. Cytokine testing was performed to identify new markers to enhance noninvasive marker development.

RESULTS

The ELF Index was determined in 459 subjects; more than half were male, non-white, and HIV-infected. MRE was obtained on a subset of 283 subjects and the group that had both studies served as the basis of the receiver-operator curve analysis. At an ELF Index of > 10.633, the area under the curve for cirrhosis (Metavir F4, MRE > 4.62 kPa) was 0.986 (95% CI 0.994-0.996; p < 0.001) with a specificity of 100%. For advanced fibrosis (Metavir F3/4), an ELF cutoff of 10 was associated with poor sensitivity but high specificity (98.9%, 95% CI 96.7-99.8%) with an AUC of 0.80 (95% CI 0.749-0.845). ELF Index performance characteristics exceeded FIB-4 performance. HCV and age were associated with increased fibrosis (p < 0.05) in a multivariable model. IP-10 was found to be a promising biomarker for improvement in noninvasive prediction algorithms.

CONCLUSIONS

The ELF Index was a highly sensitive and specific marker of cirrhosis, even among HIV-infected individuals, when compared with MRE. IP-10 may be a biomarker that can enhance performance characteristics further, but additional validation is required.

Sex Differences, Cocaine Use, and Liver Fibrosis Among African Americans in the Miami Adult Studies on HIV Cohort

Background: HIV infection disproportionally affects African Americans. Liver disease is a major cause of non-HIV morbidity and mortality in this population. Substance abuse accelerates HIV disease and may facilitate progression of liver disease. This study investigated the relationship between sex differences and cocaine use with liver injury, characterized as hepatic fibrosis. Materials and Methods: A cross-sectional study was conducted on 544 African Americans [369 people living with HIV (PLWH) and 175 HIV seronegative] from the Miami Adult Studies on HIV (MASH) cohort. Cocaine use was determined with a validated self-reported questionnaire and confirmed with urine screen. Fasting blood was used to estimate liver fibrosis using the noninvasive fibrosis-4 (FIB-4) index. Results: Men living with HIV had 1.79 times higher odds for liver fibrosis than women living with HIV (p = 0.038). African American women had higher CD4 count (p = 0.001) and lower HIV viral load (p = 0.011) compared to African American men. Fewer women (PLWH and HIV seronegative) smoked cigarettes (p = 0.002), and fewer had hazardous or harmful alcohol use (p < 0.001) than men. Women also had higher body mass index (kg/m²) (p < 0.001) compared to men. No significant association was noted among HIV seronegative participants for liver fibrosis by sex differences or cocaine use. Among African Americans living with HIV, cocaine users were 1.68 times more likely to have liver fibrosis than cocaine nonusers (p = 0.044). Conclusions: Sex differences and cocaine use appear to affect liver disease among African Americans living with HIV pointing to the importance of identifying at-risk individuals to improve outcomes of liver disease.

Urinary Paraben Concentrations and Its Association with Serum Triglyceride Concentrations in 2013–2014 NHANES Participants (P08-120-19)

Objectives

Alkyl esters of para-hydroxybenzoic acid, colloquially known as parabens, are types of preservatives found in multiple foodstuffs, pharmaceuticals and personal care products to which Americans are exposed daily. It is unclear if parabens exhibit carcinogenic or endocrine-disrupting properties. Methylparaben and propylparaben, two of the parabens most commonly found in foods, may interact with triglycerides in adipose tissue and impact lipid metabolism. Due to the potential for adverse impact, it is imperative to study how parabens interact with lipids in humans. Our objective was to evaluate the association between urinary parabens and serum triglyceride concentrations.

Methods

This cross-sectional study used data from adults 20 years and older from the 2013–2014 NHANES. Triglyceride levels were associated with urinary paraben concentrations (methyl and propyl) using a Hierarchical Multiple Regression, adjusting for ethnicity/race, gender, waist circumference, BMI and age.

Results

A total of 794 participants were included in the analyses; their mean age was 49.7 years, 52.4% were female, 43.07% were white, and 20.2% were black. Triglycerides were inversely associated with methylparaben (CI 95% −.054, −.004, β = -0.82, P = 0.022) and propylparaben (CI 95% −.04, −.003, β = -0.81, P = 0.026). When adjusting for age, gender, race/ethnicity, BMI and waist circumference, the model remained significant for methylparaben (P < 0.05, adjusted R2 = .140), and propylparaben (P < 0.05, adjusted R2 = .140).

Conclusions

Despite the potential detrimental effects of parabens on triglycerides, our results suggest that urinary excretion of methylparaben and propylparaben are associated with lower circulating triglycerides. Further research is needed to confirm the mechanisms and health impact of this relationship.

Funding Sources

Florida International University Internal Funding.

Substance Use, Cocaethylene and Obesity in HIV-Infected and Non-Infected Subjects from the Miami Adult Studies in HIV (MASH) Cohort (P10-082-19)

Objectives

Cocaethylene (CE) is a blood metabolite indicating concomitant use of cocaine and alcohol. This combination increases the euphoric effects of cocaine, as well as its longevity in blood. Its toxicity is about 30% greater than that of cocaine or alcohol alone and has plasma half-life 3 to 5 times that of cocaine. CE has been associated with increased non-AIDS related morbidity and mortality, such as heart attacks, liver damage, and increased risk for immediate death. We examined polysubstance use, including the presence of CE and obesity in the MASH Cohort.

Methods

A subset of 74 HIV-infected and 75 non-infected participants (N = 149) from the MASH Cohort were included for this analysis. Demographic characteristics and body mass index (BMI) were obtained through in-person interviews as part of the MASH Cohort's activities. Cocaine, alcohol and opioid use were determined by self-report (30-day use), urine toxicology and blood metabolites; AUDIT-C was also used for alcohol consumption.

Results

Cocaine was used by 48.6% (n = 36) of HIV-infected and 52% (n = 39) of non-infected participants. CE was present in 28.6% (n = 8) of HIV-infected and 20.5% (n = 8) of non-infected participants; most were female (75.0%) and all were Black. BMI of those CE-positive was 35.4 kg/m2. Opioid use among CE-positive subjects was equal in both groups (62.5% each), but opioid use was more prevalent in HIV-infected than non-infected participants (68.9% vs. 54.7% respectively). CE concentrations were directly correlated with AUDIT-C and drinks/week (r = .313 and r = .391, respectively; P < .001). No differences in CE concentration and alcohol consumption were found between HIV-infected and non-infected participants. However, AUDIT-C was significantly higher among CE-positive subjects for both HIV-infected (µ = 3.5 ± 1.8 vs. 1.3 ± 1.6 for CE-positive and negative, respectively; P = .001) and non-infected participants (µ = 4.13 ± 2.9 vs. 1.91 ± 2.2 for CE-positive and negative, respectively; P = .01).

Conclusions

Blood CE shows concurrent use of cocaine and alcohol. In addition, use of opioids and obesity is common among these MASH Cohort participants. Polysubstance use, in combination with obesity, may pose an increased risk for non-AIDS related morbidity and mortality. Longitudinal studies with larger samples are needed.

Funding Sources

National Institute on Drug Abuse 5U01DA040381-03.

Association of TIMP1 Levels and Liver Disease Progression Among HIV/HCV Co-infected, HIV Mono-, HCV Mono-infected, and Healthy Groups from the MASH Cohort (FS09-07-19)

Objectives

Antiretroviral therapy has increased life expectancy for HIV infected patients; however, this population is developing chronic illnesses associated with aging. Liver disease is a major cause of non-AIDS mortality, characterized by progressive fibrosis. Infection with HIV and with Hepatitis C Virus (HCV) promotes liver fibrogenesis. Tissue inhibitor of metalloproteinase-1 (TIMP1), inhibits fibrosis regression and is profibrogenic. Association between TIMP1 and liver disease progression in an aging population of HIV/HCV co-infected, HIV mono-infected, HCV mono-infected, and healthy groups from the Miami Adult Studies on HIV (MASH) cohort in Miami, Florida, was investigated.

Methods

Serum TIMP1 levels were determined by ELISA. A non-invasive estimate of liver fibrosis, FIB-4 score was calculated. Liver fibrosis was defined as FIB-4: Low <1.45, intermediate 1.45 < = FIB-4 < = 3.25, High >3.25. ANOVA with Tukey's test assessed the mean differences of FIB-4 score and TIMP1 level between groups, TIMP1 levels between 3 FIB-4 categories, and the effect of age on FIB-4 and TIMP1. Linear regression predicted the association of FIB-4 score and TIMP-1 level.

Results

Mean age of the cohort was 54.3 ± 8.1 years with no difference between groups. Mean FIB-4 for HIV/HCV co-infected group was the highest among the 4 groups (P < 0.05). Mean TIMP1 for HIV/HCV co-infected group was also the highest among the 4 groups (P < 0.05). FIB-4 and TIMP1 were associated and remained so (β = 0.01, SE = 0.002, P < 0.001) after adjusting for age. Mean TIMP1 for the high FIB-4 category was the highest among the 3 FIB-4 categories (P < 0.05). There was a direct effect of TIMP1 levels on FIB-4 category (P < 0.001). After adjusting for HIV/HCV co-infection (P < 0.001), HIV infection (P < 0.0001), HCV infection (P < 0.002), non-infection (P < 0.001) and age, the relationship between TIMP1 and FIB-4 remained significant. The adjusted TIMP1 mean for HIV/HCV co-infected group was significantly higher compared to HIV infected (P < 0.0001), HCV infected (P < 0.002), and healthy groups (P < 0.0001), regardless of age.

Conclusions

Age is a significant factor of liver diseases progression. Our findings of the highest levels of TIMP1 in HIV/HCV co-infected group, which had the highest liver fibrosis regardless of age, supports the role of TIMP1 as a regulator in the progression of hepatic fibrosis.

Funding Sources

National Institutes on Drug Abuse #5UO1DA040381.

Diet and All-cause Mortality in Hemodialysis Patients (P18-010-19)

Objectives

Evaluate the association between the hemodialysis (HD) patient's diet components and all-cause mortality in a 12-month prospective analysis.

Methods

The diet components of 77 HD participants were examined using 24-hr recalls administered on dialysis and non-dialysis days, participant's demographics were obtained from the chart and all-cause mortality was registered for 12 months.

Results

The mean age ± SD was 63.2 ± 15.7 years; 28.8% were female, 58.4% of the patients had DM and 13% died of cardiovascular disease. When comparing dietary energy intake (DEI) and dietary protein intake (DPI) with the National Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines (30–35 kcal/kg; 1.2 g/kg daily) only 59.5% of the participants met energy recommendations and 25.2% met protein recommendations. Survivors had a greater protein and energy intake when compared to non-survivors; DEI (1917 ± 400 vs 1615 ± 321, P = 0.026) DPI (81 ± 16 vs 66 ± 11, P = 0.06); greater intake of fruit servings (2.4 ± 0.99 vs 1.5 ± 0.85, P = 0.09); greater intake of cereal-fiber grams (11.6 ± 4.5 vs 7.4 ± 4.4, P = 0.07). The intake of at least two fruit servings per day, decreased four-fold the mortality risk (HR:0.246; 95.0%, C.I. 0.069–0.880) P = 0.031; and the intake of at least 7 grams of cereal-fiber per day, decreased five-fold the mortality risk (HR:0.187; 95.0%, C.I. 0.050–0.693, P = 0.012); when adjusted by age, gender and diabetes the relationships remained significant (P < 0.05).The differences in the intake of vegetables, white/red meat, nuts/soy and fat (trans-, poly, and saturated fat) did not achieve significance, P > 0.05).

Conclusions

Hemodialysis patients should be encouraged to use various food sources to meet their energy and protein requirements as well as satisfy at least two servings of fruits and 7 grams of cereal-fiber per day to prevent cardiovascular mortality.

Funding Sources

No funding resources. This study is part of a PhD dissertation thesis.

Intakes of Vitamin a and Zinc and Markers of Oxidative Stress in Newly Diagnosed HIV-positive Participants in the MASH Cohort in Miami (P24-016-19)

Objectives

HIV infection is characterized by increased oxidative stress. We examined the association of antioxidant intake with measures of oxidative stress and HIV disease progression in newly diagnosed HIV-infected participants.

Methods

Cross-sectional study of 52 newly-diagnosed HIV-positive participants in the MASH cohort. Blood was drawn for parameters of oxidative stress (oxidized glutathione % and oxidative mitochondrial DNA damage [8-oxo-dG]) and disease stage (CD4- cell counts; HIV-viral load). Questionnaires on demographics and 24-hour dietary recalls and Alcohol Use Disorders Identification Test (AUDIT) were administered. AUDIT scores ≥ 8 was considered hazardous drinking. Dietary intakes of vitamin A and Zinc were calculated. SPSS was used for analyses and Linear Regression Models were estimated.

Results

Participants were 74% male, 75% Black Non-Hispanic, and 21% Hispanics. Mean age was 42.3 ± SD10.2 years, CD4 count was 506.7 ± SD733.4 cells/µLA cross-sectional and HIV viral load was 3.63 ± SD1.23log10 copies/mL. Dietary intake of vitamin A (β = −0.001, SE = 0.0002, P = 0.044) and zinc (β = −0.0004, SE = 0.0002, P = 0.044) were inversely related with mitochondrial DNA damage (8-oxo-dG), after adjusting for education, race, age, gender, and excessive alcohol use. Oxidized glutathione percentage was directly associated with HIV-viral load (β = 0.81, SE = 0.4, P = 0.037) adjusting for age, gender, AUDIT ≥ 8 and BMI in linear regressions.

Conclusions

Lower intake of vitamin A and Zinc were associated with higher oxidative stress and higher HIV viral load. These findings suggest that antioxidant supplementation may be beneficial immediately after receiving a diagnosis of HIV infection as well as during antiretroviral treatment.

Funding Sources

Funded by the National Institute on Drug Abuse and the National Institute of Health.

Lowered Fasting Blood Glucose (FBG) in a Prediabetic Individual with HIV Despite Struggle with Weight Control Management- CASE STUDY (FS17-06-19)

Objectives

HIV infection has previously been associated with malnutrition and wasting; however, with the initiation of antiretroviral therapy (ART), a growing number of people living with HIV (PLWH) are becoming centrally obese, with disproportionate weight accumulation around the abdominal area and fat losses in the rest of their body (periphery face, arms and legs), indicative of lipodystrophy. As a result, some PLWH may struggle simultaneously with central fat accumulation and peripheral losses, trying to balance these 2 opposite effects.

Methods

PB is a 62-year-old, African-American male infected with HIV for 12 years, receiving an NRTI regimen. Participating in the Miami Adult Studies in HIV (MASH) Cohort, PB started a 6-month nutrition intervention targeted to lower diabetes risk in prediabetic PLWH. Baseline body mass index (BMI) was 24.1 kg/m2 and waist circumference (WC) was 36.5 inches. Despite having the initial intention to lose weight, PB gained ∼12.4 lbs just a month after initiation. When questioned about the weight gain, PB revealed that he had started taking an appetite stimulant (Megace) to address the wasting on his periphery, claiming that he looked “sickly”. PB stopped taking Megace after he gained >20 lbs (12.3% Wt∆) in 4 months. BMI at this time was 26.3 kg/m2 and WC was 45.5 inches, reflecting a substantially increased risk for metabolic complications. With WC increasing 9 inches and hip circumference increasing only 2 inches, it is evident that a considerable amount of the weight accumulation occurred around the waist. As can be seen, he among others in his situation, are struggling with conflicting goals by simultaneously trying to reduce central obesity and prevent peripheral losses and wasting, something that may be unique to PLWH.

Results

Despite the participant's difficulties in weight management, his fasting blood glucose (FBG) improved after the 6-month nutrition intervention, with a −14 mg/dL improvement, lowering associated risk for diabetes and cardiometabolic complications.

Conclusions

This improvement in FBG levels suggests that despite the difficulty of effective weight management in these patients, proper glucose values may still be achieved with nutrition counseling and education, thus lowering risk for diabetes and associated complications.

Funding Sources

NIGMS-RISE funding, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

MIS and SGA Indices as Predictors of Mortality and Their Relationship with Nutrition Parameters in Hemodialysis Patients (P18-009-19)

Objectives

To compare the value of Subjective Global Assessment (SGA) and Malnutrition-Inflammation Score (MIS) for the prediction of mortality and examine their relationship with other nutritional parameters.

Methods

Nutrition status was assessed at baseline by SGA and MIS; albumin, protein catabolic rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary protein intake (DPI) and dietary energy intake (DEI). Deaths were recorded for 12 months

Results

Seventy-seven participants receiving HD were included, with a mean age of 63.2 ± 14.2 years; 71.2% were male, 58.4% had diabetes and the average time on dialysis was 6.2 ± 4.2 years. The Mean ± SD of nPCR was 0.9 ± 0.2, albumin was 3.8 ± 0.3, DEI was 1867.3 ± 367.9 kcal/kg and DPI was 80.0 ± 15.8 gm/kg. MIS ≥ 6 and SGA > 1 were used as cut-off values to detect malnourished participants; 46% were malnourished by MIS vs. 35% by SGA. Albumin, nPCR, DPI and DEI were all inversely correlated with both indices (P < 0.05).Ten patients (13%) died of cardiovascular disease. Well-nourished participants with MIS < 6 lived longer (11.8 months, CI 95%, 11.6–12.1) than malnourished with MIS ≥ 6 (10.9 months, CI 95%, 10.1–11.7) (Log Rank P = 0.04). MIS was a significant predictor of mortality, while SGA did not reach significance (P = 0.264).

Conclusions

MIS was a more sensitive index to detect malnutrition than SGA among HD patients. Only MIS was a significant predictor of mortality. Both indices were strongly correlated to the examined nutrition parameters.

Funding Sources

No funding sources.

Cocaine Use, Oxidative Stress and Inflammation Among People Living with HIV in the MASH Cohort in Miami (P19-002-19)

Objectives

HIV infection and cocaine use contribute to oxidative stress; persistent oxidative stress leads to rapid rates of glutathione (GSH) consumption. GSH is an abundant intracellular antioxidant and is synthesized from its precursor amino acids. HIV promotes changes in the components of the antioxidant defense system, resulting in GSH depletion and may cause DNA damage, and is associated with chronic inflammatory diseases. Therefore, the aim is to assess oxidative stress, and biomarkers of inflammation in HIV-infected individuals from the Miami Adult Studies on HIV (MASH) cohort, on stable antiretroviral therapy (ART), with controlled HIV viral load.

Methods

A cross-sectional study of participants in the MASH cohort in Miami. Participants were consented and blood was collected for C-reactive protein (CRP), oxidized glutathione and % of reduced to oxidized glutathione (GSH: GSSG). Anthropometrics included body fat measured by the bioimpedance analysis machine.

Results

Mean age was 54.6 ± 6.3 years, 67% were male, and 50% used cocaine, mean BMI was 26.2 ± 3.1, CRP was 7.1 ± 12.4, oxidized glutathione was 34.4 ± 32.4 mmol, and the ratio of GSH: GSSG 4.86 ± 4.7. All participants had undetected viral load and were mainly overweight (70%) with a mean fat% of 28.0 ± 7.1. Cocaine use was strongly related with CRP (r = 401, P = 0.014) and GSH: GSSG (r = −389, P = 0.017) ; BMI was lower with age (r = −0.502, P = 0.024); and fat contain was lower in males (r = −0.474, P = 0.004); males also had significantly higher oxidized glutathione (r = 0.384, P = 0.018); age was inversely correlated with BMI (r = −0.335, P = 0.027). A nutritional supplementation with antioxidants with a longitudinal follow-up of outcomes is in progress.

Conclusions

Our findings suggest that cocaine use is significantly associated with markers of inflammations and oxidative stress in people living with HIV who are already at risk for these conditions, and interventions with antioxidants and detoxification interventions are important for these participants.

Funding Sources

National Institute on Drug Abuse.