Prevalence of current smoking and association with meeting 24-h movement guidelines: Results from a national convenience sample of autistic adults

LAY ABSTRACT

Cigarette smoking is a leading risk behavior for cardiovascular disease; yet its prevalence and determinants are not clear in autistic adults. We examined the prevalence of current smoking and its association between meeting 24-h movement (i.e. sleep, physical activity, and sedentary behavior) guidelines in a self-selecting convenience sample of 259 autistic adults in the United States. We found that current smokers met fewer 24-h movement guidelines. Most significant, those who had insufficient sleep and those with high levels of sedentary behavior were more likely to be current smokers. Therefore, targeting these movement behaviors may be potential intervention targets for smoking cessation.

Temporal associations between nightly sleep with daytime eating and activity levels in free-living young adults

STUDY OBJECTIVES

This study aimed to quantify the temporal associations between nightly sleep quantity and timing with daytime eating behavior and activity levels in free-living (i.e. non-experimental) settings.

METHODS

Generally healthy young adults (N = 63; 28.9 ± 7.1 years) completed concurrent sleep (wrist actigraphy), eating (photo-assisted diet records), and activity (waist actigraphy) assessments over 14 days. Multilevel models quantified the associations between nightly sleep (total sleep time, timing of sleep and wake onset) with next-day eating behavior (diet quality, caloric intake, timing of eating onset/offset, eating window duration) and activity levels (total physical activity, sedentary time). Associations in the reverse direction (i.e. eating and activity predicting sleep) were explored. Models adjusted for demographic and behavioral confounders and accounted for multiple testing.

RESULTS

At within- and between-subject levels, nights with greater-than-average total sleep time predicted a shorter eating window the next day (all p ≤ 0.002). Later-than-average sleep and wake timing predicted within- and between-subject delays in next-day eating onset and offset, and between-subject reductions in diet quality and caloric intake (all p ≤ 0.008). At within- and between-subject levels, total sleep time was bidirectionally, inversely associated with sedentary time (all p < 0.001), while later-than-average sleep and wake timing predicted lower next-day physical activity (all p ≤ 0.008).

CONCLUSIONS

These data underscore the complex interrelatedness between sleep, eating behavior, and activity levels in free-living settings. Findings also suggest that sleep exerts a greater influence on next-day behavior, rather than vice versa. While testing in more diverse samples is needed, these data have potential to enhance health behavior interventions and maximize health outcomes.

Sleep Variability, Eating Timing Variability, and Carotid Intima-Media Thickness in Early Adulthood

Background Day-to-day variability in sleep patterns and eating timing may disrupt circadian rhythms and has been linked with various adverse cardiometabolic outcomes. However, the extent to which variability in sleep patterns and eating timing relate to atherosclerotic development in subclinical stages remains unclear. Methods and Results Generally healthy adults (N=62, 29.3±7.3 years, 66% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo-assisted diet records, respectively. Variability in sleep duration, sleep onset, eating onset (time of first caloric consumption), eating offset (time of last caloric consumption), and caloric midpoint (time at which 50% of total daily calories are consumed) were operationalized as the SD across 14 days for each variable. Separate regression models evaluated the cross-sectional associations between sleep and eating variability metrics with end-diastolic carotid intima-media thickness (CIMT) measured via ultrasonography. Models adjusted for age, sex, systolic blood pressure, sleep duration, and total energy intake. Each 60-minute increase in sleep duration SD and sleep onset SD were associated with a 0.049±0.016 mm (P=0.003) and 0.048±0.017 mm (P=0.007) greater CIMT, respectively. Variability in eating onset and offset were not associated with CIMT; however, each 60-minute increase in caloric midpoint SD was associated with a 0.033±0.015 mm greater CIMT (P=0.029). Exploratory post hoc analyses suggested that sleep duration SD and sleep onset SD were stronger correlates of CIMT than caloric midpoint SD. Conclusions Variability in sleep patterns and eating timing are positively associated with clinically relevant increases in CIMT, a biomarker of subclinical atherosclerosis, in early adulthood.

Psychosocial Assessment Practices for Hematopoietic Stem Cell Transplantation: A National Survey Study

Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.

Rurality Impacts Mammography Screening Adherence Among Mid-life Women in the Kansas Region

OBJECTIVE

The gold standard for breast cancer screening and prevention is regular mammography; thus, understanding what impacts adherence to this standard is essential in limiting cancer-associated costs. We assessed the impact of various understudied sociodemographic factors of interest on adherence to the receipt of regular mammograms.

METHODS

A total Nc = 14,553 mammography-related claims from Nw = 6,336 female Kansas aged between 45 and 54 were utilized from insurance claim databases furnished by multiple providers. Adherence to regular mammography was quantified continuously via a compliance ratio, used to capture the number of eligible years in which at least one mammogram was received, as well as categorically. The relationship between race, ethnicity, rurality, insurance (public/private), screening facility type, and distance to nearest screening facility with both continuous and categorically defined compliance were individually assessed via Kruskal-Wallis one-way ANOVAs, chi-squared tests, multiple linear regression models, and multiple logistic regression, as appropriate. Findings from these individual models were used to inform the construction of a basic, multifaceted prediction model.

RESULTS

Model results demonstrated that all factors race and ethnicity had at least some bearing on compliance with screening guidelines among mid-life female Kansans. The strongest signal was observed in the rurality variable, which demonstrated a significant relationship with compliance regardless of how it was defined.

CONCLUSION

Understudied factors that are associated with regular mammography adherence, such as rurality and distance to nearest facility, may serve as important considerations when developing intervention strategies for ensuring that female patients stick to prescribed screening regimens.

Identifying the most proximal multi-level factors associated with meeting each of the 24-h movement behavior recommendations in a sample of autistic adults

BACKGROUND

Autistic adults have poorer 24-h movement behaviors, including lower levels of physical activity, more time spent being sedentary, and shorter sleep duration than neurotypical adults. Social ecological frameworks posit that 24-h movement behaviors are determined by multi-level domains; however, not known is which multi-level factors are most important to meeting each of the 24-h movement behavior guidelines among autistic adults.

OBJECTIVE

This study examined the relative importance of a range of multi-level determinants on meeting guidelines for the 24-h movement behaviors of aerobic physical activity, sedentary behavior, and sleep.

METHODS

We administered at cross-sectional electronic survey to a national self-selecting, convenience sample of autistic adults and caregivers of autistic adults residing in the USA. We used machine learning to examine the relative variable importance (VIMP) of 55 multi-level variables with meeting recommendations for physical activity, sedentary behavior, and sleep duration. VIMPs >0 indicate predictive variables/domains.

RESULTS

A greater number of group activities attended in the last 3-months, and greater independence in completing activities of daily living were most important to meeting aerobic physical activity guidelines. Group activity participation and marital status were important to meeting sedentary behavior guidelines while having a fewer number of comorbidities was most important to achieving adequate sleep.

CONCLUSIONS

These data support hypotheses about the role of family and social level interventions targeting movement behaviors in autistic adults.

Psychological and behavioral moderators of physical health among caregivers and non-caregivers

The current study sought to evaluate whether psychological and/or behavioral health moderate the relationship between caregiving and physical health.

MATERIALS AND METHODS

Using data from the Behavioral Risk Factor Surveillance System (BRFSS) survey (2017-2018), separate composite scores were created for psychological and behavioral health. Self-reported physical health was the primary outcome. The sample was 1,387 non-caregivers and 266 caregivers.

RESULTS

The psychological, behavioral, and self-reported physical health did not significantly differ between caregivers and non-caregivers, but psychological and behavioral health were shown to differentially affect self-reported health outcomes among caregivers, compared to non-caregivers. Caregivers with worse psychological health had higher odds of experiencing poor physical health versus non-caregivers, while caregivers with better behavioral health had lower odds of having better general health versus non-caregivers.

DISCUSSION

These data extend our understanding on how to consider the impact of psychological and behavioral health as a caregiver and opportunities to develop targeted interventions.

24-h movement behaviors among autistic adults: Differences by sex, age, and level of independence

BACKGROUND

Autistic adults have low levels of physical activity [PA], high levels of sedentary behavior [SB], and insufficient sleep. Not known is the extent to which engagement in these movement behaviors vary by sex, age, and level of independence in activities of daily living (ADLs).

OBJECTIVE

To characterize movement behaviors in a national sample of autistic adults by sex, age, and level of independence in ADLs.

METHODS

A national sample of autistic adults and caregivers of autistic adults self-reported PA, SB and sleep behaviors as well as demographic variables using an electronic survey. Levels of engagement in movement behaviors were described, and compared by sex, age (young-adult versus middle-age), and level of independence in ADLs.

RESULTS

Data were collected on 361 autistic adults (60.3% male, n = 217, mage = 30.82 years, SD = 10.24). Overall, 44% did not meet the PA guideline; PA guideline adherence was lowest among males and those who were dependent on others in ADLs. Overall, the SB guideline was not met by 43% of the sample at weekdays and 48% at weekends. SB guideline adherence was lowest among adults who were middle-aged, and those who were fully independent in ADLs. Overall, 35.2% did not meet the total sleep time (TST) guideline. Middle-aged autistic adults had the lowest adherence to the TST guideline.

CONCLUSIONS

These finding should prompt researchers to consider these demographic differences, and tailor research and programmatic efforts to account for the unique movement behavior profiles of different segments of this heterogenous population.

Posteriori Diet Patterns of Formula-Fed Infants During First 1.5 Years

Objectives

For the first time in American history, the 2020–2025 Dietary Guidelines for Americans (DGA) focus on the diet patterns of children under age two. Given the importance of nutrition in early life, the present study reports on the longitudinal data-derived diet patterns of a racially diverse group of infants from the age of 0.5 months, when they were exclusively formula fed, until 1.5 years.

Methods

Weighed/measured diet records were obtained monthly from enrollment (0.5 months) to 1 year, and at 1.5 years during a trial on healthy infants who were randomized to one of two isocaloric commercial infant formulas. Diet records were analyzed using Nutrient Data System for Research from which foods and beverages were assigned to mutually exclusive ‘What We Eat in America’ food categories; each infant's intake was standardized (g/kg body weight) at each age. Principal component analysis and scree plot inspection were used to derive diet patterns; an absolute loading of at least 0.2 indicated food categories highly correlated within a diet pattern.

Results

Over the first 1.5 years, regardless of randomization, four diet patterns were identified. The diet pattern for the vast majority of infants at 4.5–5.5 months consisted of iron-fortified infant formula. At 6.5–7.5 months, two-thirds of infants began to transition to a first foods diet pattern comprised primarily of infant cereals, fruits, vegetables, grain mixed dishes, and potatoes (not fried). Shortly thereafter, two unique diet patterns containing table foods emerged, such that by 1–1.5 years, the diet patterns for the majority included but were not limited to pizza, high sugar cereal, milk, fried foods, bakery products and vegetables.

Conclusions

Infant diet patterns emerge and transition rapidly. While the pattern for the majority of infants was infant formula at or before 5.5 months, as recommended, the diet patterns that emerged during the next 6–12 months contained foods that the DGA recommends should be limited (e.g., fried foods) or eliminated (e.g., added sugars) for young children, underscoring the urgent need to focus on diet patterns before 2 years.

Funding Sources

NIH Grants R01HD072307 and R03HD09408.

181 Sleep health concordance among socioeconomically disadvantaged caregiver-child dyads

Introduction

Child and caregiver sleep typically occurs within a family system. Disadvantaged families experience disproportionately poorer sleep health than more advantaged families. The extent to which objectively measured sleep health metrics (e.g. duration, timing, regularity, efficiency) are concordant within disadvantaged family systems, such as caregiver-child dyads, is not clear. To address this gap, this study aimed to: (1) characterize sleep health metrics, and (2) identify levels of sleep health concordance among disadvantaged caregiver-child dyads.

Methods

23 disadvantaged dyads were recruited from Philadelphia and Delaware communities. Dyads were eligible if the child was between 6-14 years, slept in the same house as the caregiver at least four nights/week, had no diagnosis of a sleep disorder or use of sleep medication, and qualified for federally funded food assistance programs (e.g., food stamps, WIC or SNAP benefits). Sleep health of the dyads was objectively measured for 7-14 days. Sleep metrics used to characterize the sample were: nighttime sleep duration (hours), time-to-bed, sleep regularity (standard deviation of sleep duration), sleep midpoint (halfway point between sleep onset and wake time) and efficiency (percentage of time spent asleep versus awake). Concordance in sleep health metrics within dyads was calculated using Pearson’s correlation coefficients of the average sleep metrics over the monitoring period.

Results

Children (46.2% female) slept, on average, 7.96 hours per night, with 1.25 hours of nightly sleep variability, bedtime of 10:47 PM, sleep midpoint of 2:56 AM, and sleep efficiency of 83.55%. Caregivers (mean age = 40.5 years, 85.0% female) slept, on average, 6.92 hours per night, with 1.22 hours of nightly sleep variability, bedtime of 11:24 PM, sleep midpoint of 3:04 AM, and sleep efficiency of 76.29%. Bedtime (r = 0.19, p &lt; 0.001), sleep midpoint (r = 0.39, p &lt; 0.001), and sleep efficiency (r = 0.24, p &lt; 0.001) were significantly concordant among caregiver-child dyads.

Conclusion

Given their level of concordance, bedtime, sleep midpoint and efficiency are modifiable factors of sleep health in disadvantaged dyads that could be targeted using family versus individual level interventions.

Support (if any)

University of Delaware General University Research Grant and School of Nursing SEED funding.

013 Associations Between Rest-Activity Rhythms and Nocturnal Blood Pressure are Sex-Dependent in Apparently Healthy Emerging Adults

Introduction

Misalignment between endogenous circadian rhythms and environmental signals – an emerging risk factor for cardiovascular disease (CVD) – can disrupt diurnal blood pressure (BP) rhythms, resulting in higher nocturnal BP and less-pronounced BP dipping (i.e., % decline in nighttime systolic BP [SBP] relative to daytime values). Daily patterns of rest and activity (‘rest-activity rhythms’ [RAR]) are a proxy for estimating circadian disruption in free-living settings and have been independently associated with elevated CVD risk. However, the relation between RAR and nocturnal BP is unclear. Thus, we aimed to quantify the associations between RAR and nocturnal BP characteristics in male and female emerging adults (18-25y).

Methods

Fifty healthy emerging adults (20±1y; 20M/30F) underwent 24-h ambulatory BP monitoring following 14 consecutive days of continuous wrist actigraphy. RAR variables of interdaily stability (IS; day-to-day consistency in RAR), intradaily variability (IV; within-day fragmentation of RAR), and relative amplitude (RA; difference between trough vs. peak activity) were computed. Bivariate correlations were used to quantify associations between RAR variables and nocturnal BP characteristics for all participants, and separately for males and females. Linear regression models of mean nocturnal SBP, nocturnal diastolic BP (DBP), and SBP dipping were also generated to test main and interactive effects of sex and RAR. Potential confounders (variables associated with outcomes at p&lt;0.10) of daytime BP, race, body mass index, physical activity, sleep duration, alcohol, caffeine, and sodium intake were also included as indicated.

Results

Overall, IS and RA positively correlated with % SBP dipping (IS: r=0.33, p=0.02; RA: r=0.35, p=0.01). Among females only, correlations strengthened (IS: r=0.50, p&lt;0.01; RA: r=0.52, p&lt;0.01) and an inverse association between RA and mean nocturnal SBP emerged (r=-0.46, p=0.01). Conversely, among males, no significant associations were apparent. Multivariate regressions revealed a significant sex*RAR interaction, such that in females, every 1-standard deviation increase in IS and RA were associated with an average decrease in nocturnal SBP of 5.4 mmHg (95% CI: -10.0, -0.73) and 4.8 mmHg (95% CI: -9.2, -0.34), respectively.

Conclusion

Findings suggest that consistent and high-amplitude RAR associate with more favorable nocturnal BP characteristics, particularly in emerging female adults.

Support (if any)

Supported in part by NIH P20-GM113125.

An exploration of clinical, behavioral, and community factors associated with sleep duration and efficiency among middle-aged Black/African American smokers

STUDY OBJECTIVES

We examined the most important correlates to sleep duration and efficiency from a comprehensive array of multilevel factors.

METHODS

Baseline data from a cohort of 216 Black/African American smokers aged 40-65 years were examined. The binary outcomes of healthy sleep duration (6-8 h/night) and efficiency (≥85%) were ascertained from 14 consecutive days of actigraphy. Seventy-three independent variables from socio-demographic, individual behavioral, individual physiological, interpersonal, and community domains were assessed. Random survival forest decision trees were generated for each outcome, and variable importance metrics used to rank the predictive abilities of exposure variables. The 5 most predictive exposure variables for each outcome were entered into a regression model of the respective outcome (with age and sex).

RESULTS

Study participants (N = 216) had a mean age of 54.57 years (SD = 6.17) and 57% were male. Healthy sleep duration was achieved by 56.5% and healthy sleep efficiency by 13.6% of the sample. Regression models showed every additional minute of light physical activity was associated with 1% increased odds, while every unit decrease in the inflammation marker of interleukin-8 was associated with 12% increased odds, of achieving a healthy sleep duration. Every unit increase in total social support was associated with a 34% increased odds, while every unit increase in the hazardous drinking score corresponded with 30% decreased odds, of achieving healthy sleep efficiency.

CONCLUSIONS

Light physical activity, social support, and alcohol consumption may be key modifiable intervention targets to improving sleep duration and sleep efficiency in this population.

Rest-activity rhythms in emerging adults: implications for cardiometabolic health

Emerging adulthood (18-25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (p < .05), IV was positively associated with CRP (p < .05), and autocorrelation was inversely associated with total cholesterol (p < .05) and CRP (p < .05). Conversely, associations between RA and cardiometabolic biomarkers were nonsignificant after adjustment for BMI, alcohol, and caffeine consumption. In conclusion, RAR metrics, namely, a higher IS, lower IV, and higher autocorrelation, emerged as novel biomarkers associated with more favorable indices of cardiometabolic health in this sample of apparently healthy emerging adults.

Dietary Diversity and Dietary Quality: Associations With Body Mass Index Change in Diverse Adults With Age

Dietary Diversity (DD), a variety element of a healthful diet, can be measured by count, evenness and dissimilarity scores. This study explored the associations of DD, and dietary quality measured by Dietary Approaches to Stop Hypertension (DASH) score, with annualized Body Mass Index (BMI) change in a diverse sample. Participants, 1,104 African American (57.9%) and White (42.1%) adults, were from the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span study. Mean±SE age at baseline was 48.3±0.20 years. The DD and DASH scores were calculated using four 24-hr recalls from baseline (2004-2009) and 1st follow-up wave (2009-2013). Count was based on consumption of ≥50% of an equivalent from 21 food groups. Evenness was derived using the Berry-Index adjusted by the food’s health value; dissimilarity, by Mahalanobis Distance. The DASH score was computed using the Mellen formula. BMI was calculated from measured weight and height; change in BMI from 1st to 2nd follow-up waves (2009-2017). Linear regression results are expressed as β-coefficients □ standard error of means (β□SE). After adjusting for energy, age, sex, race, poverty status, education, and smoking, of the three DD measures, only mean count was associated with annualized change in BMI (8.166±3.575, p=0.023). Mean DASH score was inversely associated with BMI change (-6.599±2.690, p=0.014). Age and smoking were the only other significant predictors (-1.137±2.938, p<0.001), (-1.169±5.472, p=0.033), respectively. These findings provide evidence that high quality is associated with a decrease in BMI with age while high count scores are associated with a rise in BMI.

Sweat, Sit, Sleep: A Compositional Analysis of 24-hr Movement Behaviors and Body Mass Index among Children with Autism Spectrum Disorder

This study (a) examined the daily composition of 24-hr movement behaviors in children with ASD using objective measures, and (b) applied compositional analysis to examine the associations of the time spent in moderate-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior (SB), and sleep duration (SD) with body mass index (BMI), relative to the time spent in the other movement behaviors in a sample of children (aged 7-19 years) with ASD. Time spent in MVPA, LPA, SB, and SD were measured using accelerometers over a 7-day period. BMI was calculated from measured height and weight. Participants (n = 46) spent 40% of time in LPA (M = 9.6 hr), 30.6% (M = 7.34 hr) in SB, 24.9% (M = 5.98 hr) asleep, and 4.5% (M = 64.8 min) in MVPA. Reallocating 30 min from LPA to SD decreased BMI by 0.471 kg/m² (P = 0.003). Reallocating 30 min from MVPA to SD decreased BMI by 0.658 kg/m² (P = 0.051). Reallocation of 60 min in equal proportions from SB, MVPA, and SD to LPA increased BMI by 0.418 kg/m² (P = 0.021), and reallocation of 60 min in equal proportions from LPA, MVPA, and SD to SB increased BMI by 0.295 kg/m² (P = 0.052). Finally, reallocation of 60 min in equal proportions from SB, LPA, and MVPA to SD decreased BMI by -0.845 kg/m² (P = 0.001). LAY SUMMARY: Data was collected on time spent in light physical activity (LPA), moderate-vigorous physical activity (MVPA), sedentary behavior (SB), and sleep in 46 children with autism. The sample had insufficient sleep (a mean of 6 hr/night). We showed that replacing 30 min of LPA or MVPA with sleep decreased BMI. Also, moving 60 min to LPA or SB from the remaining movement behaviors (i.e., 20 min from each) increased BMI, and moving 60 min to sleep from the remaining behaviors decreased BMI.

Caregiver Health by Context: Moderating Effects of Mental Health and Health Behaviors

This study assessed caregivers' perceptions of their physical health by care context and explored the moderating role of mental health and health behaviors. This a cross-sectional, secondary analysis using de-identified Behavioral Risk Factor Surveillance System survey data. Deficits in mental health and engaging in healthier behaviors was associated with an increased odds of experiencing at least one week of poor physical health or being in a fair or better health category, respectively. Differences in the odds were noted according to care context (i.e., reason for care). For example, with each unit increase in mental health score (worse mental health), the odds of experiencing at least one week of poor physical health increased among cancer caregivers at about one-and-a-half times as compared to old age caregivers (p=0.006). Findings suggest that some caregiving groups derive less benefit from positive health behaviors, while some groups are more adversely impacted by poorer mental health.

Early Weight Gain Forecasts Accelerated Eruption of Deciduous Teeth and Later Overweight Status during the First Year

OBJECTIVES

To determine whether early diet and weight gain velocity have independent or interactive effects on deciduous teeth emergence and overweight status during the first year.

STUDY DESIGN

Monthly measures of anthropometry and teeth eruption were collected during a 1-year trial (0.5-12.5 months) on formula-fed infants in which the type of randomized infant formula (cow milk or extensively hydrolyzed protein) diet significantly affected early (0.5-4.5 months) weight gain velocity. Generalized linear mixed models determined whether early diet and weight gain velocity had independent or interactive effects on timing and pattern of teeth eruption. Data from a trial on breastfed infants were used to explore effects of breast milk vs infant formula diets on teeth eruption and overweight status at 10.5 months.

RESULTS

Independent of infant formula diet, velocities of weight gain had direct effects on the age of first deciduous tooth (P < .04) and number of erupted teeth over time (P < .002). Greater velocity of weight gain from 0.5 to 4.5 months caused earlier and more frequent eruption of deciduous teeth from 4.5 to 12.5 months. Exploratory follow-up analyses on the breastfed and formula-fed diet groups found early weight gain velocity (P = .001), but not diet or its interaction, had significant effects. Infants in the upper quartile for weight gain velocity had more primary teeth (P = .002), and a greater proportion of them were overweight (P < .001) at 10.5 months.

CONCLUSIONS

Faster weight gain accretion forecasted accelerated primary teeth eruption and increased percentage of children who were overweight-risk factors for dental caries and obesity.

TRIAL REGISTRATION

ClinicalTrials.govNCT01700205 [2012-2015] and NCT01667549 [2012-2015].

Effects of Four-Week Supplementation of Ashwagandha and B-Vitamins on Mood and Stress Relief

Objectives

Currently, about 77% of Americans regularly experience physical and emotional symptoms caused by stress. The present study examined the combined effects of ashwagandha and B-vitamins on mood and stress relief.

Methods

In a pre- and post-intervention trial, forty women, 30–50 years of age, with a body mass index between 25 and 35 kg/m,2 were assigned to consume a taffy containing ashwagandha and B-vitamins twice daily for four weeks. Self-reported mood, sleep duration, and levels of stress hormones were assessed over the course of four weeks. Paired t-tests were used to compare variables across all possible pairs of time points, and linear mixed models featuring random intercepts were employed to investigate linear changes over time in the same set of variables. Pearson's correlation coefficient was used to establish the strength of the relationship between selected variables. The statistical significance level was set at 0.05.

Results

Perceived levels of stress, state anxiety, and traits anxiety scores were significantly reduced by 19.6% (P &lt; 0.001), 14.3% (P = 0.03), and 12.2% (P = 0.01), respectively at four weeks compared with baseline. Negative affect was significantly reduced by 15.6% (P = 0.02) at two weeks compared to baseline, then remained constant thereafter. Our findings also showed that participants’ hours of sleep was found to change significantly over time after controlling for participant age and BMI. Older participants with larger BMI's generally had the least amount of sleep at baseline; however, by the end of four weeks, they generally had the most. Although the levels of salivary cortisol and alpha-amylase did not significantly change over the four-week period, higher sleep hours were correlated with lower levels of cortisol over time (r = −0.329; P &lt; 0.001). In addition, higher sleep hours were correlated with higher diurnal alpha-amylase slope decline over time (r = 0.389; P = 0.006) in obese individuals.

Conclusions

The findings of this study suggest that daily supplementation of ashwagandha and B-vitamins could be a plausible intervention for improved mood and stress levels in women. Longer-term, placebo-controlled trials are needed to confirm these findings.

Funding Sources

This research was funded by the Food Sciences Corporation. Funder had no role in data collection, data analysis or interpretation, or writing of the abstract.

Sleep Duration and Efficiency Associated With Better Functional Exercise Capacity in Black Smokers at Risk for COPD

BACKGROUND

Black smokers have earlier development of lung disease as well as poorer sleep health than whites.

RESEARCH QUESTION

In a sample of black smokers, to what extent does sleep health modify the association between smoking level and functional exercise capacity?

DESIGN AND METHODS

Cross-sectional data from 209 black smokers (≥ 1 cigarette in last month), aged 40 to 65 years with no evidence of sleep-disordered breathing (apnea-hypopnea index < 15) or severe COPD (FEV₁ > 50%), were used for the current study. Self-reported smoking rate, objectively measured sleep efficiency (SE), total sleep time (TST), and the 6-min walk test (6MWT) for functional exercise capacity were the key assessments.

RESULTS

The mean age was 54.8 years (SD, 5.96), and mean cigarettes smoked per day (cpd) was 8.71 (SD, 6.78). Mean SE was 69.9% (SD, 12.3%), and mean TST was 307.99 min (SD 92.2). In adjusted linear regression models of the 6MWT (meters), TST (slope estimate, -0.14; P = .14) and SE (slope estimate, -1.0; P = .19) were negatively associated with 6MWT. The smoking rate × SE interaction was highly significant (slope estimate, 0.18; P = .007) such that in individuals who smoked ≥ 10 cpd, every additional percentage of SE garnered an additional distance of 0.83 to 6.62 m. Similarly, the smoking rate × TST interaction was significant (slope estimate, 0.019; P = .03) such that in smokers who smoked ≥ 10 cpd, every additional minute of TST garnered an additional distance of 0.04 to 0.60 m.

INTERPRETATION

Higher SE and, to a lesser extent, longer TST, in black adults who smoke ≥ 10 cpd is associated with better 6MWT performance.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT03534076; URL: www.clinicaltrials.gov.

HIV status and sleep disturbance in college students and relationship with smoking

OBJECTIVE

Adults with HIV have greater sleep difficulties and are more likely to smoke cigarettes. We tested whether current smoking plays a role in sleep difficulties experienced by young adults with HIV.

DESIGN

Cross-sectional.

SETTING

Data were from the 2011-2014 waves of the National College Health Assessment, an annual survey conducted by the American College Health Association.

PARTICIPANTS

108,159 (including N = 224 HIV positive) college students provided data for this study.

MEASUREMENTS

Health conditions (including HIV positive status) were self-reported. Participants were also asked whether "sleep difficulties" were "traumatic or difficult for you to handle" over the past 12 months. Smoking was self-reported (smokers reported smoking on at least 20 of the last 30 days). Logistic regression models were adjusted for age, sex, survey year, current alcohol use or current marijuana use, diagnosis and/or treatment of anxiety or depression in last year.

RESULTS

HIV positive students were more likely to be smokers (OR = 2.0, SE = 0.43, 95% CI [1.31, 3.05], P = .001) and were more likely to experience sleep difficulties (OR = 2.02, SE = 0.29, 95% CI [1.52, 2.68], P < .0001). While a significant HIV-x-smoking interaction was not found, when models were stratified by smoking, the relationship between HIV status and sleep difficulties was seen among non-smokers (OR = 1.97), and this relationship was stronger among smokers (OR = 2.64).

CONCLUSIONS

Among college students, HIV positive status is associated with increased sleep difficulties. These problems are worse among smokers. Sleep interventions are warranted in this vulnerable group, and could potentially enhance smoking cessation efforts.

Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial

Imagery can improve functional outcomes post-anterior cruciate ligament repair (ACLR). Research is needed to investigate potential mechanisms for this effect. The aim of this study was to (a) evaluate the effectiveness of an imagery intervention to improve functional outcomes post-ACLR, and (b) explore potential mechanisms. A randomized-controlled pilot trial was conducted. Participants were randomized to guided imagery and standard rehabilitation or standard rehabilitation alone (control). The primary outcome was knee strength 6-month post-operatively. Secondary outcomes were knee laxity at 6-months, and change in psychological (self-efficacy) and neurohormonal (adrenaline, noradrenaline, dopamine) variables. Participants (n=21; 62% male) were 34.86 (SD 8.84) years. Following the intervention, no statistical differences between groups for knee strength extension at 180°/s (t=-0.43, P=0.67), or at 60°/s (t=-0.72, P=0.48) were found. A statistically significant effect was found for knee laxity, F=4.67, P<0.05, mean difference of -3.02 (95% CI -4.44 to -1.60), favoring the intervention. No differences were found for self-efficacy; however, an overall effect was found for noradrenaline, F(1, 19) 19.65, P<0.001, η(2) =0.52, and dopamine, F(1, 19) 6.23, P=0.02, η(2) =0.29, favoring the intervention. This imagery intervention improved knee laxity and healing-related neurobiological factors.

A normal rate of cellular cholesterol removal can be mediated by plasma from a patient with familial lecithin-cholesterol acyltransferase (LCAT) deficiency

Lecithin-cholesterol acyltransferase (LCAT) is the major enzyme involved in the esterification of cholesterol in circulating plasma lipoproteins. In the present study, we describe the molecular defects in the LCAT gene and in lipoprotein metabolism of a 34-year-old patient presenting with features of classic familial LCAT deficiency. DNA sequencing revealed two separate point mutations in exon 3 of the patient's LCAT gene: a C to A substitution converting Tyr(83) to a Stop and a C to T transition converting an Arg(99) to a Cys. Digestion of patient PCR-amplified DNA with the restriction enzymes AccI and AciI established that the patient was a compound heterozygote for both mutations. In vitro expression of LCAT (Arg(99)-->Cys) in human embryonic kidney-293 cells demonstrated reduced expression, as well as reduced secretion and/or increased intracellular degradation of the mutant enzyme with significantly decreased alpha-LCAT specific activity, thus, establishing the functional significance of the LCAT (Arg(99)-->Cys) mutation. The plasma cholesterol esterification rate (CER, 2+/-0.3 nmol/ml/h), alpha-LCAT activity (2.9+/-0.1 nmol/ml/h) and LCAT concentration (0.3+/-0.1 microg/ml) were 2.9%, 2.3% and 6.1% that of normal subjects, respectively. Analysis of the patient's plasma lipid profile revealed reduced plasma concentrations of total cholesterol (111+/-0.5 mg/dl), HDL cholesterol (1.6+/-0.2 mg/dl), apolipoprotein (apo) A-I (52+/-4 mg/dl) and apo A-II (11+/-0.5 mg/dl). Nevertheless, for the first time, we demonstrate that the LCAT-deficient plasma is as efficient as control plasma in cholesterol efflux experiments performed with [(3)H]-cholesterol loaded fibroblasts. This result could explain the absence of premature atherosclerosis in this LCAT-deficient patient.

An ATP-binding cassette gene (ABCG5) from the ABCG (White) gene subfamily maps to human chromosome 2p21 in the region of the Sitosterolemia locus

We characterized a new human ATP-binding cassette (ABC) transporter gene that is highly expressed in the liver. The gene, ABCG5, contains 13 exons and encodes a 651 amino acid protein. The predicted protein is closely related to the Drosophila white gene and a human gene, ABCG1, which is induced by cholesterol. This subfamily of genes all have a single ATP-binding domain at the N-terminus and a single C-terminal set of transmembrane segments. ABCG5 maps to human chromosome 2p21, between the markers D2S117 and D2S119. The abundant expression of this gene in the liver suggests that the protein product has an important role in transport of specific molecule(s) into or out of this tissue.

Correction of the PNH defect by GPI-anchored protein transfer

Hemolytic anemia is a major feature of paroxysmal nocturnal hemoglobinuria (PNH). Intravascular red blood cell (RBC) destruction is caused by increased sensitivity of the abnormal erythrocyte to complement-mediated lysis, due to the GPI absence of a membrane-bound glycosylphosphatidylinositol (GPI)-linked protein, which functions as an inhibitor of reactive lysis (CD59). Both in vivo and in vitro models have suggested the feasibility of cell-to-cell transfer of GPI proteins, and patients with hemolysis could potentially benefit from transfer of CD59 to their deficient erythrocytes. We studied the ability of RBC components prepared from outdated packed RBC collections, as well as high-density lipoprotein (HDL) preparations, rich in CD55 and CD59, to promote protein transfer, as assessed by flow cytometry, immunoblotting, and susceptibility to complement-mediated lysis. By flow cytometry, CD55 and CD59 were present on RBC-derived microvesicles that stained with an antiglycophorin antibody Ab; in addition, soluble CD59 and CD55 were detected by immunoblot in soluble fractions eluated from RBC units stored for more than 35 days, but not in fresh blood. Both commercial HDL preparations and those prepared in our laboratory contained CD55 and CD59, as assayed by immunoblot. When RBC that were deficient (GPI)-anchored protein, obtained from five patients, with PNH were incubated with HDL preparations for 2 to 4 hours, there was significant transfer of both proteins to the cell surface, as demonstrated by flow cytometry. Washed RBC microvesicles, prepared by ultrasonification, also mediated transfer of GPI-linked proteins to deficient RBC. Pretreatment of microvesicles, RBC eluate preparations, and HDL with phosphatidylinositol-specific, phospholipase C, abrogated protein transfer to deficient cells, indicating that increased cell-associated CD55 and CD59 levels were related to insertion of the intact GPI moiety, rather than to simple adhesion. PNH RBC that were exposed to HDL, RBC eluate preparations, or microvesicles demonstrated decreased in vitro complement-mediated hemolysis in the Ham test. Transfer of GPI-linked proteins from soluble preparations containing CD55 and CD59 to PNH erythrocytes is feasible and may have clinical utility.

Closing the distance

Geriatric technicians work in the field, providing a link between care providers and rural elderly patients. In this study, the new role enhanced patient outcomes and satisfaction.

Deaths associated with warfarin in elderly patients

The four cases presented illustrate fatal errors in the management of elderly patients at different stages in the chain of their anticoagulation treatment. As indications for anticoagulation increase in the elderly, more care needs to be taken.

A multicenter study to evaluate a novel assay for quantitation of soluble interleukin 2 receptor in renal transplant recipients

The clinical utility of monitoring soluble interleukin 2 receptor (sIL-2R) as an indicator of immune stimulation in renal transplant patients was evaluated in a retrospective study at 3 centers. Serum samples (n = 2360) were obtained from 86 (17 living related donor, 69 cadaver) transplant recipients. The patients had received either triple therapy (n = 35) or antilymphocyte antibody induction therapy followed by triple therapy (n = 51). The mean period of postoperative observation was 118 days (range, 6-349 days). Serum sIL-2R concentrations were quantitated by an automated microparticle enzyme immunoassay (MEIA) (Abbott Diagnostics) in which sIL-2R was captured by 7G7/B6 monoclonal antibody-coated microparticles and detected by an immunospecific rabbit antihuman sIL-2R-alkaline phosphatase conjugate. A distinct advantage of the technique was rapid turn-around time: 1-24 results were obtained in less than 50 min. Cyclosporine trough concentrations were determined by radioimmunoassay or high-performance liquid chromatography. Diagnosis of rejection was established by clinical and histological criteria. The mean sIL-2R concentration in patients receiving antilymphocyte antibody induction therapy increased from 3486 +/- 1729 U/ml (+/- SD) at the time of transplant to a maximum of 7395 +/- 7101 U/ml on the third day posttransplant; this increase was not observed in patients receiving triple therapy (P less than 0.0001). By the sixth day of posttransplant, there were no differences in sIL-2R levels in the two groups. Fifty rejection episodes were observed in 29 patients on triple therapy. The mean sIL-2R concentration rose from 3022 U/ml at the data point prior to rejection to 3524 U/ml at the time of rejection. Thirty-four rejection episodes were observed in 26 patients receiving induction therapy. The mean sIL-2R concentration was 3015 U/ml at the data point prior to rejection and 4815 U/ml at the time of rejection. The sIL-2R concentrations began increasing earlier and rose higher in rejecting patients who received induction therapy than in those receiving triple therapy. Early posttransplant sIL-2R levels increased significantly more in cadaver recipients than in LRD recipients, reaching a maximum on day 2 posttransplant (P less than 0.001). Prerejection sIL-2R concentrations were significantly lower in LRD recipients than in cadaver recipients (2248 U/ml vs. 4290 U/ml, P less than 0.02), as were sIL-2R levels at the time of diagnosis of rejection (2800 U/ml vs. 4832 U/ml, P = 0.01). The mean sIL-2R level in stable long-term graft recipients was 2110 U/ml, with approximately 90% of values less than 3000 U/ml.(ABSTRACT TRUNCATED AT 400 WORDS)

Prevention and control of infection

Foal septicemia is a major cause of neonatal morbidity and mortality. In order to improve success rates, earlier diagnosis and treatment are essential. This article stresses methods to prevent and treat infections in the compromised equine neonate.