0176 Short Sleep Duration and Poor Sleep Quality Predict Blunted Weight Loss in a Behavioral Weight Loss Intervention

Introduction

Short sleep duration and poor sleep quality have each been associated with obesity and weight gain. However, less is known regarding how sleep may impact attempted weight loss. The purpose of this study was to investigate the associations between sleep duration and sleep quality, both independently and in combination, with weight loss in a 12-month behavioral weight loss intervention.

Methods

Young to middle-aged adults who were overweight or obese (N=296) completed a 12-month behavioral weight loss intervention, with weight assessed at baseline, 6 and 12 months. Sleep duration and quality were derived from the Pittsburgh Sleep Quality Index. Analyses examined the change in sleep over time and the association between baseline sleep and changes in sleep with 6- and 12-month weight loss following adjustment for relevant covariates including age, gender, race, education, baseline body mass index, and baseline risk for sleep apnea.

Results

Participants (with an average baseline weight of 97.0±1.0 kg) lost 6.6±1.1 kg (6.8%) and 6.7±1.2 kg (6.9%) at 6 and 12 months relative to baseline, respectively. Global sleep quality significantly improved over the 12-month intervention (P=.03), but average sleep duration and the prevalence of short sleep duration (<6 h) or poor sleep quality did not change significantly (each P≥.45). Adults with short sleep duration at baseline lost 3.3±0.9% less weight than those with ≥6 h sleep duration (P<.001). Adults with poor sleep quality at baseline lost 1.6±0.8% less weight than those with good sleep quality (P=.04). When considered together, adults with both short sleep duration and poor sleep quality lost at least 5.0% less weight compared with all other sleep duration/quality group combinations (P<.001).

Conclusion

Our findings highlight the importance of both sleep duration and sleep quality as predictors of behavioral weight loss and suggest that screening for sleep disturbance may be useful to determine who may benefit from additional counseling and resources.

Support

R01HL077525, K23HL118318

Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is strongly associated with peripheral artery disease (PAD). Detection of subclinical PAD may allow early interventions for or prevention of PAD in persons with CKD. Whether the presence of atherosclerotic plaque and femoral intima-media thickness (IMT) are associated with kidney function is unknown.

METHODS

We performed a cross-sectional observational study of 1029 community-living adults. We measured superficial and common femoral artery IMT and atherosclerotic plaque presence by ultrasound. Estimated glomerular filtration rate (eGFR; continuous) and eGFR <60 mL/min/1.73 m2 (binary) were evaluated as outcomes.

RESULTS

Mean age was 70 ± 10 years, mean eGFR was 78 ± 17 mL/min/1.73 m2, and 156 (15%) individuals had eGFR <60 mL/min/1.73 m2; 260 (25%) had femoral artery plaque. In models adjusted for demographics and cardiovascular risk factors, individuals with femoral artery plaque had mean eGFR approximately 3.0 (95% confidence interval, -5.3 to -0.8) mL/min/1.73 m2 lower than those without plaque (P < .01). The presence of plaque was also associated with a 1.7-fold higher odds of eGFR <60 mL/min/1.73 m2 (95% confidence interval, 1.1-2.8; P < .02). Associations were similar in persons with normal ankle-brachial index. The directions of associations were similar for femoral IMT measures with eGFR and CKD but were rendered no longer statistically significant with adjustment for demographic variables and cardiovascular disease risk factors.

CONCLUSIONS

Femoral artery plaque is significantly associated with CKD prevalence in community-living individuals, even among those with normal ankle-brachial index. Femoral artery ultrasound may allow evaluation of relationships and risk factors linking PAD and kidney disease earlier in its course.

Common carotid artery intima-media thickness increases throughout the pregnancy cycle: a prospective cohort study

Background

High parity is associated with greater cardiovascular disease (CVD) among mid-life and older women. Prospective studies of arterial change throughout pregnancy are needed to provide insight into potential mechanisms. This study assessed vascular adaptation across pregnancy in healthy first-time pregnant women.

Methods

The Maternal Vascular Adaptation to Healthy Pregnancy Study (Pittsburgh, PA, 2010–2015) assessed 37 primigravid women each trimester, 6–8 weeks after delivery and 1–5 years postpartum, with B-mode ultrasound imaging of common carotid artery (CCA) intima-media thickness (IMT) and inter-adventitial diameter (IAD) to assess associations with physical and cardiometabolic measures.

Results

Thirty-seven women (age 28.2 ± 4.5 years, pre-pregnant BMI 24.4 ± 3.2 kg/m²) experienced uncomplicated pregnancies. After adjustment for age and pre-pregnancy BMI, mean (SE) IAD (mm) increased each trimester, from 6.38 (0.08) in the 1st trimester to 6.92 (0.09) in the 3rd trimester, and then returned to 1st trimester levels postpartum (6.35 [0.07], P <  0.001). In contrast, mean (SE) CCA IMT (mm) increased from the 2nd trimester (i.e., 0.546 [0.01]) onward, and remained higher at an average of 2.7 years postpartum (0.581 [0.02], P = 0.03). Weight partially explained changes in IAD.

Conclusions

In uncomplicated first pregnancies, IAD increased and returned to 1st trimester levels postpartum. In contrast, CCA IMT remained increased 2 years postpartum. Maternal weight explained vascular changes better than did metabolic changes. Increased postpartum CCA IMT may persist and contribute to long-term CVD risk.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1841-y) contains supplementary material, which is available to authorized users.

Abstract 245: Metabolic Syndrome and Common Carotid Artery Remodeling: Study of Women’s Health Across the Nation

Objective

The metabolic syndrome (MetS) is linked to a higher risk of cardiovascular disease (CVD) events, including stroke. Measures of maladaptive carotid artery remodeling such as greater common carotid artery (CCA) intima-media thickness (IMT), and wider adventitial diameter (AD) are more prevalent among older women, varies by race/ethnicity and is predictive of stroke, however, data are lacking in women during the menopausal transition. Thus, we hypothesized more maladaptive carotid remodeling among MetS than those without MetS by race/ethnicity.

Methods

Study of Women’s Health Across the Nation (SWAN) participants, free of clinical CVD and with IMT and AD data at the 12th annual visit were evaluated. Lumen diameter (LD), circumferential wall stress (CWS) and circumferential wall tension (CWT) were calculated. Multivariable linear regressions were used to investigate the relationship between MetS and CCA parameters in all women and by race/ethnicity. Covariates included were age, height, site, LDL-c, education, medication use, menopause status and smoking.

Results

A total of 1183 women (41.3% MetS; 96.9% Postmenopausal; 52.1% Caucasian, 27.6% African American, 14.6% Chinese, 5.8% Hispanic) from 6 sites across the USA, aged 60.1±2.7 years old at visit 12 were included. MetS was associated with a larger LD (β(SE)): 0.222(0.033) mm, P <0.0001; AD (0.317(0.038)) mm, P <.0001; IMT(0.047(0.006)) mm, P <.0001; CWS (2.51(0.938)) kPa, P <.0077; CWT (5.53(0.637) kPa, P <.0001), after adjusting for covariates. Compared to Caucasians, LD was greater in both African American and Chinese ( (0.130 (0.040) mm, P <.0001; 0.292(0.064) mm, P<.0001, respectively), AD was greater in African American ((0.236(0.046) mm, P <.0001) and Chinese ((0.331(0.073) mm, P <.0001), a thicker IMT((0.053(0.008) mm, P <.0001), CWT was greater for African American and Chinese ((4.83(0.776) kPa, P <.0001; 3.18(1.22) kPa, P =0.0093).

Conclusion

MetS is associated with maladaptive remodeling of the CCA, as evidenced by larger AD, LD, IMT and CWT. Importantly, the association between MetS and CCA remodeling varies between race/ethnicity, which could partially explain differences in stroke rates by race.

Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass

OBJECTIVES

A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis.

METHODS

A total of 3285 laparoscopic Roux-en-Y gastric bypass operations were performed during a 5-year period. The gastrojejunostomy technique was modified in August 2002. Those patients who developed a marginal ulcer postoperatively were identified, and their charts were retrospectively analyzed for the operative technique, patient age, history of previous gastric surgery, presence of preoperative diabetes, coronary artery disease, or peptic ulcer disease, and use of nonsteroidal anti-inflammatory medications or tobacco.

RESULTS

The incidence of marginal ulceration after Roux-en-Y gastric bypass decreased significantly from 2.6% (28/1095) with the use of nonabsorbable suture to 1.3% (29/2190) after the change to absorbable suture for the inner layer of the gastrojejunal anastomosis (P < .001). The incidence of visible suture adjacent to the ulcer on endoscopy was also significantly reduced (64.3% vs 3.4%; P < .001). When the results were corrected for length of follow-up, the difference in the incidence of ulcers occurring within 1 year of surgery remained significant between the two groups (P = .002). There were no other significant differences in the factors analyzed.

CONCLUSIONS

The use of nonabsorbable sutures for the inner layer of the gastrojejunal anastomosis is associated with an increased incidence of marginal ulcers, and the adoption of absorbable suture material has reduced this incidence.