Dietary flavonoid intake and weight maintenance: three prospective cohorts of 124,086 US men and women followed for up to 24 years

Objective: To examine whether dietary intake of specific flavonoid sub-classes is associated with weight change over time, including flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, and flavonoid polymers. Design: Three prospective cohort studies. Setting: Health professionals in the United States. Participants: 124,086 men and women participating in the Health Professionals Follow-up Study (HPFS), Nurses’ Health Study (NHS), and Nurses’ Health Study II (NHS II). Main outcome measure: Self-reported change in weight over multiple 4-year time intervals between 1986 and 2011. Results: Increased consumption of most flavonoid sub-classes, including flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers was inversely associated with weight change over 4-year time intervals, after adjustment for simultaneous changes in other lifestyle factors including other aspects of diet, smoking status, and physical activity. In the pooled results, the greatest magnitude of association was observed for anthocyanins (-0.22 lbs, 95% CI -0.30 to -0.15 lbs per additional SD/day, 10 mg), flavonoid polymers (-0.18 lbs, 95% CI -0.28 to -0.08 lbs per additional SD/day, 138 mg), and flavonols (-0.16 lbs, 95% CI -0.26 to -0.06 lbs per additional SD/day, 7 mg). After additional adjustment for fiber intake associations remained significant for anthocyanins, proanthocyanidins, and total flavonoid polymers but were attenuated and no longer statistically significant for other sub-classes. Conclusions: Higher intake of foods rich in flavonols, flavan-3-ols, anthocyanins, and flavonoid polymers, may contribute to weight maintenance in adulthood, and may help to refine dietary recommendations for the prevention of obesity and its potential sequelae

Change in alcohol intake in relation to weight change in a cohort of United States men with 24 years of follow-up

Objective: We sought to prospectively investigate potential effects of alcohol by subtype on reported long-term weight change. Methods: We examined change in alcohol intake (total, wine, light beer, regular beer, liquor) and simultaneous change in reported body weight within four-year periods from 1986 to 2010 from U.S. men in the Health Professionals Follow-Up Study. We adjusted for age, change in lifestyle and dietary covariates and cardiovascular risk factors. Results: We observed 44,603 four-year periods from 14,971 men. Total alcohol, total beer, regular beer, and liquor, modeled as the increase in weight per increase in drink/day, were each directly associated with moderate weight gain over four-year periods, in pounds: total alcohol: 0.23 (0.10–0.35); total beer: 0.29 (0.08–0.51); regular beer: 0.61 (0.22–1.00); liquor: 0.28 (0.09–0.48). Results for wine and light beer were wine: 0.16 (−0.04–0.36); light beer: −0.38 (−1.07–0.08). Results were strongest for men <55 years old. Conclusions: Increased alcohol consumption was associated with minor reported weight gain at levels unlikely to be clinically meaningful. Beverage specific differences are not substantial enough to make dietary recommendations for weight loss or maintenance by beverage type. The greatest risk of weight gain was among men that increased consumption to levels well above moderation

Identification of pregnancies and infants within a United States commercial healthcare administrative claims database

PURPOSE: Health care insurance claims databases are becoming a more common data source for studies of medication safety during pregnancy. While pregnancies have historically been identified in such databases by pregnancy outcomes, International Classification of Diseases, 10 revision Clinical Modification (ICD-10-CM) Z3A codes denoting weeks of gestation provide more granular information on pregnancies and pregnancy periods (i.e. start and end dates). The purpose of this study was to develop a process that uses Z3A codes to identify pregnancies, pregnancy periods, and links infants within a commercial health insurance claims database. METHODS: We identified pregnancies, gestation periods, pregnancy outcomes, and linked infants within the United States (US)-based Optum Research Database (ORD) between 2015 and 2020 via a series of algorithms utilizing diagnosis and procedure codes on claims. The diagnosis and procedure codes included ICD-10-CM codes, Current Procedural Terminology (CPT) codes, and Healthcare Common Procedure Coding System (HCPCS) codes. RESULTS: We identified 1,030,874 pregnancies among 841,196 women of reproductive age. Of pregnancies with livebirth outcomes, 84% were successfully linked to infants. The prevalence of pregnancy outcomes (livebirth, stillbirth, ectopic, molar, abortion) was similar to national estimates. CONCLUSIONS: This process provides an opportunity to study drug safety and care patterns during pregnancy and may be replicated in other claims databases containing ICD-10-CM, CPT, and HCPCS codes. Work is underway to validate and refine the various algorithms. This article is protected by copyright. All rights reserved

Implications of new hypertension guidelines in the United States

The American Heart Association released a scientific statement based on available clinical trials and expert opinion in 2007 for the treatment of hypertension to prevent coronary artery disease. These guidelines recommend more aggressive control of blood pressure (BP \u3c130/80 mm Hg) among those at high risk for coronary artery disease, individuals with diabetes mellitus, chronic kidney disease, coronary artery disease or coronary artery disease risk equivalent, or a 10-year Framingham risk score \u3e/=10%. Based on newer clinical trial data, the 2011 American College of Cardiology Foundation/American Heart Association (AHA) hypertension guidelines for the elderly recommend a less aggressive approach of \u3c145/90 mm Hg in those over the age of 80 years. We estimated the burden of uncontrolled BP among those at an increased risk of coronary artery disease using the both the 2007 AHA and the 2011 American College of Cardiology Foundation/AHA hypertension guidelines. We used a cross-sectional analysis of National Health and Nutrition Examination Survey 2005-2008 participants. Participants were 10198 adults aged 18 to 85 years. Using the 2011 American College of Cardiology Foundation/AHA hypertension guidelines (\u3e/=140/90 mm Hg), 72 million Americans (35%) have hypertension. Using the 2007 AHA guidelines, an additional 7 million American adults (5%) have elevated BP requiring treatment, for a total of 79 million adults (40%). Although individuals at a higher risk for coronary artery disease are more likely to be aware of their hypertension and to be taking antihypertension medication, they are less likely to have their BP under control. Additional efforts are needed in the treatment of elevated BP, especially among individuals with an increased risk of coronary artery disease

Associations Between Conventional Cardiovascular Risk Factors and Risk of Peripheral Artery Disease in Men

Context Previous studies have examined the associations of individual clinical risk factors with risk of peripheral artery disease (PAD), but the combined effects of these risk factors are largely unknown. Objective To estimate the degree to which the 4 conventional cardiovascular risk factors of smoking, hypertension, hypercholesterolemia, and type 2 diabetes are associated with the risk of PAD among men. Design, Setting, and Participants Prospective study of 44 985 men in the United States without a history of cardiovascular disease at baseline in 1986; participants in the Health Professionals Follow-up Study were followed up for 25 years until January 2011. The presence of risk factors was updated biennially during follow-up. Main Outcome Measure Clinically significant PAD defined as limb amputation or revascularization, angiogram reporting vascular obstruction of 50% or greater, ankle-brachial index of less than 0.90, or physician-diagnosed PAD. Results During a median follow-up of 24.2 years (interquartile range, 20.8-24.7 years), there were 537 cases of incident PAD. Each risk factor was significantly and independently associated with a higher risk of PAD after adjustment for the other 3 risk factors and confounders. The age-adjusted incidence rates were 9 (95% CI, 6-14) cases/100 000 person-years (n=19 incident cases) for 0 risk factors, 23 (95% CI, 18-28) cases/100 000 person-years (n=99 incident cases) for 1 risk factor, 47 (95% CI, 39-56) cases/100 000 person-years (n=176 incident cases) for 2 risk factors, 92(95% CI, 76-111) cases/100 000 person-years (n=180 incident cases) for 3 risk factors, and 186(95% CI, 141-246) cases/100 000 person-years (n=63 incident cases) for 4 risk factors. The multivariable-adjusted hazard ratio for each additional risk factor was 2.06 (95% CI, 1.88-2.26). Men without any of the 4 risk factors had a hazard ratio of PAD of 0.23 (95% CI, 0.14-0.36) compared with all other men in the cohort. In 96% of PAD cases (95% CI, 94%-98%), at least 1 of the 4 risk factors was present at the time of PAD diagnosis. The population-attributable risk associated with these 4 risk factors was 75% (95% CI, 64%-87%). The absolute incidence of PAD among men with all 4 risk factors was 3.5/1000 person-years. Conclusion Among men in this cohort, smoking, hypertension, hypercholesterolemia, and type 2 diabetes account for the majority of risk associated with development of clinically significant PAD. JAMA. 2012;308(16):1660-1667 www.jama.co

Plasma homocysteine, dietary B vitamins, betaine, and choline and risk of peripheral artery disease

Objective: Few studies have examined the roles of homocysteine and related nutrients in the development of peripheral artery disease (PAD). We examined the associations between plasma homocysteine, dietary B vitamins, betaine, choline, and supplemental folic acid use and incidence of PAD. Methods: We used two cohort studies of 72,348 women in the Nurses' Health Study (NHS, 1990-2010) and 44,504 men in the Health Professionals Follow-up Study (HPFS, 1986-2010). We measured plasma homocysteine in nested matched case-control studies of clinically recognized PAD within both cohorts, including 143 PAD cases and 424 controls within the NHS (1990-2010) and 143 PAD cases and 428 controls within the HPFS (1994-2008). We examined the association between diet and risk of incident PAD in the cohorts using a food frequency questionnaire and 790 cases of PAD over 3.1 million person-years of follow-up. Results: Higher homocysteine levels were positively associated with risk of PAD in men (adjusted IRR 2.17; 95% CI, 1.08-4.38 for tertile 3 vs. 1). There was no evidence of an association in women (adjusted IRR 1.14; 95% CI, 0.61-2.12). Similarly, higher folate intake, including supplements, was inversely associated with risk of PAD in men (adjusted HR 0.90; 95% CI, 0.82-0.98 for each 250 mu g increase) but not women (HR 1.01, 95% CI, 0.88-1.15). Intakes of the other B vitamins, betaine, and choline were not consistently associated with risk of PAD in men or women. Conclusion: Homocysteine levels were positively associated and dietary folate intake was inversely associated with risk of PAD in men but not in women. (C) 2014 Published by Elsevier Ireland Ltd

Summary of reproducibility of 15 CVD-related miRNAs with CVs below 20% in duplicate samples, samples with processing delayed up to 48 hours, and samples collected 1–2 years apart.

<p>Summary of reproducibility of 15 CVD-related miRNAs with CVs below 20% in duplicate samples, samples with processing delayed up to 48 hours, and samples collected 1–2 years apart.</p

Expression levels of 12 miRNAs* with delayed processing of 0, 24, and 48 hours at 4°C.

<p>*12 miRNAs detectable in ≥ 50% of samples and with CVs below 20% for inter-assay reproducibility, delayed processing reproducibility, and short-term within-person stability, and ICCs ≥ 0.3 for short-term within-person stability.</p