Relationship of trabecular and cortical bone to circulating total homocysteine and C-reactive protein in postmenopausal women

Homocysteine (Hcy) and C-reactive protein (CRP) are established risk factors for atherosclerotic cardiovascular disease and are emerging as novel risk factors for osteoporosis. The primary purpose of this study was to determine whether total Hcy and CRP concentrations are associated with trabecular and/or cortical bone mineral content (BMC) or bone mineral density (BMD) in postmenopausal women. The secondary objective was to determine the body composition and nutritional status indices (dietary and circulating) and key biologic factors related to total Hcy and CRP. The tertiary purpose of this study was to examine changes in total Hcy and CRP over one year. We enrolled healthy postmenopausal women (N=242) as part of a randomized, double-blind, placebo-controlled multi-center clinical trial designed to examine the effect of two doses of soy isoflavones on bone loss over three years in early postmenopausal women. This study assessed volumetric BMD at the distal tibia and femur (1/3 site) using peripheral quantitative computed tomography (pQCT) in a subset of women (N=184 for distal tibia; N=237 for 1/3 femur site). Total Hcy and CRP did not contribute to the variability in trabecular BMC of the distal tibia or cortical BMC of the 1/3 femur site using pQCT. Approximately 22% of the variability in trabecular BMC was accounted for by weight, hemoglobin, serum uric acid, and blood glucose. Study site, weight, and age accounted for about 14% of the variability in cortical BMC. The overall variability (19%; p[less than or equal to]0.0001) in total Hcy was accounted for by serum vitamin B₁₂ and creatinine; the overall variability (28%; p[less than or equal to]0.0001) in CRP was accounted for by serum iron, overall percent body fat, serum uric acid, triglycerides, and white blood cell count. Total Hcy and CRP increased, while serum vitamin B₁₂, serum folate, and intracellular folate decreased over a one year period. Total Hcy and CRP were not related to trabecular or cortical bone, but this may be because these women were healthy and non-osteoporotic. Since hemoglobin was a significant contributor to trabecular BMC, while iron was a significant contributor to CRP, it is possible that inflammation may mediate the relationship between iron and trabecular BMC

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.

OBJECTIVES: To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. DESIGN: Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY: PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). SYNTHESIS METHODS: Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. RESULTS: Prespecified information was extracted from 17 cohorts (38,253 cases/10,126,754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I(2) for heterogeneity=89%) and 13% (6% to 21%, I(2)=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I(2)=70%) and 8% (2% to 15%, I(2)=64%); and for fruit juice, 5% (-1% to 11%, I(2)=58%) and 7% (1% to 14%, I(2)=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79,000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). CONCLUSIONS: Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showed positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes

There's an App for That:Development of an Application to Operationalize the Global Diet Quality Score

BACKGROUND: The global diet quality score (GDQS) is a simple, standardized metric appropriate for population-based measurement of diet quality globally.OBJECTIVES: We aimed to operationalize data collection by modifying the quantity of consumption cutoffs originally developed for the GDQS food groups and to statistically evaluate the performance of the operationalized GDQS relative to the original GDQS against nutrient adequacy and noncommunicable disease (NCD)-related outcomes.METHODS: The GDQS application uses a 24-h open-recall to collect a full list of all foods consumed during the previous day or night, and automatically classifies them into corresponding GDQS food group. Respondents use a set of 10 cubes in a range of predetermined sizes to determine if the quantity consumed per GDQS food group was below, or equal to or above food group-specific cutoffs established in grams. Because there is only a total of 10 cubes but as many as 54 cutoffs for the GDQS food groups, the operationalized cutoffs differ slightly from the original GDQS cutoffs.RESULTS: A secondary analysis using 5 cross-sectional datasets comparing the GDQS with the original and operationalized cutoffs showed that the operationalized GDQS remained strongly correlated with nutrient adequacy and was equally sensitive to anthropometric and other clinical measures of NCD risk. In a secondary analysis of a longitudinal cohort study of Mexican teachers, there were no differences between the 2 modalities with the beta coefficients per 1 SD change in the original and operationalized GDQS scores being nearly identical for weight gain (-0.37 and -0.36, respectively, P &lt; 0.001 for linear trend for both models) and of the same clinical order of magnitude for waist circumference (-0.52 and -0.44, respectively, P &lt; 0.001 for linear trend for both models).CONCLUSION: The operationalized GDQS cutoffs did not change the performance of the GDQS and therefore are recommended for use to collect GDQS data in the future.</p

Validation of Global Diet Quality Score Among Nonpregnant Women of Reproductive Age in India: Findings from the Andhra Pradesh Children and Parents Study (APCAPS) and the Indian Migration Study (IMS).

BACKGROUND: In India, there is a need to monitor population-level trends in changes in diet quality in relation to both undernutrition and noncommunicable diseases. OBJECTIVES: We conducted a study to validate a novel diet quality score in southern India. METHODS: We included data from 3041 nonpregnant women of reproductive age (15-49 years) from 2 studies in India. Diet was assessed using a validated food frequency questionnaire (FFQ). The Global Diet Quality Score (GDQS) was calculated from 25 food groups (16 healthy; 9 unhealthy), with points for each group based on the frequency and quantity of items consumed in each group. We used Spearman correlations to examine correlations between the GDQS and several nutrient intakes of concern. We examined associations between the GDQS [overall, healthy (GDQS+), and unhealthy (GDQS-) submetrics] and overall nutrient adequacy, micro- and macronutrients, body mass index (BMI), midupper arm circumference, hemoglobin, blood pressure, high density lipoprotein (HDL), and total cholesterol (TC). RESULTS: The mean GDQS was 23 points (SD, 3.6; maximum, 46.5). In energy-adjusted models, positive associations were found between the overall GDQS and GDQS+ and intakes of calcium, fiber, folate, iron, monounsaturated fatty acid (MUFA), protein, polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), total fat, and zinc (ρ = 0.12-0.39; P < 0.001). Quintile analyses showed that the GDQS was associated with better nutrient adequacy. At the same time, the GDQS was associated with higher TC, lower HDL, and higher BMI. We found no associations between the GDQS and hypertension. CONCLUSIONS: The GDQS was a useful tool for reflecting overall nutrient adequacy and some lipid measures. Future studies are needed to refine the GDQS for populations who consume large amounts of unhealthy foods, like refined grains, along with healthy foods included in the GDQS

Exploration of Machine Learning and Statistical Techniques in Development of a Low-Cost Screening Method Featuring the Global Diet Quality Score for Detecting Prediabetes in Rural India.

BACKGROUND: The prevalence of type 2 diabetes has increased substantially in India over the past 3 decades. Undiagnosed diabetes presents a public health challenge, especially in rural areas, where access to laboratory testing for diagnosis may not be readily available. OBJECTIVES: The present work explores the use of several machine learning and statistical methods in the development of a predictive tool to screen for prediabetes using survey data from an FFQ to compute the Global Diet Quality Score (GDQS). METHODS: The outcome variable prediabetes status (yes/no) used throughout this study was determined based upon a fasting blood glucose measurement ≥100 mg/dL. The algorithms utilized included the generalized linear model (GLM), random forest, least absolute shrinkage and selection operator (LASSO), elastic net (EN), and generalized linear mixed model (GLMM) with family unit as a (cluster) random (intercept) effect to account for intrafamily correlation. Model performance was assessed on held-out test data, and comparisons made with respect to area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. RESULTS: The GLMM, GLM, LASSO, and random forest modeling techniques each performed quite well (AUCs >0.70) and included the GDQS food groups and age, among other predictors. The fully adjusted GLMM, which included a random intercept for family unit, achieved slightly superior results (AUC of 0.72) in classifying the prediabetes outcome in these cluster-correlated data. CONCLUSIONS: The models presented in the current work show promise in identifying individuals at risk of developing diabetes, although further studies are necessary to assess other potentially impactful predictors, as well as the consistency and generalizability of model performance. In addition, future studies to examine the utility of the GDQS in screening for other noncommunicable diseases are recommended

The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries

Background: Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunica­ ble diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality = 8 3 :J to this double burden. Objectives: We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDOS) against Dani:' other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. � � Methods: We scored the GDOS, Minimum Dietary Diversity-Women (MDD-W). and Alternative Healthy Eating lndexen C: 2010 (AHEl-2010) using FFO data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) "'Cl "'Cl ro in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and 3 age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. (:1J) I� Results: Correlations between the GDOS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, ...... iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% Cl: 0.30, 0.38) in men and 0.37 (95% Cl: 0.32, (0 (/) 0.41) in women. The GDOS was associated (P . 0 with 01 OR in men: 0.44, 95% Cl: 0.22, 0.85; women: 0.57, 95% Cl: 0.31, 1.03] and anemia (05/01 OR in men: 0.56, (0 01 95% Cl: 0.32, 0.98; women: 0.60, 95% Cl: 0.35, 1.01 ). The MDD-W correlated better with some nutrient intakes, though w.j>. CT associated marginally with low MUAC in men (P= 0.07). The AHEl-2010 correlated better with fatty acid intakes, though '< tC C: associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was (1) !e. low, and neither the GDOS, MDD-W, nor AHEl-2010 were predictive. Conclusions: The GDOS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes i

The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults.

BACKGROUND: Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. OBJECTIVES: To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. METHODS: We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. RESULTS: In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. CONCLUSIONS: The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa

Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents.

BACKGROUND: Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. METHODS: Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2). FINDINGS: All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. INTERPRETATION: The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. FUNDING: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.UK MRC, BHF, NIHR; US NIHThis is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/S0140-6736(16)30175-

Relationship of trabecular and cortical bone to circulating total homocysteine and C-reactive protein in postmenopausal women

Homocysteine (Hcy) and C-reactive protein (CRP) are established risk factors for atherosclerotic cardiovascular disease and are emerging as novel risk factors for osteoporosis. The primary purpose of this study was to determine whether total Hcy and CRP concentrations are associated with trabecular and/or cortical bone mineral content (BMC) or bone mineral density (BMD) in postmenopausal women. The secondary objective was to determine the body composition and nutritional status indices (dietary and circulating) and key biologic factors related to total Hcy and CRP. The tertiary purpose of this study was to examine changes in total Hcy and CRP over one year. We enrolled healthy postmenopausal women (N=242) as part of a randomized, double-blind, placebo-controlled multi-center clinical trial designed to examine the effect of two doses of soy isoflavones on bone loss over three years in early postmenopausal women. This study assessed volumetric BMD at the distal tibia and femur (1/3 site) using peripheral quantitative computed tomography (pQCT) in a subset of women (N=184 for distal tibia; N=237 for 1/3 femur site). Total Hcy and CRP did not contribute to the variability in trabecular BMC of the distal tibia or cortical BMC of the 1/3 femur site using pQCT. Approximately 22% of the variability in trabecular BMC was accounted for by weight, hemoglobin, serum uric acid, and blood glucose. Study site, weight, and age accounted for about 14% of the variability in cortical BMC. The overall variability (19%; p[less than or equal to]0.0001) in total Hcy was accounted for by serum vitamin B12 and creatinine; the overall variability (28%; p[less than or equal to]0.0001) in CRP was accounted for by serum iron, overall percent body fat, serum uric acid, triglycerides, and white blood cell count. Total Hcy and CRP increased, while serum vitamin B12, serum folate, and intracellular folate decreased over a one year period. Total Hcy and CRP were not related to trabecular or cortical bone, but this may be because these women were healthy and non-osteoporotic. Since hemoglobin was a significant contributor to trabecular BMC, while iron was a significant contributor to CRP, it is possible that inflammation may mediate the relationship between iron and trabecular BMC.</p