Usual dietary intake of choline and betaine: descriptive epidemiology, repeatability and association with incident coronary events: the Atherosclerosis Risk in Communities (ARIC) study

A relative deficiency of choline and betaine has been studied for its potential atherogenic properties, which appears to be secondary to the aberrant methylation process that it induces. It is now possible to conduct studies of choline and betaine because the concentrations of choline in common foods have been relatively well characterized. The relative risk of a low dietary intake of choline and betaine in relation with incident coronary heart disease (CHD) was investigated by gender, race and menopausal status in a middle-aged biracial cohort of 14,430 men and women sampled from four U.S. locales by the Atherosclerosis Risk in Communities (ARIC) study. During the 14 years of follow-up of this large prospective cohort, there was not a significant association between dietary intake of choline (or choline plus betaine) and the risk of incident CHD. Compared with the lowest quartile of intake, incident CHD risk was 22% higher [HR = 1.22 (0.91, 1.64)] and 14% higher [HR = 1.14 (0.85, 1.53)] in the highest quartile of choline and choline plus betaine, respectively, controlling for age, gender, education, total energy intake, and dietary intakes of folate, methionine and vitamin B6. Correction for measurement error in the dietary intake of choline and related nutrients provided similar results. The hazard ratio for an interquartile difference of choline and betaine intake was 1.24 (0.92, 1.66), when the covariates considered to be measured without error were age and gender. The reliability of the dietary assessment for choline and betaine as assessed with a brief semi-quantitative food frequency questionnaire was ascertained and the ARIC population intakes of dietary choline and betaine were estimated. The reliability coefficients were in the same range as those reported for other micronutrients (0.50 for choline). The median and the 25th percentile of dietary choline intake in the ARIC population were 284 mg/day and 215 mg/day, respectively. The intake of choline was below that proposed as the Adequate Intake for 94% of men and 89% of women

Occupation recorded on certificates of death compared with self-report: the Atherosclerosis Risk in Communities (ARIC) Study

<p>Abstract</p> <p>Background</p> <p>Death certificates are a potential source of sociodemographic data for decedents in epidemiologic research. However, because this information is provided by the next-of-kin or other proxies, there are concerns about validity. Our objective was to assess the agreement of job titles and occupational categories derived from death certificates with that self-reported in mid and later life.</p> <p>Methods</p> <p>Occupation was abstracted from 431 death certificates from North Carolina Atherosclerosis Risk in Communities Study participants who died between 1987 and 2001. Occupations were coded according to 1980 Bureau of Census job titles and then grouped into six 1980 census occupational categories. This information was compared with the self-reported occupation at midlife as reported at the baseline examination (1987–89). We calculated percent agreement using standard methods. Chance-adjusted agreement was assessed by kappa coefficients, with 95% confidence intervals.</p> <p>Results</p> <p>Agreement between death certificate and self-reported job titles was poor (32%), while 67% of occupational categories matched the two sources. Kappa coefficients ranged from 0.53 for technical/sales/administrative jobs to 0.68 for homemakers. Agreement was lower, albeit nonsignificant, for women (kappa = 0.54, 95% Confidence Interval, CI = 0.44–0.63) than men (kappa = 0.62, 95% CI = 0.54–0.69) and for African-Americans (kappa = 0.47, 95% CI = 0.34–0.61) than whites (kappa = 0.63, 95% CI = 0.57–0.69) but varied only slightly by educational attainment.</p> <p>Conclusion</p> <p>While agreement between self- and death certificate reported job titles was poor, agreement between occupational categories was good. This suggests that while death certificates may not be a suitable source of occupational data where classification into specific job titles is essential, in the absence of other data, it is a reasonable source for constructing measures such as occupational SES that are based on grouped occupational data.</p

Outcomes from a single-intervention trial to improve interprofessional practice behaviors at a student-led free clinic

Background Interprofessional collaboration (IPC) is the practice of two or more healthcare professionals working together and learning from one another to improve health outcomes. IPC is important for quality training, typically improving individual and group level outcomes. Students value the opportunity for leadership and teamwork development when IPC is offered in their curriculum. The Indiana University Student Outreach Clinic (IUSOC) is a student run clinic that provides free primary care services to underserved residents residing in Indianapolis, Indiana. The IUSOC partner leaders identified a need to enhance knowledge about partner roles, scope of practice, and professional training with the hopes of improving quality of care through IPC and utilization of clinic resources. Methods A cluster randomized design consisted of education session days and control days. Participants had an equal selection probability. Student partners from ten different disciplines were involved. Two survey instruments were used for data collection: 1) The Interprofessional Socialization and Valuing Scale and 2) The Professional Consciousness Raising Questionnaire. The former measured the attitudes and beliefs that underlie interprofessional socialization, while the latter assessed pre/post student knowledge of the roles and responsibilities of each partner. Results The control arm of the study was composed of 167 student participants and the intervention arm had 170 participants. Participants in the intervention arm had greater scores for “ability to work with others”, “value in working with others”, and “comfort in working with others.” The intervention arm also had significantly increased odds of correctly identifying the roles responsibilities of the nursing, law, dental, and global health disciplines. Conclusions Results of this study demonstrate that administering a short interprofessional education exercise to healthcare professional students leads to improved IPC through increased interprofessional knowledge about other professions and change in beliefs and values toward the value of interprofessional collaboration among healthcare professionals

Occupation recorded on certificates of death compared with self-report: the Atherosclerosis Risk in Communities (ARIC) Study

Abstract Background Death certificates are a potential source of sociodemographic data for decedents in epidemiologic research. However, because this information is provided by the next-of-kin or other proxies, there are concerns about validity. Our objective was to assess the agreement of job titles and occupational categories derived from death certificates with that self-reported in mid and later life. Methods Occupation was abstracted from 431 death certificates from North Carolina Atherosclerosis Risk in Communities Study participants who died between 1987 and 2001. Occupations were coded according to 1980 Bureau of Census job titles and then grouped into six 1980 census occupational categories. This information was compared with the self-reported occupation at midlife as reported at the baseline examination (1987–89). We calculated percent agreement using standard methods. Chance-adjusted agreement was assessed by kappa coefficients, with 95% confidence intervals. Results Agreement between death certificate and self-reported job titles was poor (32%), while 67% of occupational categories matched the two sources. Kappa coefficients ranged from 0.53 for technical/sales/administrative jobs to 0.68 for homemakers. Agreement was lower, albeit nonsignificant, for women (kappa = 0.54, 95% Confidence Interval, CI = 0.44–0.63) than men (kappa = 0.62, 95% CI = 0.54–0.69) and for African-Americans (kappa = 0.47, 95% CI = 0.34–0.61) than whites (kappa = 0.63, 95% CI = 0.57–0.69) but varied only slightly by educational attainment. Conclusion While agreement between self- and death certificate reported job titles was poor, agreement between occupational categories was good. This suggests that while death certificates may not be a suitable source of occupational data where classification into specific job titles is essential, in the absence of other data, it is a reasonable source for constructing measures such as occupational SES that are based on grouped occupational data

The association of dietary choline and betaine with the risk of type 2 diabetes: The atherosclerosis risk in communities (aric) study

OBJECTIVE To examine the association between dietary intake of choline and betaine and the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS Among 13,440 Atherosclerosis Risk in Communities (ARIC) study participants, the prospective longitudinal association between dietary choline and betaine intake and the risk of type 2 diabetes was assessed using interval-censored Cox pro-portional hazards and logistic regression models adjusted for baseline potential confounding variables. RESULTS Among 13,440 participants (55% women, mean age 54 [SD 7.4] years), 1,396 developed incident type 2 diabetes during median follow-up of 9 years from 1987 to 1998. There was no statistically significant association between every 1-SD increase in dietary choline and risk of type 2 diabetes (hazard ratio [HR] 1.01 [95% CI 0.87, 1.16]) nor between dietary betaine intake and the risk of type 2 diabetes (HR 1.01 [0.94, 1.10]). Those in the highest quartile of dietary choline intake did not have a statistically significant higher risk of type 2 diabetes than those in the lowest choline quartile (HR 1.09 [0.84, 1.42]); similarly, dietary betaine intake was not associated with the risk of type 2 diabetes comparing the highest quartile to the lowest (HR 1.06 [0.87, 1.29]). Among women, there was a higher risk of type 2 diabetes, comparing the highest to lowest dietary choline quartile (HR 1.54 [1.06, 2.25]), while in men, the association was null (HR 0.82 [0.57, 1.17]). Nevertheless, there was a nonsignificant interaction between high choline intake and sex on the risk of type 2 diabetes (P 5 0.07). The results from logistic regression were similar. CONCLUSIONS Overall and among male participants, dietary choline or betaine intakes were not associated with the risk of type 2 diabetes. Among female participants, there was a trend for a modestly higher risk of type 2 diabetes among those with the highest as compared with the lowest quartile of dietary choline intake. Our study should inform clinical trials on dietary choline and betaine supplementation in relationship with the risk of type 2 diabetes

Trial to Improve Inter-professional Practice Behaviors at a Student-Run, Free Clinic

The Indiana University Student Outreach Clinic (IUSOC) is a student-run, free clinic on the east side of Indianapolis. Students from eleven different disciplines (pharmacy, social work, occupational therapy, physical therapy, law, dentistry, global health, optometry, public health, nursing and medicine), covering three institutions (Indiana University, Butler University, and the University of Indianapolis), volunteer at the IUSOC. This study is a randomized-controlled intervention designed to improve inter-professional practice knowledge and behaviors within the IUSOC. On intervention clinic days, all clinic volunteers will gather in a huddle before seeing patients for a structured didactic information session. The session will highlight the importance of screening patients for comorbid conditions and subsequently referring patients to the appropriate clinic partners through inter-professional consultations. Clinic volunteers will receive a knowledge sheet that lists the top roles of each partner organization, in addition to a description of the screening tool, to be utilized on intervention days. The information session, knowledge sheet handout, and screening tool will not be employed on clinic control days. The primary aim is to assess the efficacy of the intervention by tracking and comparing the number of consults made during control and intervention days. The secondary aims are to investigate the impact of the intervention on collaboration and relationships among the professions represented at the clinic, to assess professional students’ knowledge of services provided by partner organizations, and to assess volunteer satisfaction of inter-professional relationships. We propose the intervention will increase the number of partner-to-partner consults and improve the measures listed above. Students will be surveyed using the Interprofessional Socialization and Valuing Scale, along with other survey tools developed by IUSOC research scientists. The project aims enhance inter-professional practice behaviors in students, as well as offer insight into the roles of healthcare professional and explore attitudes regarding teamwork in a healthcare setting. Learning Objectives: Describe how IPE measures in a student-run, free clinic setting may be structured to improve teamwork among volunteers. Knowledge regarding how an innovative screening and knowledge protocol may lead to increased inter-professional practice behaviors among student volunteers. Explore personal attitudes and values regarding teamwork in a healthcare setting

Distribution of cardiovascular health by individual- and neighborhood-level socioeconomic status: Findings from the Jackson Heart Study

BACKGROUND: Data demonstrate a positive relationship between socioeconomic status (SES) and cardiovascular health (CVH). OBJECTIVE: To assess the association between individual- and neighborhood-level SES and CVH among participants of the JHS (Jackson Heart Study), a community-based cohort of African Americans in Jackson, Mississippi. METHODS: We included all JHS participants with complete SES and CVH information at the baseline study visit (n = 3,667). We characterized individual- and neighborhood-level SES according to income (primary analysis) and education (secondary analysis), respectively. The outcome of interest for these analyses was a CVH score, based on 7 modifiable behaviors and factors, summed to a total of 0 (worst) to 14 (best) points. We utilized generalized estimating equations to account for the clustering of participants within the same residential areas to estimate the linear association between SES and CVH. RESULTS: The median age of the participants was 55 years, and 64% were women. Nearly one-third of eligible participants had individual incomes \u3c$20,000 and close to 40$25,480). Adjusted for age, sex, and neighborhood SES, there was an average increase in CVH score of 0.31 points associated with each 1-category increase in individual income. Similarly, each 1-category increase in neighborhood SES was associated with a 0.19-point increase in CVH score. These patterns held for our secondary analyses, which used educational attainment in place of income. These data did not suggest a synergistic effect of individual- and neighborhood-level SES on CVH. CONCLUSIONS: Our findings suggest a potential causal pathway for disparities in CVH among vulnerable populations. These data can be useful to the JHS community to empower public health and clinical interventions and policies for the improvement of CVH

Contribution of obesity to racial and ethnic disparities in the risk of fetal myelomeningocele: a population-based study.

BACKGROUND: Prepregnancy obesity and racial-ethnic disparities has been shown to be associated with meningomyelocele. OBJECTIVE: This study aimed to investigate the association of maternal periconceptional factors, including race-ethnicity and prepregnancy body mass index, with the prevalence of isolated fetal myelomeningocele. METHODS: This was a population-based cross-sectional study using Centers for Disease Control and Prevention birth data from 2016 to 2021. Major structural anomalies or chromosomal abnormalities were excluded. Race-ethnicity was classified as non-Hispanic White (reference population), non-Hispanic Black, non-Hispanic Asian, Hispanic, and others. Maternal prepregnancy body mass index was classified as underweight (<18.5 kg/m2), normal (reference group; 18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and class I (30-34.9 kg/m2), class II (35-39.9 kg/m2), and class III obesity (≥40 kg/m2). A chi-square test of independence was performed to identify factors significantly associated with myelomeningocele. These factors were then stratified into 3 adjusted clusters/levels. The prevalence was calculated per 10,000 live births. The Cochran-Armitage test for trend was used to detect any significant increasing or decreasing trends. RESULTS: A total of 22,625,308 pregnancies with live birth, including 2866 pregnancies with isolated fetal myelomeningocele, were included in the analysis. The prevalence of isolated fetal myelomeningocele per 10,000 live births varied among different racial/ethnic groups, with the highest prevalence found among the non-Hispanic White (1.60 [1.52-1.67]) and lowest among the non-Hispanic Asian (0.50 [0.40-0.64]) population. The prevalence significantly increased with body mass index, with the highest prevalence found in the population with class III obesity (1.88 per 10,000 live births). Subgroup analysis of the associations between the significant variables (obesity, diabetes, hypertension, and education) and each ethnicity in cases with myelomeningocele showed significant variations in prevalence of these variables among different racial/ethnic groups. Following the model with the 3 levels of adjustment described in the Methods section, prepregnancy overweight and class I, II, and III obesity remained significantly associated with the odds of isolated fetal myelomeningocele. The adjusted odds ratios were 1.32 (95% confidence interval, 1.19-1.46; P<.001) for overweight, 1.55 (95% confidence interval, 1.38-1.75; P<.001) for class I obesity, 1.68 (95% confidence interval, 1.45-1.94; P<.001) for class II obesity, and 1.73 (95% confidence interval, 1.47-2.04; P<.001) for class III obesity. Similarly, following the 3-level adjustment model, the obesity-mediated effect of maternal race-ethnicity on the odds of myelomeningocele remained significant (non-Hispanic Black: adjusted odds ratio, 1.03; 95% confidence interval, 1.02-1.05; P<.001; non-Hispanic Asian: adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P<.001; Hispanic: adjusted odds ratio, 1.5; 95% confidence interval, 1.03-1.6; P<.001). The test for trend among different racial/ethnic groups did not show significant results across the past 6 years. However, the test for trend showed a significant increase in the prevalence of isolated myelomeningocele associated with class II and III obesity over the past 6 years. CONCLUSION: There has been a rising trend of fetal isolated myelomeningocele in pregnancies with maternal class II and III obesity over the past 6 years after adjusting for other covariates. Prepregnancy obesity, a modifiable risk factor, is a significant driver of racial/ethnic disparities in the overall risk for isolated fetal myelomeningocele

Change in Physical Activity and Sitting Time After Myocardial Infarction and Mortality Among Postmenopausal Women in the Women\u27s Health Initiative-Observational Study

BACKGROUND: How physical activity (PA) and sitting time may change after first myocardial infarction (MI) and the association with mortality in postmenopausal women is unknown. METHODS AND RESULTS: Participants included postmenopausal women in the Women\u27s Health Initiative-Observational Study, aged 50 to 79 years who experienced a clinical MI during the study. This analysis included 856 women who had adequate data on PA exposure and 533 women for sitting time exposures. Sitting time was self-reported at baseline, year 3, and year 6. Self-reported PA was reported at baseline through year 8. Change in PA and sitting time were calculated as the difference between the cumulative average immediately following MI and the cumulative average immediately preceding MI. The 4 categories of change were: maintained low, decreased, increased, and maintained high. The cut points were \u3e /=7.5 metabolic equivalent of task hours/week versus /=8 h/day versus /day for sitting time. Cox proportional hazard models estimated hazard ratios and 95% CIs for all-cause, coronary heart disease, and cardiovascular disease mortality. Compared with women who maintained low PA (referent), the risk of all-cause mortality was: 0.54 (0.34-0.86) for increased PA and 0.52 (0.36-0.73) for maintained high PA. Women who had pre-MI levels of sitting time /day, every 1 h/day increase in sitting time was associated with a 9% increased risk (hazard ratio=1.09, 95% CI: 1.01, 1.19) of all-cause mortality. CONCLUSIONS: Meeting the recommended PA guidelines pre- and post-MI may have a protective role against mortality in postmenopausal women

Dietary choline and betaine intakes and risk of total and lethal prostate cancer in the Atherosclerosis Risk in Communities (ARIC) Study

Purpose: Two prior cohort studies suggested that choline, but not betaine intake, is associated with an increased risk of advanced prostate cancer (PCa). Given that evidence remains limited, we evaluated whether intakes of choline and derivative betaine are associated with total and lethal PCa risk and PCa death in men with PCa. Methods: We included 6,528 men (24.4% African American) without a cancer diagnosis at baseline (1987–1989) followed through 2012. Dietary intake was assessed using a food frequency questionnaire coupled with a nutrient database. We used Cox proportional hazards regression to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) of total and lethal PCa risk overall and by race. Results: Choline intake was not associated with total (n = 811) or lethal (n = 95) PCa risk overall or by race. Betaine intake was inversely associated with lethal (tertile 3 vs 1, HR 0.59, 95% CI 0.35–1.00, p trend = 0.04), but not total PCa risk; patterns for lethal PCa were similar by race. Neither nutrient was associated with PCa death in men with PCa. Conclusions: Choline intake was not associated with total or lethal PCa or with PCa death in men with PCa. Betaine intake was inversely associated with lethal, but not total PCa risk or with PCa death in men with PCa. Our results do not support the hypothesis that higher choline intake increases lethal PCa risk, but do suggest that higher betaine intake may be associated with lower lethal PCa risk. Further investigation with a larger number of lethal cases is needed