Multi-Level Predictors of Obesity and Diet in Multi-Ethnic Populations

The obesity epidemic in the United States is a major public health issue. Poor socio-economic conditions such as poverty or living under financial stress may adversely influence health outcomes such as obesity, and often disproportionately impact ethnic minority populations. Further, individuals living in poverty are often exposed to environments that promote unhealthy diet and obesity. Such obesogenic environments are characterized by increased exposure to foods high in sodium and low in potassium which may also be independently associated with obesity. Yet these associations have not been adequately explored, especially among ethnic minority populations. The current dissertation seeks to explore: 1) whether individual-level socio-economic status, as measured by exposure to poverty, is associated with trajectories of BMI over 20 years, using data from the Coronary Artery Risk Development In Young Adults Study; 2) whether neighborhood-level socio-economic environment is associated with individual-level measures of obesity and diet quality (urinary sodium and potassium), using data from the Heart Follow-Up Study; and 3) whether diet quality (sodium and potassium) is associated with obesity, using data from the Hispanic Community Health Study/Study of Latinos. From fully-adjusted linear mixed effects regression models, sustained poverty was found to be associated with faster BMI growth in White men and women, slower BMI growth in Black men, and no association in Black women. Using multi-level regression models, low vs. high neighborhood socio-economic status was found to be associated with higher BMI and lower urinary potassium excretion among women but not men. Finally, from fully-adjusted linear regression analyses, higher sodium and lower potassium was found to be associated with higher BMI and waist circumference. Taken together, the results highlight the multi-level and multi-factorial nature of the relationships among socio-economic status, dietary nutrients, and obesity among diverse populations

Sugary Drink Consumption Among NYC Children, Youth, and Adults: Disparities Persist Over Time, 2007–2015

Sugary drink consumption is associated with many adverse health outcomes, including weight gain, diabetes, and other chronic conditions. These beverages are widely marketed and ubiquitously available. This analysis explores sugary drink consumption across all age groups among New York City (NYC) residents using representative survey data. Three population-based representative surveys of NYC residents of different age groups were analyzed. Adult participants, youth participants, and caregivers of child participants self-reported the number of sugary drinks they consumed per day. Mean sugary drink intake per day was estimated overall and by demographic characteristics, for the 2015 cycle of each survey and the 2007–2015 cycles of the adult survey. T tests were used to determine whether means differed by demographics. Long-term trends in mean sugary drink consumption among adult participants were conducted to examine changes over time overall and by demographic characteristics. In 2015, the mean daily number of sugary drinks consumed was 0.53 (95% CI 0.45, 0.61) among children 0–5 years old, 1.05 (95% CI 0.90, 1.21) among children 6–12 years old, and 1.16 (95% CI 1.09, 1.29) among NYC high school students. Among all NYC adults, sugary drink intake decreased 36% from 1.03 (95% CI 0.99, 1.08) in 2007 to 0.66 (95% CI 0.62, 0.70) drinks per day in 2015, p < 0.01. However, at each age level, there were persistent disparities in sugary drink consumption by sex, race/ethnicity, educational attainment, and poverty level. Decreasing overall rates of sugary drink consumption are promising; however, disparities by socio-demographics are a concern. Reducing sugary drink consumption across all ages is recommended as is minimizing the introduction at an early age. Reduction of sugary drink consumption will require a collaborative, multi-sectoral approach

Trends in cigarette, cigar, and smokeless tobacco use among New York City public high school youth smokers, 2001–2013

Objective: This study aimed to describe the recent trends in youth smoking behaviors, and examine cigar and smokeless tobacco use patterns among youth smokers in New York City. Methods: Data, analyzed in 2014, were from the New York City Youth Risk Behavior Survey, a cross-sectional survey conducted bi-annually since 1997 in a representative sample of New York City public high school students (2001–2013), n = 59,122. Results: Cigarette smoking declined 53%, from 17.6% in 2001 to 8.2% in 2013 (p < 0.001). The proportion of cigar use among smokers doubled, from 22.2% in 2001 to 45.9% in 2013 (p < 0.001), while the proportion of smokeless tobacco use among smokers increased by 400% between 2001 and 2013 (4.2% vs. 21.2%, p < 0.001). Conclusions: Youth cigarette smoking rates in New York City decreased, while cigar smoking and smokeless tobacco use among smokers increased considerably. These data highlight trends in youth smoking behaviors within the context of New York City's comprehensive tobacco control program and stress the need for additional activity to spur further declines in cigarette smoking and reverse the trends in cigar and smokeless tobacco use among New York City youth. Results demonstrate the need for continuous surveillance and action by the public health community to counteract tobacco industry promotion of other products

Abstract P232: Associations Between Income And Education With ASCVD Risk, NHANES, 1999-2018

Introduction: Factors used to calculate cardiovascular disease (CVD) risk scores include age, sex, race, cholesterol, blood pressure, diabetes, and smoking status, but exclude social determinants of health (SDOH). Objectives: To determine whether SDOH factors are independently associated with CVD risk. Methods: The National Health and Nutrition Examination Survey is an annual, cross-sectional representative survey of the US adult population. We combined years 1999-2018 and included participants age 40-79 without CVD history, and with information to calculate CVD risk (n=23,877). Ten-year risk of ASCVD was calculated using the AHA/ACC pooled cohort equation. SDOH were conceptualized using self-reported educational attainment and income. We used linear regression models to estimate the association between SDOH and ASCVD risk adjusting for age, sex, race, marital status, and insurance. All analyses accounted for the complex survey design. Results: Among US adults, income of ≥ $100k was reported in 23$100k), income < $25k was associated with a 5.3$25k-$44.9k,$45-74.9k, and $75-$99.9k, experienced a 3.2% (95% CI: 2.4, 4.1), 1.5% (95% CI: 0.8, 1.5), and 1.1% (95% CI: 0.5, 1.7), greater CVD risk, respectively. Additionally, compared to college graduates, less than a high school education was associated with a 4.4% (95% CI: 3.7, 5.1) greater CVD risk, while high school graduates or some amount of college still experienced a 2.8% (95% CI: 2.3, 3.3) and 1.6% (95% CI: 1.2, 2.1) greater CVD risk, respectively. Conclusion: In a large US population-based sample of adults, we found strong graded associations between lower income and lower educational attainment with greater CVD risk. Though SDOH are not inputs into calculators of ASCVD risk, they are strongly associated with ASCVD risk scores

Abstract P020: High Sensitivity C-reactive Protein Is Associated With Incidence Of Metabolic Syndrome Among Hispanic/Latino Participants Of The Hispanic Community Health Study/Study Of Latinos

Introduction: High Sensitivity C-reactive protein (HsCRP) is a non-specific marker of systemic inflammation. Elevated levels of HsCRP have been shown to be predictive of cardiovascular disease and cardiovascular related events. The relationship between HsCRP and longitudinal onset of metabolic syndrome (MetS) has not been fully elucidated, especially among U.S. Hispanics/Latinos, which is a growing diverse group in the U.S. Objectives: To determine whether HsCRP is associated with incident MetS among U.S. Hispanics/Latinos. Methods: The Hispanic Community Health Study/Study of Latinos is a longitudinal observational cohort assessing cardiovascular health among diverse U.S. Hispanics/Latinos. HsCRP was measured at visit 1 (2008-2011) using a Roche Modular Chemistry Analyzer. HsCRP was classified as low, moderate, or high, based on ACC/AHA guidelines. All MetS components (abdominal obesity, triglycerides, HDL cholesterol, blood pressure, and fasting glucose) were measured at visit 1 and visit 2 (2014-2017). MetS was defined as the presence of three or more components based on the definition from the Third Report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III). Participants free of MetS at visit 1 and with complete data on HsCRP and all MetS components were included (n=6,699 participants). We used Poisson regression analysis to determine whether HsCRP was associated with incident MetS after adjusting for age, follow-up time, sex, Hispanic/Latino background, income, education, marital status, employment, health insurance status, nativity, alcohol use, smoking, anxiety, CESD-10, physical activity, and diet. All analyses included sample weights and accounted for the complex survey design of the study. Results: Mean age was 38.2 years, 29.0% had less than a high school education, 59.7% had an income less than $30,000, and 48.4% were female. Average follow-up time was 6.1 years. In fully adjusted models, moderate vs. low HsCRP was associated with a 39% increased risk of MetS (IDR: 1.39, 95% CI: 1.13, 1.71), while high vs. low HsCRP was associated with a 109% increased risk of MetS (IDR: 2.09, 95% CI: 1.70, 2.57). Conclusions: Greater levels of HsCRP were associated with new onset of MetS in a diverse sample of U.S. Hispanics/Latinos. Results suggest that HsCRP may be an independent risk factor for, rather than a marker of MetS

Lower 24- hour urinary sodium excretion is associated with hypertension control: the 2010 Heart Follow-Up Study

Among individuals with hypertension, controlling high blood pressure (BP) reduces the risk for cardiovascular events and death. Reducing dietary sodium can help achieve BP control. The study aim was to use a population-based sample utilizing the gold-standard for urinary sodium to quantify the degree with which sodium was independently associated with BP control among individuals with hypertension. Participants included 1 568 adults from the Heart Follow-Up Study, a New York City population-based representative study conducted in 2010. Participants collected urine for 24 hours and had BP and other anthropometrics measured. Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or being on BP lowering medication. Sodium intake (mg/day) was measured from a single 24-hour urine collection. Hypertension prevalence was 30.8%. Among those with hypertension, 64.6% were aware, 56.3% were treated, and 40.3% were controlled. Among those treated for hypertension, 73.0% were controlled. Mean sodium intake among those with hypertension was 3 564 mg/day. From multivariable adjusted logistic regression models, each 500mg decrease in 24-hour urinary sodium excretion was associated with a 18% higher odds of hypertension control among those with hypertension (1.18, 95% CI: 1.07, 1.30). In New York City, approximately one in three people has hypertension with a majority uncontrolled. Sodium intake among those with hypertension was 55% greater than recommended upper limit of 2 300 mg per day. Among individuals with hypertension, lower sodium intake was associated with hypertension control

Associations Between Ultra-Processed Food Intake and Cardiometabolic Health Among Diverse U.S. Adults 50 or Older

Abstract Asian American (AA) diets are naturally adapted to the NOVA dietary recommendations, favoring minimally processed foods. Yet the relationship between dietary intake and metabolic health, among AAs is largely unknown. We examined the association between ultra-processed foods and cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among US adults 50 or older reporting a single ethnicity, using the National Health and Nutrition Examination Survey (2001-2018). From multivariable adjusted logistic regression models, the highest compared to the lowest quartile of ultra-processed food intake was associated with obesity only, among AAs (OR: 2.15, 95% CI: 1.04, 4.45), followed by non-Hispanic blacks (OR: 1.73, 95% CI: 1.40, 2.14), non-Hispanic whites (OR: 1.41, 95% CI: 1.19, 1.68), and Hispanics (OR: 1.34, 95% CI: 1.08, 1.65). AAs are more likely than other ethnic/racial groups to be obese when consuming ultra-processed foods. Cultural adaptation of current North American-focused dietary recommendations should drive AA preventive dietary recommendations