Serum Fatty Acids and Risk of Ischemic Stroke in Postmenopausal Women

Ischemic stroke is a major cause of death and disability among postmenopausal women. One of the risk factors of ischemic stroke is diet, including dietary fat intake. It has been established that intake of trans and saturated fatty acids are positively associated with coronary heart disease, whereas monounsaturated and polyunsaturated fatty acids are inversely associated. Despite the expectation that these associations would be consistent for ischemic stroke, this has not been the case in studies using participant reported measures of fatty acid intake. Rather, studies using biomarkers of fatty acid intake, such as serum, have had more success in finding the expected associations. This dissertation attempts to explain these inconsistent results through two aims. The first aim was to estimate the correlations between individual serum fatty acids and fatty acid intakes, which may partially explain previous inconsistent results from studies using different fatty acid assessment methods. The participants were 925 women from the Women's Health Initiative Observational Study (WHI-OS) of postmenopausal US women. Serum fatty acid composition was determined from a fasting serum sample collected at enrollment. Fatty acid intakes were measured using a 122-item food frequency questionnaire also at enrollment. Individual fatty acids with the highest Spearman rank correlations between serum and dietary intake were docosapentaenoic (DHA), eicosapentaenoic (EPA), and 18:1t fatty acid. Serum saturated, monounsaturated, and n6 polyunsaturated fatty acids were not correlated with the corresponding intake measures. This work highlights the need for further research to find suitable biomarkers for intakes of individual fatty acids. The second aim was to estimate the association between individual serum fatty acids and incidence of ischemic stroke and ischemic stroke subtypes. We conducted a case-control study nested in the WHI-OS. Incident ischemic stroke cases were centrally adjudicated, classified by etiologic subtype, and matched (1:1) to controls for a total of 964 case-control pairs. Serum linelaidic, palmitic, and oleic acids were associated with higher incidence of ischemic stroke, while serum EPA, docosapentaenoic (DPA), DHA, and arachidonic acids were associated with lower incidence. These associations were generally consistent for atherothrombotic and lacunar, but not cardioembolic, stroke. This work highlights the importance of individual fatty acids in the development of particular subtypes of ischemic stroke. This dissertation brings to attention the areas for future research. First, there is a need to find suitable biomarkers for individual fatty acid intakes. Second, future studies should explore the associations between individual fatty acids and disease, not only focusing on fatty acid groups. Third, the heterogeneous etiology of ischemic stroke suggests that ischemic stroke subtypes should be examined separately. Lastly, public health initiatives to increase the intake of DHA and EPA and reduce intake of 18:1t may reduce the incidence of ischemic stroke among postmenopausal US women.Doctor of Philosoph

Food concern and its associations with obesity and diabetes among lower-income New Yorkers

OBJECTIVE: To examine food concern (FC) and its associations with obesity and diabetes in a racially diverse, urban population. DESIGN: Cross-sectional population-based survey. SETTING: Five boroughs of New York City. SUBJECTS: Lower-income adults (n 5981) in the 2004 New York City Community Health Survey. RESULTS: The overall prevalence of obesity was 24 % and was higher among FC than non-FC white men and women, black women, US- and foreign-born whites and foreign-born blacks. In multivariable analysis, FC was marginally associated with obesity (OR = 1·18, 95 % CI 0·98, 1·42) among all lower-income New Yorkers, after controlling for socio-economic factors. The association of FC and obesity varied by race/ethnicity, with FC being positively associated with obesity only among white New Yorkers. FC whites had 80 % higher odds of obesity than whites without FC (OR = 1·80; 95 % CI 1·21, 2·68), with a model-adjusted obesity prevalence of 20 % among non-FC whites v. 31 % among FC whites. FC was not associated with diabetes after controlling for obesity and socio-economic factors. CONCLUSIONS: The prevalence of obesity was significantly higher among FC whites and certain subgroups of blacks. FC was positively associated with obesity risk among lower-income white New Yorkers. Programmes designed to alleviate FC and poverty should promote the purchase and consumption of nutritious, lower-energy foods to help address the burden of obesity in lower-income urban populations

Trans fat, aspirin, and ischemic stroke in postmenopausal women

To examine the associations between dietary fat intake and ischemic stroke among postmenopausal women

Outpatient Management of Heart Failure in the United States, 2006–2008

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States

Serum Fatty Acids and Incidence of Ischemic Stroke Among Postmenopausal Women

While studies have linked types of fatty acids with coronary heart disease, data on individual fatty acids and risk of ischemic stroke are limited. We aimed to examine the associations between serum fatty acid concentrations and incidence of ischemic stroke and its subtypes

Bodyweight Perceptions among Texas Women: The Effects of Religion, Race/Ethnicity, and Citizenship Status

Despite previous work exploring linkages between religious participation and health, little research has looked at the role of religion in affecting bodyweight perceptions. Using the theoretical model developed by Levin et al. (Sociol Q 36(1):157–173, 1995) on the multidimensionality of religious participation, we develop several hypotheses and test them by using data from the 2004 Survey of Texas Adults. We estimate multinomial logistic regression models to determine the relative risk of women perceiving themselves as overweight. Results indicate that religious attendance lowers risk of women perceiving themselves as very overweight. Citizenship status was an important factor for Latinas, with noncitizens being less likely to see themselves as overweight. We also test interaction effects between religion and race. Religious attendance and prayer have a moderating effect among Latina non-citizens so that among these women, attendance and prayer intensify perceptions of feeling less overweight when compared to their white counterparts. Among African American women, the effect of increased church attendance leads to perceptions of being overweight. Prayer is also a correlate of overweight perceptions but only among African American women. We close with a discussion that highlights key implications from our findings, note study limitations, and several promising avenues for future research

On the use of fingernail images as transient biometric identifiers

The significant advantages that biometric recognition technologies offer are in danger of being left aside in everyday life due to concerns over the misuse of such data. The biometric data employed so far focuses on the permanence of the characteristics involved. A concept known as ‘the right to be forgotten’ is gaining momentum in international law and this should further hamper the adoption of permanent biometric recognition technologies. However, a multitude of common applications are short-term and, therefore, non-permanent biometric characteristics would suffice for them. In this paper we discuss ‘transient biometrics,’ i.e. recognition via biometric characteristics that will change in the short term and show that images of the fingernail plate can be used as a transient biometric with a useful life-span of less than 6 months. A direct approach is proposed that requires no training and a relevant evaluation dataset is made publicly available

The Effect of Personalised Weight Feedback on Weight Loss and Health Behaviours: Evidence from a Regression Discontinuity Design

Using a regression‐discontinuity approach on a U.K. longitudinal dataset, this research analyses whether personalised weight feedback resulted in individuals losing weight over a period of between 2 and 7 years. The analysis presented here finds that being told one was “overweight” had, on average, no effect on subsequent weight loss; however, being told one was “very overweight” resulted in individuals losing, on average, approximately 1% of their bodyweight. The effect of feedback was found to be strongly moderated by household income, with those in higher income households accounting for seemingly all of the estimated effect due, in part, to increased physical activity. These findings suggest that the provision of weight feedback may be a cost‐effective way to reduce obesity in adults. They do however also highlight that the differential response to the provision of health information may be a driver of health inequalities and that the provision of feedback may bias longitudinal health studies

Toxic metals in toenails as biomarkers of exposure: A review

This work was supported by FIS grants PI12/00150, PI17CIII/00034, PI18/00287 (Instituto de Salud Carlos III, State Secretary of R + D + I and European Union (ERDF/ESF, "Investing in your future") ) , P42ES010349 and P30ES009089 (National Institute of Environmental Health Sciences) .Toenails have been used as biomarkers of exposure to toxic metals, but their validity for this purpose is not yet clear and might differ depending on the specific agent. To evaluate this issue, we reviewed the literature on: a) the time-window of exposure reflected by toenails; b) the reproducibility of toenail toxic-metal levels in repeated measures over time; c) their relationship with other biomarkers of exposure, and; d) their association with potential determinants (i.e. sociodemographic, anthropometric, or lifestyle characteristics) or with sources of exposure like diet or environmental pollution. Thus, we performed a systematic review, searching for articles that provided original data for levels of any of the following toxic metals in toenails: aluminum, beryllium, cadmium, chromium, mercury, nickel, lead, thallium and uranium. We identified 88 articles, reporting data from 67 different research projects, which were quite heterogeneous with regard to population profile, sample size and analytical technique. The most commonly studied metal was mercury. Concerning the time-window of exposure explored by toenails, some reports indicate that toenail cadmium, nickel and lead may reflect exposures that occurred 7–12 months before sampling. For repeated samples obtained 1–6 years apart, the range of intraindividual correlation coefficients of aluminum, chromium and mercury was 0.33–0.56. The correlation of toxic metal concentrations between toenails and other matrices was higher for hair and fingernails than for urine or blood. Mercury levels were consistently associated with fish intake, while other toxic metals were occasionally associated with specific sources (e.g. drinking water, place of residence, environmental pollution, and occupation). The most frequently evaluated health endpoints were cardiovascular diseases, cancer, and central nervous system diseases. Available data suggest that toenail mercury levels reflected long-term exposures and showed positive associations with fish intake. The lack of standardization in sample collection, quality control, analytical techniques and procedures – along with the heterogeneity and conflicting results among studies – mean it is still difficult to conclude that toenails are a good biomarker of exposure to toxic metals. Further studies are needed to draw solid conclusions about the suitability of toenails as biomarkers of exposure to toxic metals.FIS (Instituto de Salud Carlos III, State Secretary of R + D + I) PI12/00150 PI17CIII/00034 PI18/00287FIS (European Union (ERDF/ESF, "Investing in your future") PI12/00150 PI17CIII/00034 PI18/00287 United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Environmental Health Sciences (NIEHS) P42ES010349 P30ES00908

A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes

It is commonly assumed that a person identifying that they are ‘overweight’ is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight‐related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight