Publications by authors named "Jianwen Cai"

256 Publications

Sedentary Behavior and Change in Kidney Function: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Kidney360 2021 Feb 25;2(2):245-253. Epub 2021 Feb 25.

Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.

Background: There is accumulating evidence linking prolonged sedentary time to adverse health outcomes. The effect of sedentary behavior on kidney function has not been evaluated in US Hispanics/Latinos, a population disproportionately affected by CKD.

Methods: We evaluated the association between accelerometer-measured (1 week) sedentary time at baseline and kidney function among 7134 adults without CKD at entry in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who completed a baseline visit with accelerometry (2008-2011) and a follow-up visit (2014-2017). Outcomes included: () change in kidney function (eGFR and urine albumin-to-creatinine ratio, ACR), () incident low eGFR (eGFR <60 ml/min per 1.73 m and eGFR decline ≥1 ml/min per year), and () incident albuminuria (ACR ≥17 mg/g in men or ≥25 mg/g in women). Linear regression using survey procedures was used to evaluate change in kidney function (eGFR and ACR), and Poisson regression with robust variance was used to evaluate incident low eGFR and albuminuria.

Results: The median sedentary time was 12 hours/d. Over a median follow-up of 6.1 years, the mean relative change in eGFR was -0.50% per year, and there were 167 incident low eGFR events. On multivariable analysis, each 1 hour increase in sedentary time was associated with a longitudinal decline in eGFR (-0.06% per year, 95% CI, -0.10 to -0.02). There was a significant interaction with sex, and on stratified analyses, higher sedentary time was associated with eGFR decline in women but not men. There was no association between sedentary time and the other outcomes.

Conclusions: Sedentary time was associated with a small longitudinal decline in eGFR, which could have important implications in a population that experiences a disproportionate burden of CKD but further investigation is needed.
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http://dx.doi.org/10.34067/kid.0006202020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443247PMC
February 2021

Association of elevated serum aminotransferase levels with chronic kidney disease measures: hispanic community health study/study of latinos.

BMC Nephrol 2021 Sep 7;22(1):302. Epub 2021 Sep 7.

Institute for Minority Health Research, University of Illinois at Chicago, 1819 W Polk St, Ste 246, IL, 60612, Chicago, USA.

Background: Previous studies have shown an association between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD), but it is unclear whether the association is independent of metabolic syndrome.

Methods: Data from 13,006 participants aged 18 to 74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) without viral hepatitis, excessive alcohol consumption, or high transferrin saturation levels were analyzed. Suspected NAFLD was defined as presence of sex-specific elevations in serum aminotransferase levels (aspartate aminotransferase (AST) > 37 U/L or alanine aminotransferase (ALT) > 40 U/L for men and AST or ALT > 31 U/L for women). Logistic regression was used to examine cross-sectional associations of elevated serum aminotransferase levels with low estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m based on cystatin C), and with high urinary albumin-to-creatinine ratio (UACR) (> 17 mg/g in men and > 25 mg/ g in women) in separate models adjusting for demographic characteristics and metabolic syndrome.

Results: Mean (SD) age was 41 (0.27) years, and 45 % were male. Elevated serum aminotransferase levels were noted in 18.8 % of the population and were associated with greater odds of high UACR (OR = 1.31; 95 % CI = 1.10, 1.56) after adjusting for demographic characteristics; this association became non-significant after adjustment for metabolic syndrome (OR = 1.11, 95 % CI = 0.92, 1.33). In contrast, elevated serum aminotransferase levels were not associated with low eGFR (odds ratio (OR) = 0.73; 95 % confidence interval (CI) = 0.45, 1.18) after adjusting for covariates.

Conclusions: In this sample of diverse U.S. Hispanic Latino adults, elevated serum aminotransferase levels were not independently associated with measures of CKD.
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http://dx.doi.org/10.1186/s12882-021-02483-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422630PMC
September 2021

Conditional screening for ultrahigh-dimensional survival data in case-cohort studies.

Lifetime Data Anal 2021 Aug 20. Epub 2021 Aug 20.

Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7420, USA.

The case-cohort design has been widely used to reduce the cost of covariate measurements in large cohort studies. In many such studies, the number of covariates is very large, and the goal of the research is to identify active covariates which have great influence on response. Since the introduction of sure independence screening, screening procedures have achieved great success in terms of effectively reducing the dimensionality and identifying active covariates. However, commonly used screening methods are based on marginal correlation or its variants, they may fail to identify hidden active variables which are jointly important but are weakly correlated with the response. Moreover, these screening methods are mainly proposed for data under the simple random sampling and can not be directly applied to case-cohort data. In this paper, we consider the ultrahigh-dimensional survival data under the case-cohort design, and propose a conditional screening method by incorporating some important prior known information of active variables. This method can effectively detect hidden active variables. Furthermore, it possesses the sure screening property under some mild regularity conditions and does not require any complicated numerical optimization. We evaluate the finite sample performance of the proposed method via extensive simulation studies and further illustrate the new approach through a real data set from patients with breast cancer.
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http://dx.doi.org/10.1007/s10985-021-09531-7DOI Listing
August 2021

Longitudinal study of glomerular hyperfiltration and normalization of estimated glomerular filtration in adults with sickle cell disease.

Br J Haematol 2021 Aug 16. Epub 2021 Aug 16.

Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA.

Glomerular hyperfiltration is common in sickle cell disease (SCD) and precedes proteinuria and declining kidney function. We evaluated hyperfiltration in SCD patients and its "normalization." Routine visit data were collected retrospectively from adult SCD patients in a single centre from 2004 to 2013. Baseline was defined as first available serum creatinine and hyperfiltration as estimated glomerular filtration rates (eGFR) >130 ml/min/1·73 m for women and >140 ml/min/1·73 m for men. Normalization of hyperfiltration was eGFR reduction to 90-130 ml/min/1·73 m for women or 90-140 ml/min/1·73 m for men. Among 292 patients, median age was 27 years [interquartile range (IQR):20·0-38·0], and 56·8% had baseline hyperfiltration. Baseline hyperfiltration was inversely associated with age [odds ratio (OR):0·86, 95% confidence interval (CI): 0·82-0·90; P < 0·0001], male sex (OR:0·16, 95% CI: 0·07-0·41; P = 0·0001), haemoglobin (OR:0·76, 95% CI 0·61-0·94; P = 0·01), weight (OR:0·96, 95% CI: 0·93-0·99; P = 0·004), and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) use (OR:0·08, 95% CI: 0·01-0·75; P = 0·03), and positively with hydroxycarbamide use (OR:2·99, 95% CI: 1·18-7·56; P = 0·02). Of 89 hyperfiltration patients without baseline proteinuria, 10 (11·2%) developed new-onset proteinuria [median 1·05 years (IQR:0·63-2·09)]. Normalization of hyperfiltration was less likely with higher baseline eGFR [hazard ratio (HR):0·90, 95% CI: 0·86-0·95; P < 0·0001] and more likely in males (HR:6·35, 95% CI:2·71-14·86, <0·0001). Hyperfiltration is common in adult SCD patients, particularly when younger. Decline to normal values is more likely in males, possibly representing kidney function loss rather than improvement in hyperfiltration.
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http://dx.doi.org/10.1111/bjh.17723DOI Listing
August 2021

Periodontal Disease and Incident CKD in US Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos.

Kidney Med 2021 Jul-Aug;3(4):528-535.e1. Epub 2021 Jul 3.

Department of Medicine, University of Illinois at Chicago, Chicago, IL.

Rationale & Objective: Recent studies suggest that periodontal disease may be associated with incident chronic kidney disease (CKD). However, studies have focused on older populations, and US Hispanics/Latinos were not well represented.

Study Design: Observational cohort.

Setting & Participants: We analyzed data from the Hispanic Community Health Study/Study of Latinos who completed a baseline visit with a periodontal examination and a follow-up visit, and did not have CKD at baseline.

Predictors: Predictors included ≥30% of sites with clinical attachment loss ≥3 mm, ≥30% of sites with probing depth ≥4 mm, percentage of sites with bleeding on probing, and absence of functional dentition (<21 permanent teeth present).

Outcomes: Outcomes were incident low estimated glomerular filtration rate (eGFR) (eGFR <60 mL/min/1.73 m and decline in eGFR ≥1 mL/min/year); incident albuminuria (urine albumin:creatinine ratio [ACR] ≥30 mg/g); and change in eGFR and ACR.

Analytic Approach: Poisson and linear regression.

Results: For the sample (n = 7.732), baseline mean age was 41.5 years, 45.2% were male, 11.7% had ≥30% of sites with clinical attachment loss ≥3 mm, 5.1% had ≥30% of sites with probing depth ≥4 mm, 30.7% had ≥50% of sites with bleeding on probing, and 16.2% had absent functional dentition. During a median follow-up of 5.9 years, 149 patients developed low eGFR and 415 patients developed albuminuria. On multivariable analysis, presence versus absence of ≥30% of sites with probing depth ≥4 mm and absence of functional dentition were each associated with increased risk for incident low eGFR (incident density ratio, 2.31; 95% CI, 1.14-4.65 and 1.65, 95% CI, 1.01-2.70, respectively). None of the other predictors were associated with outcomes.

Limitations: Only a single kidney function follow-up measure.

Conclusions: In this cohort of US Hispanics/Latinos, we found that select measures of periodontal disease were associated with incident low eGFR. Future work is needed to assess whether the treatment of periodontal disease may prevent CKD.
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http://dx.doi.org/10.1016/j.xkme.2021.02.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350839PMC
July 2021

Case-cohort design in hematopoietic cell transplant studies.

Bone Marrow Transplant 2021 Aug 16. Epub 2021 Aug 16.

Division of Biostatistics, Medical College of Wisconsin, Wauwatosa, WI, USA.

Series Editors- Note: Imagine you and your colleagues have done 1000 transplants in persons with acute myeloid leukaemia in 1st remission. 5% of the 20% of recipients relapsing posttransplant have an isolated central nervous system relapse. You are curious and want to know whether there is anything special about this 5%, specifically whether this risk corelates with any pretransplant clinical and laboratory co-variates. You have extensive clinical data and some typical laboratory data on all 1000 but you suspect the culprit is mutation topography. What to do? Fortunately you have bio-banked DNA from the 1000. If resources and monies are not limiting you can do targeted or next generation sequencing on all 1000 DNA samples and off you go. However, most of us lack unlimited resources and monies. How can you sensibly and efficiently tackle this research problem? The answer is a case-cohort design study. In the typescript which follows Profs. Cai and Kim explain how to accomplish this. If you follow their advice you may need only to analyze samples from <300 recipients rather than 1000 to test your hypothesis. They explain how to design such a study and provide references to estimate sample size. Sadly, their typescript will not tell you how to get funding for the study, whish poor devil who will have to write the protocol, worse, who will shepherd it though endless committees for approval and the like. Help on these issues is outside the scope of our statistics series. In this context we suggest advice from Woody Allen's article in the New Yorker: The Kugelmass Episode (April 24, 1977). When Prof. Kugelmass (English, City College) tells his analyst Dr. Mandel he has fallen in love with Emma Bovary who died of arsenic poisoning near Rouen, France 120 years earlier the analyst says: After all, I'm an analyst, not a magician. Kugelmass' reply: Then perhaps what I need is a magician and is off to Coney Island to find one. Good luck, the magician may still be there! (Note: This typescript is R-rated. It contains an equation.).
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http://dx.doi.org/10.1038/s41409-021-01433-4DOI Listing
August 2021

Associations of Insulin Resistance With Systolic and Diastolic Blood Pressure: A Study From the HCHS/SOL.

Hypertension 2021 Sep 11;78(3):716-725. Epub 2021 Aug 11.

Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY (N.A.B.).

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16905DOI Listing
September 2021

Association of Subjective Social Status With Life's Simple 7s Cardiovascular Health Index Among Hispanic/Latino People: Results From the HCHS/SOL.

J Am Heart Assoc 2021 Aug 11;10(16):e012704. Epub 2021 Aug 11.

Department of Medicine University of Illinois at Chicago IL.

Background Evidence suggests that subjective (perceived) social status (SSS) may predict health outcomes more strongly than objective social status, but little is known about the relationship between SSS and cardiovascular health (CVH). This study focuses on this relationship among diverse Hispanic/Latino adults because while poor CVH profiles are prevalent in this population, immigration complicates attempts to measure their social status. Methods and Results We analyzed baseline HCHS/SOL (Hispanic Community Health Study/Study of Latinos) data on 15 374 Hispanic/Latino adults aged 18 to 74 years in 2008 to 2011. SSS was assessed using the McArthur Scale, a 10-rung "social ladder." CVH was based on levels of 7 metrics defined by the American Heart Association. Linear and logistic regressions were used to examine cross-sectional associations of SSS with CVH (overall and single metrics) after adjusting for objective social status, demographic, and health factors. Less than half of the population (46%) had Ideal scores in ≥4 metrics of CVH. In multivariable-adjusted models, an increase in SSS was associated with a higher overall CVH score (β=0.04; 95% CI, 0.01-0.06) and greater likelihood of Ideal levels of body mass index, physical activity, and fasting blood glucose levels. Nativity and time in the United States modified the association between SSS and Ideal smoking. Conclusions Subjective measures of social status can enhance an understanding of CVH among Hispanic/Latino people. Future studies should explore the stability of SSS over time in comparison with objective social status and the mechanisms through which SSS may influence CVH.
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http://dx.doi.org/10.1161/JAHA.119.012704DOI Listing
August 2021

Risk factor control across the spectrum of cardiovascular risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Am J Prev Cardiol 2021 Mar 13;5:100147. Epub 2021 Jan 13.

Department of Hospital Medicine, San Francisco VA Medical Center, San Francisco, CA, USA.

Background: Presence of cardiovascular disease (CVD) risk factors (RFs) should prompt patients and their providers to work aggressively towards controlling those that are modifiable. The extent to which a greater CVD RF burden is related to CVD RF control in a contemporary and diverse Hispanic/Latino population is not well-understood.

Methods: Using multicenter community-based data from the Hispanic Community Health Study/Study of Latinos, we assessed the self-reported prevalence of hypertension, hypercholesterolemia, diabetes, and prevalent CVD (ischemic heart disease or stroke). We used contemporaneous guidelines to define RF control. Multivariable logistic regression for complex survey sampling was used to examine whether having more CVD RFs was associated with CVD RF control (adjusting for age, sex, Hispanic background group, education, and health insurance).

Results: Our sample included 8521 participants with at least one CVD RF or prevalent CVD. The mean age in HCHS/SOL target population was 49 (SE 0.3) years and 56% were women. Frequency of one, two, or three self-reported CVD RFs was 57%, 26%, 8%, respectively, and overall 9% of participants had prevalent CVD. After adjusting for sociodemographic factors, compared to those reporting one CVD RF, individuals with three CVD RFs were the least likely to have blood pressure, cholesterol, and glucose optimally controlled (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.40-0.80). However, those with prevalent CVD were more likely to have all three risk factors controlled, (OR: 1.43; 95% CI: 1.01-2.01).

Conclusion: Hispanic/Latino adults with three major CVD RFs represent a group with poor overall CVD RF control. Secondary CVD prevention fares better. The potential contributors to inadequate CVD RF control in this highly vulnerable group warrants further investigation.
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http://dx.doi.org/10.1016/j.ajpc.2021.100147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315414PMC
March 2021

Central Obesity, Cardiometabolic Risk, and Cognitive Change in the Study of Latinos - Investigation of Neurocognitive Aging.

J Alzheimers Dis 2021 ;82(3):1203-1218

Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA.

Background: The relationships between obesity and cognitive decline in aging are mixed and understudied among Hispanics/Latinos.

Objective: To understand associations between central obesity, cognitive aging, and the role of concomitant cardiometabolic abnormalities among Hispanics/Latinos.

Methods: Participants included 6,377 diverse Hispanics/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and SOL-Investigation for Neurocognitive Aging (SOL-INCA). Participants were 45 years and older at the first cognitive testing session (Visit 1). Cognitive outcomes (z-score units) included global composite and domain specific (learning, memory, executive functioning, processing speed) measures at a second visit (SOL-INCA, on average, 7 years later), and 7-year change. We used survey linear regression to examine associations between central obesity (waist circumference≥88 cm and≥102 cm for women and men, respectively) and cognition. We also tested whether the relationships between obesity and cognition differed by cardiometabolic status (indication of/treatment for 2 + of the following: high triglycerides, hypertension, hyperglycemia, low high-density lipoprotein cholesterol).

Results: Central obesity was largely unassociated with cognitive outcomes, adjusting for covariates. However, among individuals with central obesity, cardiometabolic abnormality was linked to poorer cognitive function at SOL-INCA (ΔGlobalCognition =-0.165, p < 0.001) and to more pronounced cognitive declines over the average 7 years (ΔGlobalCognition = -0.109, p < 0.05); this was consistent across cognitive domains.

Conclusion: Central obesity alone was not associated with cognitive function. However, presence of both central obesity and cardiometabolic abnormalities was robustly predictive of cognition and 7-year cognitive declines, suggesting that in combination these factors may alter the cognitive trajectories of middle-aged and older Hispanics/Latinos.
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http://dx.doi.org/10.3233/JAD-210314DOI Listing
September 2021

Semiparametric estimation of the proportional rates model for recurrent events data with missing event category.

Stat Methods Med Res 2021 Jul 18;30(7):1624-1639. Epub 2021 Jun 18.

Department of Medicine, University of North Carolina at Chapel Hill, NC, USA.

Proportional rates models are frequently used for the analysis of recurrent event data with multiple event categories. When some of the event categories are missing, a conventional approach is to either exclude the missing data for a complete-case analysis or employ a parametric model for the missing event type. It is well known that the complete-case analysis is inconsistent when the missingness depends on covariates, and the parametric approach may incur bias when the model is misspecified. In this paper, we aim to provide a more robust approach using a rate proportion method for the imputation of missing event types. We show that the log-odds of the event type can be written as a semiparametric generalized linear model, facilitating a theoretically justified estimation framework. Comprehensive simulation studies were conducted demonstrating the improved performance of the semiparametric method over parametric procedures. Multiple types of infections of young cystic fibrosis patients were analyzed to demonstrate the feasibility of our proposed approach.
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http://dx.doi.org/10.1177/09622802211023975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411467PMC
July 2021

Host and gut microbial tryptophan metabolism and type 2 diabetes: an integrative analysis of host genetics, diet, gut microbiome and circulating metabolites in cohort studies.

Gut 2021 Jun 14. Epub 2021 Jun 14.

Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objective: Tryptophan can be catabolised to various metabolites through host kynurenine and microbial indole pathways. We aimed to examine relationships of host and microbial tryptophan metabolites with incident type 2 diabetes (T2D), host genetics, diet and gut microbiota.

Method: We analysed associations between circulating levels of 11 tryptophan metabolites and incident T2D in 9180 participants of diverse racial/ethnic backgrounds from five cohorts. We examined host genome-wide variants, dietary intake and gut microbiome associated with these metabolites.

Results: Tryptophan, four kynurenine-pathway metabolites (kynurenine, kynurenate, xanthurenate and quinolinate) and indolelactate were positively associated with T2D risk, while indolepropionate was inversely associated with T2D risk. We identified multiple host genetic variants, dietary factors, gut bacteria and their potential interplay associated with these T2D-relaetd metabolites. Intakes of fibre-rich foods, but not protein/tryptophan-rich foods, were the dietary factors most strongly associated with tryptophan metabolites. The fibre-indolepropionate association was partially explained by indolepropionate-associated gut bacteria, mostly fibre-using . We identified a novel association between a host functional variant (determining lactase persistence) and serum indolepropionate, which might be related to a host gene-diet interaction on gut , a probiotic bacterium significantly associated with indolepropionate independent of other fibre-related bacteria. Higher milk intake was associated with higher levels of gut and serum indolepropionate only among genetically lactase non-persistent individuals.

Conclusion: Higher milk intake among lactase non-persistent individuals, and higher fibre intake were associated with a favourable profile of circulating tryptophan metabolites for T2D, potentially through the host-microbial cross-talk shifting tryptophan metabolism toward gut microbial indolepropionate production.
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http://dx.doi.org/10.1136/gutjnl-2021-324053DOI Listing
June 2021

Semiparametric regression analysis of case-cohort studies with multiple interval-censored disease outcomes.

Stat Med 2021 06 29;40(13):3106-3123. Epub 2021 Mar 29.

Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Interval-censored failure time data commonly arise in epidemiological and biomedical studies where the occurrence of an event or a disease is determined via periodic examinations. Subject to interval-censoring, available information on the failure time can be quite limited. Cost-effective sampling designs are desirable to enhance the study power, especially when the disease rate is low and the covariates are expensive to obtain. In this work, we formulate the case-cohort design with multiple interval-censored disease outcomes and also generalize it to nonrare diseases where only a portion of diseased subjects are sampled. We develop a marginal sieve weighted likelihood approach, which assumes that the failure times marginally follow the proportional hazards model. We consider two types of weights to account for the sampling bias, and adopt a sieve method with Bernstein polynomials to handle the unknown baseline functions. We employ a weighted bootstrap procedure to obtain a variance estimate that is robust to the dependence structure between failure times. The proposed method is examined via simulation studies and illustrated with a dataset on incident diabetes and hypertension from the Atherosclerosis Risk in Communities study.
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http://dx.doi.org/10.1002/sim.8962DOI Listing
June 2021

Dietary factors, gut microbiota, and serum trimethylamine-N-oxide associated with cardiovascular disease in the Hispanic Community Health Study/Study of Latinos.

Am J Clin Nutr 2021 06;113(6):1503-1514

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.

Background: Trimethylamine-N-oxide (TMAO), a diet-derived and gut microbiota-related metabolite, is associated with cardiovascular disease (CVD). However, major dietary determinants and specific gut bacterial taxa related to TMAO remain to be identified in humans.

Objectives: We aimed to identify dietary and gut microbial factors associated with circulating TMAO.

Methods: This cross-sectional study included 3972 participants (57.3% women) aged 18-74 y from the Hispanic Community Health Study/Study of Latinos in the United States. Dietary information was collected by 24-h dietary recalls at baseline interview (2008-2011), and baseline serum TMAO and its precursors were measured by an untargeted approach. Gut microbiome was profiled by shotgun metagenomic sequencing in a subset of participants (n = 626) during a follow-up visit (2016-2018). Logistic and linear regression were used to examine associations of inverse-normalized metabolites with prevalent CVD, dietary intake, and bacterial species, respectively, after adjustment for sociodemographic, behavioral, and clinical factors.

Results: TMAO was positively associated with prevalent CVD (case number = 279; OR = 1.34; 95% CI: 1.17, 1.54, per 1-SD). Fish (P = 1.26 × 10-17), red meat (P = 3.33 × 10-16), and egg (P = 3.89 × 10-5) intakes were top dietary factors positively associated with TMAO. We identified 9 gut bacterial species significantly associated with TMAO (false discovery rate <0.05). All 4 species positively associated with TMAO belong to the order Clostridiales, of which 3 might have homologous genes encoding carnitine monooxygenase, an enzyme converting carnitine to trimethylamine (TMA). The red meat-TMAO association was more pronounced in participants with higher abundances of these 4 species compared with those with lower abundance (Pinteraction = 0.013), but such microbial modification was not observed for fish-TMAO or egg-TMAO associations.

Conclusion: In US Hispanics/Latinos, fish, red meat, and egg intakes are major dietary factors associated with serum TMAO. The identified potential TMA-producing gut microbiota and microbial modification on the red meat-TMAO association support microbial TMA production from dietary carnitine, whereas the fish-TMAO association is independent of gut microbiota.
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http://dx.doi.org/10.1093/ajcn/nqab001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8168354PMC
June 2021

A pilot study of the effect of rivaroxaban in sickle cell anemia.

Transfusion 2021 06 4;61(6):1694-1698. Epub 2021 Mar 4.

Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.

Introduction: The contribution of coagulation activation to the pathogenesis of sickle cell disease (SCD) remains incompletely defined. We evaluated the efficacy and safety of rivaroxaban, an oral direct factor Xa inhibitor, in subjects with sickle cell anemia.

Materials And Methods: In this pilot, single-center, randomized, double-blind, placebo-controlled, crossover study, eligible subjects with sickle cell anemia received rivaroxaban or placebo. The effect of rivaroxaban on coagulation activation, endothelial activation, inflammation, and microvascular blood flow was evaluated.

Results: Fourteen patients (HbSS - 14; females - 9) with mean age of 38 ± 10.6 years were randomized to receive rivaroxaban 20 mg daily or placebo for 4 weeks and, following a 2-week washout phase, were "crossed-over" to the treatment arm opposite to which they were initially assigned. Mean adherence to treatment with rivaroxaban, assessed by pill counts, was 85.6% in the first treatment period and 93.6% in the second period. Treatment with rivaroxaban resulted in a decrease from baseline of thrombin-antithrombin complex versus placebo (-34.4 ug/L [95% CI: -69.4, 0.53] vs. 0.35 ug/L [95% CI: -3.8, 4.5], p = .08), but the difference was not statistically significant. No significant differences were observed in changes from baseline of D-dimer, inflammatory, and endothelial activation markers or measures of microvascular blood flow. Rivaroxaban was well tolerated.

Conclusions: Rivaroxaban was safe but did not significantly decrease coagulation activation, endothelial activation, or inflammation. Rivaroxaban did not improve microvascular blood flow. Adequately powered studies are required to further evaluate the efficacy of rivaroxaban in SCD. Clinicaltrials.gov Identifier: NCT02072668.
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http://dx.doi.org/10.1111/trf.16343DOI Listing
June 2021

Inverse probability weighted estimation for recurrent events data with missing category.

Stat Med 2021 05 4;40(12):2765-2782. Epub 2021 Mar 4.

Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA.

Modeling recurrent event data with multiple event types has drawn interest in recent biomedical studies due to its flexibility for understanding different risk factors for multiple recurrent event processes. However, in such data type, missing event type appears frequently because of various reasons such as recording ignorance or resource limitation. In this study, we aim to propose an inverse probability weighted estimation that is commonly used in the missing data literature to correct possibly biased estimation by a complete-case analysis. This approach is not limited to a specific form of the recurrent event model. We derive the large sample theory in a general form. We demonstrate that our approach can be applied to either multiplicative or additive rates model with practical sample size via comprehensive simulations. Nonmucoid and mucoid Pseudomonas aeruginosa infections of 14 888 patients in 2016 Cystic Fibrosis Foundation Patient Registry data are analyzed to show that, without including 12% events with missing event type in the analysis, several factors may be misidentified as risk factors for the nonmucoid type of infections.
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http://dx.doi.org/10.1002/sim.8927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269380PMC
May 2021

Stroke Risk Factor Status and Use of Stroke Prevention Medications Among Hispanic/Latino Adults in HCHS/SOL.

Stroke 2021 Apr 4;52(4):1339-1346. Epub 2021 Mar 4.

Department of Neurology and Rehabilitation (F.B., D.P., F.D.T.), University of Illinois at Chicago.

Background And Purpose: We investigated the prevalence, awareness, and control of vascular risk factors (VRFs) and the use of antithrombotic and statin agents in HCHS (Hispanic Community Health Study)/SOL (Study of Latinos) participants with self-reported history of stroke or transient ischemic attack.

Methods: Sociodemographic characteristics, medications, and prevalence of different VRFs were recorded. VRF diagnoses and goals were based on the recommendations of professional organizations. Factors associated with optimal VRF control and use of antithrombotic and statin agents were investigated using multivariate logistic regression.

Results: The analysis included 404 participants (39% men). The prevalences of hypertension, dyslipidemia, and diabetes were 59%, 65%, and 39%, respectively. Among those who met the diagnostic criteria for these diagnoses, the frequencies of awareness were 90%, 75%, and 83%, respectively. In participants who were aware of their VRFs, the prevalences of controlled hypertension, dyslipidemia, and diabetes were 46%, 32%, and 54%. Approximately 46% of the participants were on antithrombotics, 39% on statins, and 26% on both. Only 38% of those with atrial fibrillation received anticoagulation. In multivariate analyses adjusted for baseline sociodemographic characteristics, older age was associated with uncontrolled hypertension and diabetes. Residing in the United States for ≥10 years and born in the United States were associated with uncontrolled diabetes, female sex with uncontrolled dyslipidemia, and lack of health insurance with decreased use of statins and hyperlipidemia.

Conclusions: Hispanic/Latino adults in the United States have high prevalence and awareness of VRFs but low adherence to secondary stroke prevention strategies. Older adults, women, and uninsured people are vulnerable groups that may benefit from targeted interventions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02060344.
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http://dx.doi.org/10.1161/STROKEAHA.120.031216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988300PMC
April 2021

Long-Term Exposure to Ambient Air Pollution and Cognitive Function Among Hispanic/Latino Adults in San Diego, California.

J Alzheimers Dis 2021 ;79(4):1489-1496

Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.

Background: Hispanics/Latinos in the United States are more likely to live in neighborhoods with greater exposure to air pollution and are projected to have the largest increase in dementia among race/ethnic minority groups.

Objective: We examined the associations of air pollution with performance on cognitive function tests in Hispanic/Latino adults.

Methods: We used data from the San Diego site of the Hispanic Community Health Study/Study of Latinos, an ongoing cohort of Hispanics/Latinos. This analysis focused on individuals ≥45 years of age who completed a neurocognitive battery examining overall mental status, verbal learning, memory, verbal fluency, and executive function (n = 2,089). Air pollution (PM2.5 and O3) before study baseline was assigned to participants' zip code. Logistic and linear regression were used to estimate the associations of air pollution on overall mental status and domain-specific standardized test scores. Models accounted for complex survey design, demographic, and socioeconomic characteristics.

Results: We found that for every 10μg/m3 increase in PM2.5, verbal fluency worsened (β: -0.21 [95%CI: -0.68, 0.25]). For every 10 ppb increase in O3, verbal fluency and executive function worsened (β: -0.19 [95%CI: -0.34, -0.03]; β: -0.01 [95%CI: -0.01, 0.09], respectively). We did not identify any detrimental effect of pollutants on other domains.

Conclusion: Although we found suggestions that air pollution may impact verbal fluency and executive function, we observed no consistent or precise evidence to suggest an adverse impact of air pollution on cognitive level among this cohort of Hispanic/Latino adults.
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http://dx.doi.org/10.3233/JAD-200766DOI Listing
September 2021

Obesogenic home food availability, diet, and BMI in Pakistani and White toddlers.

Matern Child Nutr 2021 07 19;17(3):e13138. Epub 2021 Jan 19.

Departments of Nutrition and Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Individuals of South Asian ethnicity have an increased risk for obesity and related diseases. Foods available in the home during the first 1000 days (conception to 24 months old) are an important determinant of diet, yet no study has examined the association of early-life home food availability (HFA) with later diet and obesity risk in South Asian households. We examined whether obesogenic HFA at 18 months of age is associated with dietary intake and body mass index (BMI) at 36 months of age in low-income Pakistani and White households in the United Kingdom. In this prospective birth cohort study (Born in Bradford 1000), follow-up assessments occurred at 18 (n = 1032) and 36 (n = 986) months of age. Variety and quantity of snack foods and sugar-sweetened beverages (SSBs) in the home and consumed were measured using the HFA Inventory Checklist and food frequency questionnaires, respectively. BMI was calculated using measured length/height and weight. Multinomial logistic regression models examined associations between HFA and tertiles of dietary intake, and multivariable linear regression models assessed associations between HFA and BMI. Pakistani households had a greater variety and quantity of snack foods and SSBs available compared with White households. Variety and quantity of snack foods and SSBs in the home at 18 months were positively associated with children's intake of these items at 36 months, but associations between HFA and BMI were null. Reducing obesogenic HFA during the first 1000 days may promote the development of more healthful diets, though this may not be associated with lower obesity risk during toddlerhood.
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http://dx.doi.org/10.1111/mcn.13138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189220PMC
July 2021

Association of liver enzymes with incident diabetes in US Hispanic/Latino adults.

Diabet Med 2021 Aug 28;38(8):e14522. Epub 2021 Jan 28.

Albert Einstein College of Medicine, Bronx, NY, USA.

Introduction: Non-alcoholic fatty liver disease (NAFLD) has been associated with increased risk of incident diabetes. But such evidence is lacking in the Hispanic/Latino population, which has high prevalence of obesity and NAFLD.

Methods: We conducted a prospective cohort study of 6,928 adults of Hispanic/Latino background who had no diabetes, did not report excessive alcohol use, and no hepatitis B and C infection at baseline (2008-2011). We estimated risk ratios (RR) for incident diabetes, identified from visit 2 examination by glucose measurements or antidiabetic medication use, with baseline liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT)).

Results: A total of 738 adults developed diabetes during 6 years of follow-up. After adjusting for participant characteristics at baseline, versus the lowest quartile, highest quartiles of ALT and GGT were associated with risks for incident diabetes (RR for ALT: 1.51 [95% CI 1.03-2.22], p-trend = 0.006; RR for GGT: 2.39 [1.60-3.55], p-trend = 0.001). Higher GGT levels predicted increased risk of incident diabetes even among those with ALT or AST below the median levels. The associations of ALT and GGT with incident diabetes were similar among most Hispanic background but were not seen among Dominicans (p for interaction <0.05). The association of AST with incident diabetes was found only among light-to-moderate alcohol drinkers (RR = 1.50 [1.20-1.86]) but not abstainers (RR = 0.91 [0.69-1.20], p for interaction = 0.006).

Conclusion: Higher ALT and GGT levels are associated with increased risk of developing diabetes among Latinos. Liver enzyme tests might aid in diabetes prevention by identifying high-risk individuals.
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http://dx.doi.org/10.1111/dme.14522DOI Listing
August 2021

Semiparametric regression based on quadratic inference function for multivariate failure time data with auxiliary information.

Lifetime Data Anal 2021 04 8;27(2):269-299. Epub 2021 Jan 8.

Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7420, USA.

This paper deals with statistical inference procedure of multivariate failure time data when the primary covariate can be measured only on a subset of the full cohort but the auxiliary information is available. To improve efficiency of statistical inference, we use quadratic inference function approach to incorporate the intra-cluster correlation and use kernel smoothing technique to further utilize the auxiliary information. The proposed method is shown to be more efficient than those ignoring the intra-cluster correlation and auxiliary information and is easy to implement. In addition, we develop a chi-squared test for hypothesis testing of hazard ratio parameters. We evaluate the finite-sample performance of the proposed procedure via extensive simulation studies. The proposed approach is illustrated by analysis of a real data set from the study of left ventricular dysfunction.
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http://dx.doi.org/10.1007/s10985-020-09513-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943434PMC
April 2021

Whole genome sequence analyses of eGFR in 23,732 people representing multiple ancestries in the NHLBI trans-omics for precision medicine (TOPMed) consortium.

EBioMedicine 2021 Jan 6;63:103157. Epub 2021 Jan 6.

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.

Background: Genetic factors that influence kidney traits have been understudied for low frequency and ancestry-specific variants.

Methods: We combined whole genome sequencing (WGS) data from 23,732 participants from 10 NHLBI Trans-Omics for Precision Medicine (TOPMed) Program multi-ethnic studies to identify novel loci for estimated glomerular filtration rate (eGFR). Participants included European, African, East Asian, and Hispanic ancestries. We applied linear mixed models using a genetic relationship matrix estimated from the WGS data and adjusted for age, sex, study, and ethnicity.

Findings: When testing single variants, we identified three novel loci driven by low frequency variants more commonly observed in non-European ancestry (PRKAA2, rs180996919, minor allele frequency [MAF] 0.04%, P = 6.1 × 10; METTL8, rs116951054, MAF 0.09%, P = 4.5 × 10; and MATK, rs539182790, MAF 0.05%, P = 3.4 × 10). We also replicated two known loci for common variants (rs2461702, MAF=0.49, P = 1.2 × 10, nearest gene GATM, and rs71147340, MAF=0.34, P = 3.3 × 10, CDK12). Testing aggregated variants within a gene identified the MAF gene. A statistical approach based on local ancestry helped to identify replication samples for ancestry-specific variants.

Interpretation: This study highlights challenges in studying variants influencing kidney traits that are low frequency in populations and more common in non-European ancestry.
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http://dx.doi.org/10.1016/j.ebiom.2020.103157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804602PMC
January 2021

Patterns of Sedentary Time in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Youth.

J Phys Act Health 2020 12 22;18(1):61-69. Epub 2020 Dec 22.

Background: Total sedentary time and prolonged sedentary patterns can negatively impact health. This study investigated rates of various sedentary pattern variables in Hispanic/Latino youth.

Methods: Participants were 956 youths (50.9% female) in the Hispanic Community Health Study/Study of Latinos Youth, a population-based cohort study of Hispanic/Latino 8- to 16-year-olds from 4 geographic regions in the United States (2012-2014). Total sedentary time and 10 sedentary pattern variables were measured through 1 week of accelerometer wear. Differences were examined by sociodemographic characteristics, geographic location, weekdays versus weekends, and season.

Results: On average, youth were sedentary during 67.3% of their accelerometer wear time, spent 24.2% engaged in 10- to 29-minute sedentary bouts, and 7.2% in ≥60-minute bouts. 8- to 12-year-olds had more favorable sedentary patterns (less time in extended bouts and more breaks) than 13- to 16-year-olds across all sedentary variables. Sedentary patterns also differed by Hispanic/Latino background, with few differences across sex, household income, season, and place of birth, and none between weekdays versus weekends.

Conclusions: Variables representing prolonged sedentary time were high among Hispanic/Latino youth. Adolescents in this group appear to be at especially high risk for unhealthy sedentary patterns. Population-based efforts are needed to prevent youth from engaging in increasingly prolonged sedentary patterns.
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http://dx.doi.org/10.1123/jpah.2020-0135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035218PMC
December 2020

Accelerated failure time model for data from outcome-dependent sampling.

Lifetime Data Anal 2021 01 12;27(1):15-37. Epub 2020 Oct 12.

Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.

Outcome-dependent sampling designs such as the case-control or case-cohort design are widely used in epidemiological studies for their outstanding cost-effectiveness. In this article, we propose and develop a smoothed weighted Gehan estimating equation approach for inference in an accelerated failure time model under a general failure time outcome-dependent sampling scheme. The proposed estimating equation is continuously differentiable and can be solved by the standard numerical methods. In addition to developing asymptotic properties of the proposed estimator, we also propose and investigate a new optimal power-based subsamples allocation criteria in the proposed design by maximizing the power function of a significant test. Simulation results show that the proposed estimator is more efficient than other existing competing estimators and the optimal power-based subsamples allocation will provide an ODS design that yield improved power for the test of exposure effect. We illustrate the proposed method with a data set from the Norwegian Mother and Child Cohort Study to evaluate the relationship between exposure to perfluoroalkyl substances and women's subfecundity.
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http://dx.doi.org/10.1007/s10985-020-09508-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856009PMC
January 2021

A Genome-wide Association Study Discovers 46 Loci of the Human Metabolome in the Hispanic Community Health Study/Study of Latinos.

Am J Hum Genet 2020 11 7;107(5):849-863. Epub 2020 Oct 7.

Human Genetics Center, University of Texas Health Science Center, Houston, TX 77030, USA. Electronic address:

Variation in levels of the human metabolome reflect changes in homeostasis, providing a window into health and disease. The genetic impact on circulating metabolites in Hispanics, a population with high cardiometabolic disease burden, is largely unknown. We conducted genome-wide association analyses on 640 circulating metabolites in 3,926 Hispanic Community Health Study/Study of Latinos participants. The estimated heritability for 640 metabolites ranged between 0%-54% with a median at 2.5%. We discovered 46 variant-metabolite pairs (p value < 1.2 × 10, minor allele frequency ≥ 1%, proportion of variance explained [PEV] mean = 3.4%, PEV = 1%-22%) with generalized effects in two population-based studies and confirmed 301 known locus-metabolite associations. Half of the identified variants with generalized effect were located in genes, including five nonsynonymous variants. We identified co-localization with the expression quantitative trait loci at 105 discovered and 151 known loci-metabolites sets. rs5855544, upstream of SLC51A, was associated with higher levels of three steroid sulfates and co-localized with expression levels of SLC51A in several tissues. Mendelian randomization (MR) analysis identified several metabolites associated with coronary heart disease (CHD) and type 2 diabetes. For example, two variants located in or near CYP4F2 (rs2108622 and rs79400241, respectively), involved in vitamin E metabolism, were associated with the levels of octadecanedioate and vitamin E metabolites (gamma-CEHC and gamma-CEHC glucuronide); MR analysis showed that genetically high levels of these metabolites were associated with lower odds of CHD. Our findings document the genetic architecture of circulating metabolites in an underrepresented Hispanic/Latino community, shedding light on disease etiology.
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http://dx.doi.org/10.1016/j.ajhg.2020.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675000PMC
November 2020

Current Smoking Raises Risk of Incident Hypertension: Hispanic Community Health Study-Study of Latinos.

Am J Hypertens 2021 03;34(2):190-197

Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.

Background: Hypertension has been implicated as a smoking-related risk factor for cardiovascular disease but the dose-response relationship is incompletely described. Hispanics, who often have relatively light smoking exposures, have been understudied in this regard.

Methods: We used data from a 6-year follow-up study of US Hispanic adults aged 18-76 to address the dose-response linking cigarette use with incident hypertension, which was defined by measured blood pressure above 140/90 mm Hg or initiation of antihypertensive medications. Adjustment was performed for potential confounders and mediators, including urinary albumin-to-creatinine ratio which worsened over time among smokers.

Results: Current smoking was associated with incident hypertension, with a threshold effect above 5 cumulative pack-years of smoking (vs. never smokers, hazard ratio for hypertension [95% confidence interval] of 0.95 [0.67, 1.35] for 0-5 pack-years, 1.47 [1.05, 2.06] for 5-10 pack-years, 1.40 [1.00, 1.96] for 10-20 pack-years, and 1.34 [1.09, 1.66] for ≥20 pack-years, P = 0.037). In contrast to current smokers, former smokers did not appear to have increased risk of hypertension, even at the highest cumulative pack-years of past exposure.

Conclusions: The results confirm that smoking constitutes a hypertension risk factor in Hispanic adults. A relatively modest cumulative dose of smoking, above 5 pack-years of exposure, raises risk of hypertension by over 30%. The increased hypertension risk was confined to current smokers, and did not increase further with higher pack-year levels. The lack of a smoking-hypertension association in former smokers underscores the value of smoking cessation.
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http://dx.doi.org/10.1093/ajh/hpaa152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951044PMC
March 2021

A longitudinal analysis of nondaily smokers: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Ann Epidemiol 2020 09 23;49:61-67. Epub 2020 Jun 23.

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. Electronic address:

Purpose: Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers.

Methods: The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design.

Results: After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs.
Conclusions: Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases.
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http://dx.doi.org/10.1016/j.annepidem.2020.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506143PMC
September 2020

Empirically Derived Dietary Patterns Using Robust Profile Clustering in the Hispanic Community Health Study/Study of Latinos.

J Nutr 2020 10;150(10):2825-2834

Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Background: Latent class models (LCMs) have been used in exploring dietary behaviors over a wide set of foods and beverages in a given population, but are prone to overgeneralize these habits in the presence of variation by subpopulations.

Objectives: This study aimed to highlight unique dietary consumption differences by both study site and ethnic background of Hispanic/Latino populations in the United States, that otherwise might be missed in a traditional LCM of the overall population. This was achieved using a new model-based clustering method, referred to as robust profile clustering (RPC).

Methods: A total of 11,320 individuals aged 18-74 y from the Hispanic Community Health Study/Study of Latinos (2008-2011) with complete diet data were classified into 9 subpopulations, defined by study site (Bronx, Chicago, Miami, San Diego) and ethnic background. At baseline, dietary intake was ascertained using a food propensity questionnaire. Dietary patterns were derived from 132 food groups using the RPC method to identify patterns of the general Hispanic/Latino population and those specific to an identified subpopulation. Dietary patterns derived from the RPC were compared to those identified from an LCM.

Results: The LCM identified 48 shared consumption behaviors of foods and beverages across the entire cohort, whereas significant consumption differences in subpopulations were identified in the RPC model for these same foods. Several foods were common within study site (e.g., chicken, orange juice, milk), ethnic background (e.g., papayas, plantain, coffee), or both (e.g., rice, tomatoes, seafood). Post hoc testing revealed an improved model fit in the RPC model [Deviance Information Criterion DICRPC = 2.3 × 104, DICLCM  = 9.5 × 106].

Conclusions: Dietary pattern behaviors of Hispanics/Latinos in the United States tend to align by ethnic background for some foods and by location for other foods. Consideration of both factors is imperative to better understand their contributions to population health and developing targeted nutrition intervention studies.
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http://dx.doi.org/10.1093/jn/nxaa208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549309PMC
October 2020
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