Publications by authors named "Thomas G Hurley"

72 Publications

Changes in dietary inflammatory potential predict changes in sleep quality metrics, but not sleep duration.

Sleep 2020 11;43(11)

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.

Study Objectives: Non-pharmacological sleep interventions may improve sleep profiles without the side-effects observed with many pharmacological sleep aids. The objective of this research was to examine the association between sleep and inflammation and to examine how changes in dietary inflammatory potential influence changes in sleep.

Methods: The Inflammation Management Intervention Study (IMAGINE), which was a dietary intervention designed to lower inflammation, provided access to 24-h dietary recalls (24HR), objectively measured sleep using SensewearTM armbands, and a range of self-reported demographics, health histories, lifestyle behaviors, psychosocial metrics, anthropometric measurements, and inflammatory biomarkers. Dietary Inflammatory Index® (DII®) scores were calculated from three unannounced 24HR-derived estimated intakes of whole foods and micro and macronutrients over a 2-week period at baseline and post-intervention (i.e. month 3). Statistical analyses primarily utilized linear regression.

Results: At baseline, for every 1-min increase in sleep onset latency, tumor necrosis factor-α increased by 0.015 pg/mL (±0.008, p = 0.05). Every one-percentage increase in sleep efficiency was associated with decreased C-reactive protein (CRP) of -0.088 mg/L (±0.032, p = 0.01). Every 1-min increase in wake-after-sleep-onset (WASO) increased both CRP and interleukin-6. Compared to participants with pro-inflammatory DII changes over 3 months, those with anti-inflammatory changes decreased WASO (0 vs. -25 min, respectively, p < 0.01) and improved sleep efficiency (-2.1% vs. +2.6%, respectively, p = 0.04).

Conclusions: Non-pharmacological treatments, such as anti-inflammatory diets, may improve sleep in some adults. Future research involving dietary treatments to improve sleep should not only focus on the general population, but also in those commonly experiencing co-morbid sleep complaints.

Clinical Trial Information: NCT02382458.
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http://dx.doi.org/10.1093/sleep/zsaa093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658634PMC
November 2020

The impact of a randomized dietary and physical activity intervention on chronic inflammation among obese African-American women.

Women Health 2020 08 5;60(7):792-805. Epub 2020 Apr 5.

Cancer Prevention and Control Program, University of South Carolina , Columbia, South Carolina, USA.

Lifestyle interventions may reduce inflammation and lower breast cancer (BrCa) risk. This randomized trial assessed the impact of the Sistas Inspiring Sistas Through Activity and Support (SISTAS) study on plasma C-reactive protein (CRP), interleukin-6 (IL-6) and Dietary Inflammatory Index (DII). This unblinded, dietary and physical activity trial was implemented in 337 obese (body mass index [BMI] ≥30 kg/m) African American (AA) women recruited between 2011 and 2015 in South Carolina through a community-based participatory approach with measurements at baseline, 3 months, and 12 months. Participants were randomized into either intervention (n = 176) or wait-list control group (n = 161). Linear mixed-effect models were used for analyses of CRP and IL-6. Baseline CRP was significantly higher in those with greater obesity, body fat percentage, and waist circumference (all <.01). No difference was observed between groups for CRP or IL-6 at 3 or 12 months; however, improvements in diet were observed in the intervention group compared to the control group ( = .02) at 3 months but were not sustained at 12 months. Although the intervention was not successful at reducing levels of CRP or IL-6, a significant decrease was observed in DII score for the intervention group, indicating short-term positive dietary change.
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http://dx.doi.org/10.1080/03630242.2020.1746950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332405PMC
August 2020

Reply to FJB van Duijnhoven et al.

Adv Nutr 2020 01;11(1):179-180

From the Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.

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http://dx.doi.org/10.1093/advances/nmz089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964986PMC
January 2020

Adiposity does not modify the effect of the dietary inflammatory potential on type 2 diabetes incidence among a prospective cohort of men.

J Nutr Intermed Metab 2019 Jun 1;16. Epub 2019 Mar 1.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.

Purpose: Inflammatory contributions from diet and adiposity may interact with respect to the development of type 2 diabetes mellitus (T2DM). We investigated the degree to which adiposity modified the association between dietary inflammatory potential and incident T2DM.

Methods: Data from 6,016 US men in the Aerobics Center Longitudinal Study who completed a 3-day diet record were used. The inflammatory potential of diet was characterized by the Dietary Inflammatory Index (DII®), and adiposity was assessed with body mass index, waist circumference, body fat percentage (BF) and waist-to-height ratio. Inverse probability weights were used in modified Poisson regression models to examine whether adiposity modifies the relationship between the DII and T2DM, while accounting for selection bias from participants who were lost to follow-up.

Results: There were 336 incident cases of T2DM after a mean follow-up of 6.5 years. DII scores were not significantly associated with T2DM incidence in multivariable models, but point estimates were consistently elevated across increasing DII quartiles compared to the most anti-inflammatory DII quartile. In the model that evaluated BF, the term for overall effect modification was significant (p = 0.02), but there was no evidence of effect modification on the multiplicative and additive scales when examined further. Effect modification was not present for any other adiposity measures.

Conclusions: We did not observe evidence that a pro-inflammatory diet, as measured by the DII, is associated with incidence of T2DM, nor evidence that adiposity modifies a potential relationship. Further investigation is needed in larger cohorts with longer follow-up.
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http://dx.doi.org/10.1016/j.jnim.2019.100095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440686PMC
June 2019

Impact of a 12-month Inflammation Management Intervention on the Dietary Inflammatory Index, inflammation, and lipids.

Clin Nutr ESPEN 2019 04 1;30:42-51. Epub 2019 Mar 1.

Department of Epidemiology and Biostatistics, Arnold School of Public Health, USA; Cancer Prevention and Control Program, Arnold School of Public Health, USA; Connecting Health Innovations LLC, USA.

Background And Aims: The objective of this study was to assess the feasibility (ability to recruit participants and develop the 12-month intervention), acceptability (retention of participants in the intervention), and impact on systemic inflammation and Dietary Inflammatory Index (DII®) scores over a 12-month DII-based intervention.

Methods: Adults were recruited to participate in a self-selection trial (intervention: n = 61, in-person classes; control: n = 34, newsletters). Classes included participatory cooking and dietary recommendations focused on consuming a plant-based diet rich in anti-inflammatory foods (spices, vegetables, etc.). Changes in markers of inflammation, lipids, and DII were analyzed using general linear models with repeated measurements.

Results: At 3 months, intervention participants had significantly lower DII scores (-2.66 ± 2.44) compared to controls (-0.38 ± 2.56) (p < 0.01); but not at 12 months (P = 0.10). The only biomarker to approach a significant group effect or group-by-time interaction was CRP (P = 0.11 for the group-by-time interaction). CRP decreased by -0.65 mg/L (95%CI = 0.10-1.20, P = 0.02) at 12 months in the intervention group; no significant decrease was seen for the control group. With both groups combined at 3 months, those with the greatest decrease/improvement in DII score (tertile 1) compared with those whose scores increased (tertile 3) had greater reductions in CRP (-1.09 vs. +0.52 mg/L, P = 0.04), total cholesterol (-9.38 vs. +12.02 mg/dL, P = 0.01), and LDL cholesterol (-11.99 vs. +7.16 mg/dL, P = 0.01).

Conclusions: Although the intervention group had reductions in DII and CRP, main inflammation and lipid outcomes did not differ between groups. Overall, those participants with the largest reduction in DII scores had the largest reductions in CRP and LDL and total cholesterol. Future interventions may need to have more components in place to support maintenance and continued reductions in the DII. CLINICALTRIALS.

Gov Identifier: NCT02382458.
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http://dx.doi.org/10.1016/j.clnesp.2019.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435295PMC
April 2019

Relationships between chronotype, social jetlag, sleep, obesity and blood pressure in healthy young adults.

Chronobiol Int 2019 04 21;36(4):493-509. Epub 2019 Jan 21.

a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , South Carolina , USA.

Sleep disturbances, chronotype and social jetlag (SJL) have been associated with increased risks for major chronic diseases that take decades to develop, such as obesity, metabolic syndrome and cardiovascular disease. Potential relationships between poor sleep, chronotype and SJL as they relate to metabolic risk factors for chronic disease have not been extensively investigated. This prospective study examined chronotype, SJL and poor sleep in relation to both obesity and elevated blood pressure among healthy young adults. SJL and objective sleep measures (total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency) were derived from personal rest/activity monitoring (armband actigraphy) among 390 healthy adults 21-35 years old. Participants wore the device for 6-10 days at 6-month intervals over a 2-year period (n = 1431 repeated observations). Chronotypes were categorized into morning, intermediate and evening groups using repeated measures latent class analysis. Means of SJL and sleep measures among latent chronotype groups were compared using partial F-tests in generalized linear mixed models. Generalized linear mixed models also were used to generate odds ratios (ORs) with 95% confidence intervals (CIs) examining the relationship between repeated measures of chronotype, SJL, sleep and concurrent anthropometric outcome measures (body mass index, percentage of body fat, waist-to-hip ratio, waist-to-height ratio), systolic blood pressure and diastolic blood pressure. Sleep latency ≥12 min was associated with increased odds of a high waist-to-height ratio (OR = 1.37; CI: 1.03-1.84). Neither chronotype nor SJL was independently associated with anthropometric outcomes or with blood pressure. Relationships between poor sleep and anthropometric outcomes or blood pressure varied by chronotype. Morning types with total sleep time <6 h, sleep efficiency <85% or wake after sleep onset ≥60 min were more likely to have an increased percentage of body fat, waist-to-hip ratio and waist-to-height ratio relative to those with an intermediate chronotype. Similarly, sleep latency ≥12 min was associated with increased odds of elevated systolic blood pressure (OR = 1.90; CI: 1.15-3.16, p = 0.02) among morning versus intermediate chronotypes. No relationships between poor sleep and obesity or elevated blood pressure were observed among evening chronotypes. The results from this study among healthy young adults suggest that poor sleep among morning types may be more strongly associated with obesity and elevated blood pressure relative to those with an intermediate (neutral) chronotype. Sleep-related metabolic alterations among different chronotypes warrant further investigation.
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http://dx.doi.org/10.1080/07420528.2018.1563094DOI Listing
April 2019

Perspective: The Dietary Inflammatory Index (DII)-Lessons Learned, Improvements Made, and Future Directions.

Adv Nutr 2019 03;10(2):185-195

Cancer Prevention and Control Program.

The literature on the role of inflammation in health has grown exponentially over the past several decades. Paralleling this growth has been an equally intense focus on the role of diet in modulating inflammation, with a doubling in the size of the literature approximately every 4 y. The Dietary Inflammatory Index (DII) was developed to provide a quantitative means for assessing the role of diet in relation to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. Based on literature from a variety of different study designs ranging from cell culture to observational and experimental studies in humans, the DII was designed to be universally applicable across all human studies with adequate dietary assessment. Over the past 4 y, the DII has been used in >200 studies and forms the basis for 12 meta-analyses. In the process of conducting this work, lessons were learned with regard to methodologic issues related to total energy and nutrient intake and energy and nutrient densities. Accordingly, refinements to the original algorithm have been made. In this article we discuss these improvements and observations that we made with regard to misuse and misinterpretation of the DII and provide suggestions for future developments.
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http://dx.doi.org/10.1093/advances/nmy071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416047PMC
March 2019

Baseline markers of inflammation, lipids, glucose, and Dietary Inflammatory Index scores do not differ between adults willing to participate in an intensive inflammation reduction intervention and those who do not.

Nutr Health 2019 Mar 19;25(1):9-19. Epub 2018 Sep 19.

2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA.

Background:: Chronic inflammation is associated with numerous chronic diseases and can be managed with diet.

Aim:: The purpose of this study was to examine differences in baseline characteristics and plasma inflammation levels between two groups of participants that participated in an intensive, lifestyle intervention or a remotely delivered intervention. This work also assessed the association between Dietary Inflammatory Index (DII) scores and participants' inflammatory and metabolic biomarkers at baseline.

Method:: Ninety-five participants (61 intervention, 34 control) chose to enroll in either a 12-month intervention consisting of a face-to-face nutrition, physical activity, and stress management intervention or a remotely-delivered intervention (control group) focusing on general cancer prevention. The intervention group met at the University of South Carolina for classes and the control group had materials emailed to them. A quantile regression was used to compare participants' high-sensitivity C-reactive protein and interleukin-6 levels. Multiple linear regression was used to determine the association between DII scores and biomarkers.

Results:: There were significant differences in age, body mass index, body fat percentage, and blood pressure between groups, but there were no differences in levels of inflammatory biomarkers. Values of interleukin-6 at the 90th percentile of its distribution were 8.31 pg/ml higher among those in DII quartile 4 compared with quartile 1 ( p = 0.02). All other outcomes were not significant.

Conclusion:: Given similar levels of inflammatory biomarkers, participants opting for the control group would also have benefited from a more intensive lifestyle intervention focusing on reducing inflammation.
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http://dx.doi.org/10.1177/0260106018800645DOI Listing
March 2019

Design, Development and Construct Validation of the Children's Dietary Inflammatory Index.

Nutrients 2018 Jul 30;10(8). Epub 2018 Jul 30.

Statewide Cancer Prevention and Control Program (CPCP), Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.

Objective: To design and validate a literature-derived, population-based Children's Dietary Inflammatory Index (C-DII).

Design: The C-DII was developed based on a review of literature through 2010. Dietary data obtained from children in 16 different countries were used to create a reference database for computing C-DII scores based on consumption of macronutrients, vitamins, minerals, and whole foods. Construct validation was performed using quantile regression to assess the association between C-reactive protein (CRP) concentrations and C-DII scores.

Data Sources: All data used for construct validation were obtained from children between six and 14 years of age ( = 3300) who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) (2005⁻2010).

Results: The C-DII was successfully validated with blood CRP concentrations in this heterogeneous sample of 3300 children from NHANES (52% male; 29% African American, 25% Mexican American; mean age 11 years). The final model was adjusted for sex, age, race, asthma, body mass index (BMI), and infections. Children in level 3 (i.e., quartiles 3 and 4 combined) of the C-DII (i.e., children with the most pro-inflammatory diets) had a CRP value 0.097 mg/dL higher than that in level 1 (i.e., quartile 1) for CRP values at the 75th percentile of CRP using quantile regression ( < 0.05).

Conclusion: The C-DII predicted blood CRP concentrations among children 6⁻14 years in the NHANES. Further construct validation with CRP and other inflammatory markers is required to deepen understanding of the relationship between the C-DII and markers of inflammation in children.
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http://dx.doi.org/10.3390/nu10080993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115957PMC
July 2018

Sistas Inspiring Sistas Through Activity and Support (SISTAS): Study Design and Demographics of Participants.

Ethn Dis 2018 26;28(2):75-84. Epub 2018 Apr 26.

Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina.

Introduction: Recruiting racial, ethnic, and other underserved minorities into conventional clinic-based and other trials is known to be challenging. The Sistas Inspiring Sistas Through Activity and Support (SISTAS) Program was a one-year randomized controlled trial (RCT) to promote physical activity and healthy eating among AA women in SC to reduce inflammatory biomarkers, which are linked to increased breast cancer (BrCa) risk and mortality. This study describes the development, recruitment, and implementation of the SISTAS clinical trial and provides baseline characteristics of the study participants.

Methods: SISTAS was developed using community-based participatory research (CBPR) approaches. At baseline, study participants completed assessments and underwent clinical measurements and blood draws to measure C-reactive protein (CRP) and interleukin-6 (IL-6). Participants randomized to the intervention received 12 weekly classes followed by nine monthly booster sessions. Post-intervention measurements were assessed at 12-week and 12-month follow-ups.

Results: We recruited a total of 337 women who tended to: be middle-aged (mean age 48.2 years); have some college education; be employed full-time; have Medicare as their primary insurance; be non-smokers; and perceive their personal health as good. On average, the women were pre-hypertensive at baseline (mean systolic blood pressure = 133.9 mm Hg; mean diastolic blood pressure = 84.0 mm Hg) and morbidly obese (mean BMI >40.0 kg/m); the mean fat mass and fat-free mass among participants were 106.4 lb and 121.0 lb, respectively.

Conclusion: The SISTAS RCT addresses some of the gaps in the literature with respect to CBPR interventions targeting AA women, such as implementing diet and physical activity in CBPR-based studies to decrease BrCa risk.
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http://dx.doi.org/10.18865/ed.28.2.75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926857PMC
October 2019

Association between the Dietary Inflammatory Index (DII) and urinary enterolignans and C-reactive protein from the National Health and Nutrition Examination Survey-2003-2008.

Eur J Nutr 2019 Mar 19;58(2):797-805. Epub 2018 Apr 19.

Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Room 233, Suite 200, Columbia, SC, 29208, USA.

Background: Enterolignans are important biomarkers of microbiota diversity, with higher levels indicating greater diversity. Diet and inflammation have been shown to play a role in maintaining microbiota diversity. This study examined whether inflammatory potential of diet, as measured by the Dietary Inflammatory Index (DII) has an impact on levels of urinary enterolignans in the National Health and Nutrition Examination Survey (NHANES) 2003-2008. We also carried out construct validation of the DII with C-reactive protein (CRP).

Methods: Data came from NHANES 2003-2008. Enterolignans [enterodiol (END) and enterolactone (ENL)] and CRP were assayed from urine and serum specimens, respectively. Energy-adjusted DII (E-DII) scores were calculated from food intakes assessed using 24-h dietary recalls and expressed per 1000 calories consumed. Associations were examined using survey-based multivariable linear and logistic regression for enterolignans, and logistic regression for CRP.

Results: After multivariable adjustment, higher E-DII scores (i.e., indicating a relatively more pro-inflammatory diet) were associated with lower levels of creatinine-normalized END [beta coefficient (b) = - 1.22; 95% CI = - 0.69, - 1.74; P ≤ 0.001] and ENL (b = - 7.80; 95% CI = - 5.33, - 10.26; P ≤ 0.001). A positive association was also observed when enterolignans were dichotomized based on the cut-off of the 75th percentile value. In this same sample, the E-DII also was associated with CRP ≥ 3 mg/l (OR = 1.12; 95% CI 1.05, 1.19).

Conclusion: In these NHANES data, there was an association between E-DII score and enterolignans. This study also provided construct validation of the E-DII using CRP in a nationally representative sample. The results indicate that dietary inflammatory potential is associated with urinary enterolignans, a potential marker for microbiota diversity. However, studies are required to understand the direct association between DII and microbiota.
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http://dx.doi.org/10.1007/s00394-018-1690-5DOI Listing
March 2019

Energy Intake Derived from an Energy Balance Equation, Validated Activity Monitors, and Dual X-Ray Absorptiometry Can Provide Acceptable Caloric Intake Data among Young Adults.

J Nutr 2018 03;148(3):490-496

Departments of Epidemiology and Biostatistics and Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.

Background: Assessments of energy intake (EI) are frequently affected by measurement error. Recently, a simple equation was developed and validated to estimate EI on the basis of the energy balance equation [EI = changed body energy stores + energy expenditure (EE)].

Objective: The purpose of this study was to compare multiple estimates of EI, including 2 calculated from the energy balance equation by using doubly labeled water (DLW) or activity monitors, in free-living adults.

Methods: The body composition of participants (n = 195; mean age: 27.9 y; 46% women) was measured at the beginning and end of a 2-wk assessment period with the use of dual-energy X-ray absorptiometry. Resting metabolic rate (RMR) was calculated through indirect calorimetry. EE was assessed with the use of the DLW technique and an arm-based activity monitor [Sensewear Mini Armband (SWA); BodyMedia, Inc.]. Self-reported EI was calculated by using dietitian-administered 24-h dietary recalls. Two estimates of EI were calculated with the use of a validated equation: quantity of energy stores estimated from the changes in fat mass and fat-free mass occurring over the assessment period plus EE from either DLW or the SWA. To compare estimates of EI, reporting bias (estimated EI/EE from DLW × 100) and Goldberg ratios (estimated EI/RMR) were calculated.

Results: Mean ± SD EEs from DLW and SWA were 2731 ± 494 and 2729 ± 559 kcal/d, respectively. Self-reported EI was 2113 ± 638 kcal/d, EI derived from DLW was 2723 ± 469 kcal/d, and EI derived from the SWA was 2720 ± 730 kcal/d. Reporting biases for self-reported EI, DLW-derived EI, and SWA-derived EI are as follows: -21.5% ± 22.2%, -0.7% ± 18.5%, and 0.2% ± 20.8%, respectively. Goldberg cutoffs for self-reported EI, DLW EI, and SWA EI are as follows: 1.39 ± 0.39, 1.77 ± 0.38, and 1.77 ± 0.38 kcal/d, respectively.

Conclusions: These results indicate that estimates of EI based on the energy balance equation can provide reasonable estimates of group mean EI in young adults. The findings suggest that, when EE derived from DLW is not feasible, an activity monitor that provides a valid estimate of EE can be substituted for EE from DLW.
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http://dx.doi.org/10.1093/jn/nxx029DOI Listing
March 2018

Persistence of social jetlag and sleep disruption in healthy young adults.

Chronobiol Int 2018 03 12;35(3):312-328. Epub 2017 Dec 12.

a Department of Epidemiology and Biostatistics , University of South Carolina , Columbia , SC , USA.

Sleep disruption has been associated with increased risks for several major chronic diseases that develop over decades. Differences in sleep/wake timing between work and free days can result in the development of social jetlag (SJL), a chronic misalignment between a person's preferred sleep/wake schedule and sleep/wake timing imposed by his/her work schedule. Only a few studies have examined the persistence of SJL or sleep disruption over time. This prospective investigation examined SJL and sleep characteristics over a 2-year period to evaluate whether SJL or poor sleep were chronic conditions during the study period. SJL and sleep measures (total sleep time [TST], sleep onset latency [SOL], wake after sleep onset [WASO]), and sleep efficiency [SE]), were derived from armband monitoring among 390 healthy men and women 21-35 years old. Participants wore the armband for periods of 4-10 days at 6-month intervals during the follow-up period (N = 1431 repeated observations). The consistency of SJL or sleep disruption over time was analyzed using generalized linear mixed models (GLMMs) for repeated measures. Repeated measures latent class analysis (RMLCA) was then used to identify subgroups among the study participants with different sleep trajectories over time. Individuals in each latent group were compared using GLMMs to identify personal characteristics that differed among the latent groups. Minor changes in mean SJL, chronotype, or TST were observed over time, whereas no statistically significant changes in SOL, WASO, or SE were observed during the study period. The RMLCA identified two groups of SJL that remained consistent throughout the study (low SJL, mean ± SE: 0.4 ± 0.04 h, 42% of the study population; and high SJL, 1.4 ± 0.03 h, 58%). Those in the SJL group with higher values tended to be employed and have an evening chronotype. Similarly, two distinct subgroups were observed for SOL, WASO, and SE; one group with a pattern suggesting disrupted sleep over time, and another with a consistently normal sleep pattern. Analyses of TST identified three latent groups with relatively short (5.6 ± 1.0 h, 21%), intermediate (6.5 ± 1.0 h, 44%), and long (7.3 ± 1.0 h, 36%) sleep durations, all with temporally stable, linear trajectories. The results from this study suggest that sleep disturbances among young adults can persist over a 2 year period. Latent groups with poor sleep tended to be male, African American, lower income, and have an evening chronotype relative to those with more normal sleep characteristics. Characterizing the persistence of sleep disruption over time and its contributing factors could be important for understanding the role of poor sleep as a chronic disease risk factor.
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http://dx.doi.org/10.1080/07420528.2017.1405014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800574PMC
March 2018

The Dietary Inflammatory Index is associated with elevated white blood cell counts in the National Health and Nutrition Examination Survey.

Brain Behav Immun 2018 03 5;69:296-303. Epub 2017 Dec 5.

Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208, United States; Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208, United States; Connecting Health Innovations, LLC, 915 Greene Street, Suite 200, Columbia, SC 29208, United States.

White blood cells (WBCs) are considered a reliable biomarker of inflammation. Elevations in both WBCs and pro-inflammatory cytokines are associated with several chronic conditions. Diet is a strong moderator of inflammation and WBCs. The purpose of this study was to examine the association between the Dietary Inflammatory Index (DII®) and WBCs using data from the United States National Health and Nutrition Examination Survey (NHANES). NHANES is a cross-sectional study that occurs in two-year cycles. Respondents from five cycles (n = 26,046) with available data on diet (collected through a single 24-h dietary recall [24HR]) and WBCs (derived using the Coulter method) were included. The DII (theoretical range is about -8 to +8) was derived from the micro and macronutrients calculated from the 24HR. Linear regression models, using survey design procedures, were used to estimate adjusted mean WBC (i.e., total, lymphocytes, monocytes, and neutrophils) counts and percentages by DII quartiles. Among all participants no statistically significant difference in WBCs were observed when comparing DII quartile 4 (most pro-inflammatory) to quartile 1 (most anti-inflammatory). However, a one-unit increase in the DII was associated with a 0.028 (1000 per µL) increase in total WBCs (p = .01). Additionally, a 0.024 increase in neutrophils (p < .01) was observed for a one-unit increase in the DII. In the group of participants with normal body mass index (BMI, 18.5-24.9 kg/m), those in DII quartile 4 had higher levels of total WBCs compared to subjects with normal BMI in DII quartile 1 (7.12 vs. 6.88, p = .01). Similar comparisons were observed for monocytes and neutrophils. However, these relationships were not observed for participants who were overweight or obese, which are pro-inflammatory conditions. Normal-weight individuals consuming more pro-inflammatory diets were more likely to have elevated WBCs. Because of its cross-sectional design, NHANES cannot inform directly on temporal relations, thus limiting causal inference. Future research is needed to examine the impact of anti-inflammatory diet adoption on lowering levels of WBCs, in addition to other inflammatory mediators.
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http://dx.doi.org/10.1016/j.bbi.2017.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857420PMC
March 2018

Predictors of Retention among African Americans in a Randomized Controlled Trial to Test the Healthy Eating and Active Living in the Spirit (HEALS) Intervention.

Ethn Dis 2017 20;27(3):265-272. Epub 2017 Jul 20.

Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.

Introduction: Retention of racial/ethnic minority groups into research trials is necessary to fully understand and address health disparities. This study was conducted to identify participants' characteristics associated with retention of African Americans (AAs) in a randomized controlled trial (RCT) of a behavioral intervention.

Methods: Using data from an RCT conducted from 2009 to 2012 among AAs, participant-level factors were examined for associations with retention between three measurement points (ie, baseline, 3-month, and 12-month). Chi-square tests and logistic regression analyses were conducted to compare retained participants to those who were not retained in order to identify important predictors of retention.

Results: About 57% of participants (n=238) were retained at 12 months. Baseline characteristics that showed a statistically significant association with retention status were age, marital status, body mass index (BMI), intervention group, enrollment of a partner in the study, and perceived stress score (PSS). Multivariable logistic regression that adjusted for age, BMI, and PSS showed the odds of being retained among participants who enrolled with a partner was 2.95 (95% CI: 1.87-4.65) compared with participants who had no study partner enrolled. The odds of being retained among participants who were obese and morbidly obese were .32 and .27 (95% CI: .14-.74 and .11-.69), respectively, compared with participants who had normal weight.

Conclusion: Having a partner enrolled in behavioral interventions may improve retention of study participants. Researchers also need to be cognizant of participants' obesity status and potentially target retention efforts toward these individuals.
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http://dx.doi.org/10.18865/ed.27.3.265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5517145PMC
July 2019

The Dietary Inflammatory Index, shift work, and depression: Results from NHANES.

Health Psychol 2017 08 29;36(8):760-769. Epub 2017 May 29.

Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina.

Objectives: Abnormal physiology (e.g., inflammation), brought on by environmental exposures (e.g., diet or shift work [SW]), can affect numerous bodily systems, including the brain, and may be associated with depressive symptomatology. The study examined the associations between SW and depressive symptoms and diet-related inflammation (estimated by the Dietary Inflammatory Index [DII]) and depressive symptoms. Additionally, diet was examined as a mediator between SW and depressive symptoms.

Method: Data were obtained from the U.S. National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention, 2013). SW data were based on self-report. Dietary data were collected using 24-hr dietary recalls for DII calculation. Depressive symptoms were defined using a cut-point of 10 (moderate) on the Patient Health Questionnaire-9 (PHQ-9). Logistic regression was used to estimate odds ratios and 95% confidence intervals (95% CI) for depressive symptoms by SW and DII quartiles.

Results: DII scores were associated with depressive symptoms among women. Women in DII quartile 4 were 30% more likely to report depressive symptoms than women in quartile 1 (95% CI [1.00-1.68]). There was no association between symptoms and SW when using a PHQ-9 cut-point of 10. When using a cut-point of 5 (mild depressive symptoms), those working any form of SW were more likely to suffer from mild symptoms than day workers (odds ratio = 1.22; 95% CI [1.04-1.43]). There was some evidence for mediation by the DII between SW and depressive symptoms.

Conclusions: Future longitudinal studies should examine effects of reductions in inflammation through diet on depressive symptoms, especially among shift workers, to elucidate the role of diet on depression among these groups. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646681PMC
August 2017

Effect of Cruciferous Vegetable Intake on Oxidative Stress Biomarkers: Differences by Breast Cancer Status.

Cancer Invest 2017 Apr 8;35(4):277-287. Epub 2017 Mar 8.

a Department of Epidemiology and Biostatistics , Arnold School of Public Health, University of South Carolina , Columbia , South Carolina , USA.

This post hoc analysis examined cruciferous vegetable intake on urinary oxidative metabolites in postmenopausal women. Intervention participants (n = 69) received cruciferous vegetables (≥14 cups/week) during a 3-week period. First morning urine measured 8-isoprostane and 8-hydroxy-2'-deoxyguanosine. Dietary intake was estimated using 24-h recalls. When stratified by history of breast cancer, those with breast cancer had significantly lower post-intervention urinary 8-hydroxy-2'-deoxyguanosine values in the intervention arm versus. the control arm (1.1 ng/mL vs. 3.2 ng/mL, p = .01) after adjustment for baseline 8-hydroxy-2'-deoxyguanosine. This was not observed in those without breast cancer. Further work is needed to understand the role of breast cancer in these relationships.
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http://dx.doi.org/10.1080/07357907.2017.1289218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664216PMC
April 2017

Association between the dietary inflammatory index (DII) and telomere length and C-reactive protein from the National Health and Nutrition Examination Survey-1999-2002.

Mol Nutr Food Res 2017 04 1;61(4). Epub 2017 Feb 1.

Cancer Prevention and Control Program,, Columbia, SC, USA.

Scope: Leukocyte telomere length (LTL) is an important biomarker of aging. This study examined whether inflammatory potential of diet, as measured by the Dietary Inflammatory Index (DII) has an impact on telomere shortening in the National Health and Nutrition Examination Survey (NHANES). We also carried out validation of the DII with C-reactive protein (CRP).

Methods And Results: Data came from NHANES 1999-2002. LTL and CRP were assayed from leukocyte DNA and serum specimens, respectively. The DII was calculated from food intakes assessed using 24-h dietary recalls and expressed per 1000 calories consumed. Associations were examined using survey-based multivariable linear regression for log-transformed LTL. After multivariable adjustment, higher DII scores (i.e. relatively more pro inflammatory) were associated with shorter LTL both when used as continuous (b  =  -0.003; 95% confidence interval [CI]  =  -0.005, -0.0002) and as quartiles (b   =  -0.013; 95% CI  =  -0.025, -0.001; P   =  .03). In this same sample the DII also was associated with CRP ≥3 mg/L (OR = 1.10; 95% CI = 1.06, 1.16).

Conclusion: In these NHANES data there was an association between DII and LTL. This study also provided a successful construct validation of the DII using CRP in a nationally representative sample. These results are consistent with the hypothesis that diet-associated inflammation determines LTL.
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http://dx.doi.org/10.1002/mnfr.201600630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380547PMC
April 2017

Association between the dietary inflammatory index, waist-to-hip ratio and metabolic syndrome.

Nutr Res 2016 11 19;36(11):1298-1303. Epub 2016 Apr 19.

Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208, USA; Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208, USA; Connecting Health Innovations, LLC, Columbia, SC, USA.

Inflammation due to poor diet may contribute to the development of metabolic syndrome (MetSyn). The Dietary Inflammatory Index (DII) was created to characterize diet on a scale from anti- to pro-inflammatory. Our hypothesis was that higher (i.e., more pro-inflammatory) DII scores are associated with an increased prevalence of MetSyn compared to those with lower (i.e., more anti-inflammatory) DII scores. Data from the Polish-Norwegian (PONS) Study were analyzed using logistic and linear regression procedures in SAS (version 9.4). Comparisons of interest were between the first and fourth DII quartiles; analyses were stratified by sex. Mean waist-to-hip ratio (WHR) and diastolic blood pressure were greater among those in DII quartile 4 compared to 1. No statistically significantly increased MetSyn risks were observed for DII quartile 4 among men or women. Men in DII quartile 4 had elevated odds of fulfilling the waist component of MetSyn (odds ratio=1.65, 95% confidence interval=1.01-2.69). Although this study benefited from the DII and large sample sizes for both men and women, its cross-sectional nature and use of self-reported data may limit interpretation of results. Further work must be done in longitudinal studies to understand whether pro-inflammatory diets are associated with an increased risk of MetSyn, its components or other metabolic-related conditions. Additionally, further examination of the DII in relation to body habitus will be needed to understand the role of pro-inflammatory diets on anthropometrics, as observed in this study.
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http://dx.doi.org/10.1016/j.nutres.2016.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5119948PMC
November 2016

Perspective: Randomized Controlled Trials Are Not a Panacea for Diet-Related Research.

Adv Nutr 2016 05 16;7(3):423-32. Epub 2016 May 16.

Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA.

Research into the role of diet in health faces a number of methodologic challenges in the choice of study design, measurement methods, and analytic options. Heavier reliance on randomized controlled trial (RCT) designs is suggested as a way to solve these challenges. We present and discuss 7 inherent and practical considerations with special relevance to RCTs designed to study diet: 1) the need for narrow focus; 2) the choice of subjects and exposures; 3) blinding of the intervention; 4) perceived asymmetry of treatment in relation to need; 5) temporal relations between dietary exposures and putative outcomes; 6) strict adherence to the intervention protocol, despite potential clinical counter-indications; and 7) the need to maintain methodologic rigor, including measuring diet carefully and frequently. Alternatives, including observational studies and adaptive intervention designs, are presented and discussed. Given high noise-to-signal ratios interjected by using inaccurate assessment methods in studies with weak or inappropriate study designs (including RCTs), it is conceivable and indeed likely that effects of diet are underestimated. No matter which designs are used, studies will require continued improvement in the assessment of dietary intake. As technology continues to improve, there is potential for enhanced accuracy and reduced user burden of dietary assessments that are applicable to a wide variety of study designs, including RCTs.
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http://dx.doi.org/10.3945/an.115.011023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863268PMC
May 2016

Association between previously diagnosed circulatory conditions and a dietary inflammatory index.

Nutr Res 2016 Mar 26;36(3):227-33. Epub 2015 Nov 26.

Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC 29208; Connecting Health Innovations, LLC, 1417 Gregg Street, Columbia, SC 29201.

Inflammation is a key contributor to the development or recurrence of circulatory disorders. Diet is a strong modifier of inflammation. It was hypothesized that more pro-inflammatory diets, as indicated by higher Dietary Inflammatory Index (DII) scores, would be associated with self-reported previously diagnosed circulatory disorders using National Health and Nutrition Examination Survey (NHANES) data. This analysis included NHANES respondents from 2005-2010 (n = 15,693). The DII was calculated from micro and macronutrients derived from a single 24-hour recall. Logistic regression, stratified by sex and adjusted for important covariates, was used to determine the odds of previous circulatory disorder diagnoses by quartile of DII scores. Excluding hypertension, which had a prevalence of 30%, the prevalence of any circulatory disorder was 8%. Those in DII quartile 4 were 1.30 (95%CI = 1.06-1.58) times more likely to have a previous circulatory disorder (excluding hypertension) compared to those in DII quartile 1. Similar findings were observed for specific CVDs including congestive heart failure, stroke, and heart attack. Participants in DII quartile 4 were more likely to have a diagnosis of hypertension compared to those in DII quartile 1 (prevalence odds ratio = 1.19, 95%CI = 1.05-1.34). Results tended to be stronger among females. Individuals with a previous circulatory disorder diagnosis from NHANES appear to have more pro-inflammatory diets compared to those without a previous diagnosis. Because inflammation is an important factor related to recurrence of circulatory disorders, the DII could be used in treatment programs to monitor dietary modulators of inflammation among individuals with these conditions.
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http://dx.doi.org/10.1016/j.nutres.2015.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774054PMC
March 2016

Anti-inflammatory Dietary Inflammatory Index scores are associated with healthier scores on other dietary indices.

Nutr Res 2016 Mar 14;36(3):214-9. Epub 2015 Nov 14.

Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St, Suite 200, Columbia, SC 29208, USA; Department of Exercise Science, University of South Carolina, 921 Assembly St, Columbia, SC 29208, USA.

Dietary components are important determinants of systemic inflammation, a risk factor for most chronic diseases. The Dietary Inflammatory Index (DII) was developed to assess dietary inflammatory potential. It was hypothesized that anti-inflammatory DII scores would be associated with "healthier" scores on other dietary indices. The Energy Balance Study is an observational study focusing on energy intake and expenditure in young adults; only baseline data were used for this analysis (n=430). The DII, as well as the Healthy Eating Index-2010 (HEI-2010), the Alternative Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension Index (DASH) were calculated based on one to three 24-hour dietary recalls. General linear models were used to estimate least square means of the AHEI, HEI-2010, and DASH according to DII quartiles. Those with higher (ie, more proinflammatory) DII scores were more likely to be males, have less than a completed college education, and be younger. In addition, those with higher scores for cognitive restraint for eating or drive for thinness had lower (ie, anti-inflammatory) DII scores. Linear regression analyses indicated that as the DII increased, the AHEI, HEI-2010, and DASH dietary indices decreased (ie, became more unhealthy, all P<.01). The DII is a novel tool that characterizes the inflammatory potential of diet and is grounded in the peer-reviewed literature on diet and inflammation. Findings from the Energy Balance Study indicate that the DII is associated with other dietary indices, but has the added advantage of specifically measuring dietary inflammatory potential, a risk factor for chronic disease.
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http://dx.doi.org/10.1016/j.nutres.2015.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773655PMC
March 2016

Is nutrient intake associated with physical activity levels in healthy young adults?

Public Health Nutr 2016 08 22;19(11):1983-9. Epub 2016 Feb 22.

2Department of Exercise Science,Arnold School of Public Health,University of South Carolina,Columbia, SC,USA.

Objective: Both physical activity (PA) and diet are important contributors to health and well-being; however, there is limited information on the association of these behaviours and whether observed associations differ by weight. The present study aimed to evaluate whether nutrient intake is associated with PA and if this association varies by weight in young adults.

Design: Cross-sectional study to analyse the association between PA and nutrient intake.

Setting: Participants were stratified as normal weight (18·5 kg/m2
Subjects: Adults (n 407; age 27·6 (sd 3·8) years, 48 % male), with BMI between 20 and 35 kg/m2, having at least two 24 h diet recalls and at least 5 d (including two weekend days) of valid, objectively measured PA data were included in the analysis.

Results: In normal-weight participants, higher PAL was associated with higher intakes of minerals (except Ca, Fe and Zn), B-vitamins and choline (P for trend <0·05). In the overweight/obese group, higher PAL was associated with higher intakes of fibre, K, Na and Cu (P for trend <0·05). These differences, however, were no longer significant after additionally controlling for total energy intake.

Conclusions: More active young adults have higher intakes of essential micronutrients. The benefits of PA may be predominantly due to a higher overall food intake while maintaining energy balance rather than a healthier diet.
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http://dx.doi.org/10.1017/S1368980015003717DOI Listing
August 2016

Nutrient Composition and Anti-inflammatory Potential of a Prescribed Macrobiotic Diet.

Nutr Cancer 2015 25;67(6):933-40. Epub 2015 Jul 25.

a Division of Social and Behavioral Sciences, School of Public Health, University of Memphis , Memphis , Tennessee , USA.

Despite nutrient adequacy concerns, macrobiotic diets are practiced by many individuals with cancer and other life-threatening illnesses. This study compared the nutrient composition and inflammatory potential of a macrobiotic diet plan with national dietary recommendations and intakes from a nationally representative sample. Nutrient comparisons were made using the 1) macrobiotic diet plan outlined in the Kushi Institute's Way to Health; 2) recommended dietary allowances (RDA); and 3) National Health and Nutrition Examination Survey (NHANES) 2009-2010 data. Comparisons included application of the recently developed dietary inflammatory index (DII). Analyses focused on total calories, macronutrients, 28 micronutrients, and DII scores. Compared to NHANES data, the macrobiotic diet plan had a lower percentage of energy from fat, higher total dietary fiber, and higher amounts of most micronutrients. Nutrients often met or exceeded RDA recommendations, except for vitamin D, vitamin B12, and calcium. Based on DII scores, the macrobiotic diet was more anti-inflammatory compared to NHANES data (average scores of -1.88 and 1.00, respectively). Findings from this analysis of a macrobiotic diet plan indicate the potential for disease prevention and suggest the need for studies of real-world consumption as well as designing, implementing, and testing interventions based on the macrobiotic approach.
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http://dx.doi.org/10.1080/01635581.2015.1055369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596721PMC
June 2016

Plasma carotenoids and tocopherols in relation to prostate-specific antigen (PSA) levels among men with biochemical recurrence of prostate cancer.

Cancer Epidemiol 2015 Oct 9;39(5):752-62. Epub 2015 Jul 9.

Epidemiology and Biostatistics Arnold School of Public Health, 915 Greene St, Columbia, SC 29208, United States; Cancer Prevention and Control Program, Arnold School of Public Health, 915 Greene St, Columbia, SC 29208, United States.

Background: Although men presenting with clinically localized prostate cancer (PrCA) often are treated with radical prostatectomy or radiation therapy with curative intent, about 25-40% develop biochemically recurrent PrCA within 5 years of treatment, which has no known cure. Studies suggest that carotenoid and tocopherol intake may be associated with PrCA risk and progression. We examined plasma carotenoid and tocopherol levels in relation to prostate-specific antigen (PSA) levels among men with PSA-defined biochemical recurrence of PrCA.

Methods: Data analyzed were from a 6-month diet, physical activity and stress-reduction intervention trial conducted in South Carolina among biochemically recurrent PrCA patients (n=39). Plasma carotenoids and tocopherol levels were measured using high-performance liquid chromatography (HPLC). Linear regression was used to estimate least-square means comparing PSA levels of men with high versus low carotenoid/tocopherol levels, adjusting for covariates.

Results: After adjusting for baseline PSA level, plasma cis-lutein/zeaxanthin level at 3 months was related inversely to PSA level at 3 months (P=0.0008), while α-tocopherol (P=0.01), β-cryptoxanthin (P=0.01), and all-trans-lycopene (P=0.004) levels at 3 months were related inversely to PSA levels at 6-months. Percent increase in α-tocopherol and trans-β-carotene levels from baseline to month 3 were associated with lower PSA levels at 3 and 6 months. Percent increase in β-cryptoxanthin, cis-lutein/zeaxanthin and all-trans-lycopene were associated with lower PSA levels at 6 months only.

Conclusions: Certain plasma carotenoids and tocopherols were related inversely to PSA levels at various timepoints, suggesting that greater intake of foods containing these micronutrients might be beneficial to men with PSA-defined PrCA recurrence.
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http://dx.doi.org/10.1016/j.canep.2015.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577465PMC
October 2015

Association between actigraphic sleep metrics and body composition.

Ann Epidemiol 2015 Oct 14;25(10):773-8. Epub 2015 May 14.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Department of Exercise Science, University of South Carolina, Columbia.

Purpose: Determine if individuals with poor sleep characteristics (i.e., late sleep onset or wake times, short sleep duration, long sleep latency, low sleep efficiency, high wake after sleep onset) have greater body mass index (BMI = kg/m(2)) or body fat.

Methods: Data for these cross-sectional analyses were from the Energy Balance Study (University of South Carolina). Participants were between 21 and 35 years of age and had a BMI of 20 to 35 kg/m(2). Body fat percent was measured by dual X-ray absorptiometry. Sleep and physical activity were measured by actigraphy (BodyMedia's SenseWear physical activity armband). General linear models were used to estimate mean BMI and body fat percent by sleep metric categories.

Results: Greater BMI and body fat percent were associated with low sleep efficiency (BMI = 25.5 vs. 24.8 kg/m(2), P < .01; body fat = 27.7% vs. 26.5%, P = .04) and high wake after sleep onset (BMI = 25.6 vs. 25.0 kg/m(2), P = .02; body fat = 28.0% vs. 26.7%, P = .03). Elevated BMI or body fat percent also were observed for later wake times, shorter sleep duration, and longer sleep latency. Sex modified the association between wake times and body composition.

Conclusions: Understanding the complex relationships between sleep and health outcomes could help reduce chronic disease burden by incorporating sleep components, measured through novel noninvasive techniques (SenseWear armband), into weight loss interventions.
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http://dx.doi.org/10.1016/j.annepidem.2015.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567903PMC
October 2015

The association of C-reactive protein and physical activity among a church-based population of African Americans.

Prev Med 2015 Aug 22;77:137-40. Epub 2015 May 22.

Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; Statewide Cancer Prevention & Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. Electronic address:

Objective: Regular physical activity can reduce systemic inflammation and, thereby, the burden of chronic inflammatory-related conditions. This study examined whether regular physical activity, measured subjectively (Rapid Assessment of Physical Activity [RAPA]) and objectively (Bodymedia's SenseWear® activity monitor [SWA]), is associated with inflammatory or glycemic control markers.

Methods: Subjects were 345 participants of the Healthy Eating and Active Living in the Spirit (HEALS) lifestyle intervention among African American (AA) churches in South Carolina from 2009 to 2012. Linear regression analyses were performed to assess the relationship between both subjectively and objectively measured physical activity and inflammatory markers including high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), and glycosylated hemoglobin (HbA1c).

Results: Those who participated in regular physical activity (from RAPA) had lower CRP values compared to those who were sedentary (2.3 vs. 3.8mg/L, p<0.01). Lower levels of CRP or IL-6 were observed among those in the highest quartile of active energy expenditure (CRP: 2.0 vs. 3.6 mg/L, p=0.01) or moderate-vigorous physical activity minutes (CRP=1.7 vs. 4.5mg/L, p<0.01; IL-6=1.5 vs. 2.1pg/mL, p=0.01) compared to their lowest respective quartiles as measured by the SWA.

Conclusion: Physical activity may improve chronic inflammation, which is a primary pathophysiological mechanism for numerous chronic disorders, especially among minority populations.
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http://dx.doi.org/10.1016/j.ypmed.2015.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490070PMC
August 2015

Construct validation of the dietary inflammatory index among postmenopausal women.

Ann Epidemiol 2015 Jun 19;25(6):398-405. Epub 2015 Mar 19.

South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia; Center for Research in Nutrition and Health Disparities, University of South Carolina, Columbia.

Purpose: Many dietary factors have either proinflammatory or anti-inflammatory properties. We previously developed a dietary inflammatory index (DII) to assess the inflammatory potential of diet. In this study, we conducted a construct validation of the DII based on data from a food frequency questionnaire and three inflammatory biomarkers in a subsample of 2567 postmenopausal women in the Women's Health Initiative Observational Study.

Methods: We used multiple linear and logistic regression models, controlling for potential confounders, to test whether baseline DII predicted concentrations of interleukin-6, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha receptor 2, or an overall biomarker score combining all three inflammatory biomarkers.

Results: The DII was associated with the four biomarkers with beta estimates (95% confidence interval) comparing the highest with lowest DII quintiles as follows: interleukin-6: 1.26 (1.15-1.38), Ptrend < .0001; tumor necrosis factor alpha receptor 2: 81.43 (19.15-143.71), Ptrend = .004; dichotomized hs-CRP (odds ratio for higher vs. lower hs-CRP): 1.30 (0.97-1.67), Ptrend = .34; and the combined inflammatory biomarker score: 0.26 (0.12-0.40), Ptrend = .0001.

Conclusions: The DII was significantly associated with inflammatory biomarkers. Construct validity of the DII indicates its utility for assessing the inflammatory potential of diet and for expanding its use to include associations with common chronic diseases in future studies.
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http://dx.doi.org/10.1016/j.annepidem.2015.03.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433562PMC
June 2015

The dietary inflammatory index is associated with colorectal cancer in the National Institutes of Health-American Association of Retired Persons Diet and Health Study.

Br J Nutr 2015 Jun 14;113(11):1819-27. Epub 2015 Apr 14.

The South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina,915 Greene Street, Suite 200,Columbia,SC29223,USA.

Diet is a strong moderator of systemic inflammation, an established risk factor for colorectal cancer (CRC). The dietary inflammatory index (DII) measures the inflammatory potential of individuals' diets. The association between the DII and incident CRC was examined, using the National Institutes of Health-American Associations of Retired Persons Diet and Health Study individuals (n 489,422) aged 50-74 years at recruitment, starting between 1995-6, and followed for a mean of 9·1 (sd 2·9) years. Baseline data from a FFQ were used to calculate the DII; higher scores are more pro-inflammatory, and lower scores are more anti-inflammatory. First, primary CRC diagnoses were identified through linkage to state cancer registries. Anatomic location and disease severity also were examined. Cox proportional hazards models estimated CRC hazard ratios (HR) and 95% CI using quartile 1 as the referent. DII quartile 4 compared to quartile 1 was associated with CRC risk among all subjects (HR 1·40, 95% CI 1·28, 1·53; P for trend < 0·01). Statistically significant associations also were observed for each anatomic site examined, for moderate and poorly differentiated tumours, and at each cancer stage among all subjects. Effects were similar when stratified by sex; however, results were statistically significant only in males. The only result reaching statistical significance in females was risk of moderately differentiated CRC tumours (DII quartile 4 v. quartile 1 HR 1·26, 95% CI 1·03, 1·56). Overall, the DII was associated with CRC risk among all subjects. The DII may serve as a novel way to evaluate dietary risk for chronic disorders associated with inflammation, such as CRC.
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http://dx.doi.org/10.1017/S000711451500104XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466003PMC
June 2015

Reply to E Archer and SN Blair.

Adv Nutr 2015 Mar 13;6(2):230-3. Epub 2015 Mar 13.

From the Cancer Prevention and Control Program (JRH, e-mail: THG; and SES); and the Department of Health Promotion, Education and Behavior (EAF), Arnold School of Public Health; University of South Carolina, Columbia, SC; Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA (DRM); the Department of Nutrition and Epidemiology, Harvard TH CHan School of Public Health, Boston, MA (FKT); and the Division of Research, Kaiser Permanente Northern California, Oakland, CA.

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http://dx.doi.org/10.3945/an.114.007831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352184PMC
March 2015
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