Background: Few studies have evaluated the relative utility of sagittal abdominal diameter (SAD) as a risk marker of prediabetes and insulin resistance.

Objectives: This analysis compared the utility of SAD with other anthropometric measures (body mass index, BMI; waist circumference, WC; and waist-to-hip ratio, WHR) to identify the presence of prediabetes and insulin resistance in overweight and obese adults.

Methods: A total of 627 adults, aged 40-65 years, free of diabetes were selected from the San Juan Overweight Longitudinal Study (SOALS). Separate multivariable logistic regression models were used to evaluate the associations of the anthropometric measures with prediabetes and HOMA-IR as the binary outcomesadjusted for age, gender, smoking status, and physical activity.

Results: The upper tertile of SAD (>15.35 cm), compared to the lowest (<12.26 cm), had higher association with prediabetes (OR: 2.31, 95% CI: 1.53-3.48) compared to WC (OR: 1.83, 95% CI: 1.22-2.75), BMI (OR: 1.90, 95% CI: 1.27-2.86), and WHR (OR: 1.41, 95% CI: 0.91-2.19). Similarly, the upper tertile of SAD had higher association with HOMA-IR (OR: 7.47, 95% CI: 4.24-13.2) compared to WC (OR: 7.06, 95% CI: 4.01-12.4), BMI (OR: 5.13, 95% CI: 3.00-8.76), and WHR (OR: 4.11, 95% CI: 2.42-6.96). Although the middle tertile of SAD was associated with both prediabetes and HOMA-IR, the strengths of the associations were slightly higher for WC.

Conclusion: These findings suggest that SAD may be a good alternative to WC in identifying prediabetes and insulin resistance in overweight and obese adults.

Background

Obesity has been linked to the development of cardiovascular disease (CVD). Studies that examine the associations of positive psychosocial factors with measures of adiposity are few.

Objectives

Using the Jackson Heart Study (JHS) data, we examined the associations of dispositional optimism (DO) with measures of adiposity among African Americans (AA).

Methods

We analyzed baseline data (2000-2004) for 4624 African American adults. We investigated the associations of DO with adiposity parameters (Body Mass Index-BMI, Waist Circumference-WC and Waist to Height Ratio-WHtR). DO was measured with the Revised Life Orientation Test (LOT-R) and categorized based on tertile split. Multivariable Poisson regression analysis with robust standard errors was used to estimate the prevalence ratios (PRs; 95% confidence intervals-CI) of DO by adiposity measures, adjusting for demographics, socioeconomic status (SES), behavioral factors and depressive symptoms.

Results

After full adjustments, high (vs low) optimism was significantly associated with a 5% reduced prevalence of WHtR ≄ 0.05 (PR 0.95; 95% CI [0.91-0.99]; p = 0.006). High (vs low) DO was also protective of WC ≄ 102 cm (male), 88cm (female) after adjusting for demographics, SES and behaviors (PR 0.94; 95% CI [0.89 - 0.99]; p = 0.04). The association between high (vs low) optimism and BMI ≄30 kg/m² was not significant (PR 0.96; 95% CI [0.88 - 1.06]; p = 0.43, after full adjustments.

Conclusion

High levels of DO were inversely associated with adiposity phenotypes, except BMI. Abdominal adiposity may play a role in the relationship between optimism and adiposity phenotypes in AA.

Introduction: This study assessed health literacy and behaviors among adults with prediabetes and the mediating role of health literacy on health behaviors.

Methods: Data were extracted from the 2016 BRFSS. Low health literacy (Yes/No) was defined as a response of “somewhat difficult” or “very difficult” to any of the three questions on obtaining information, understanding health care providers, and comprehending written information. Prediabetes status was self-reported by respondents. Three health behavior indicators were included in this analysis— current smoking, physical inactivity, and getting inadequate sleep, all measured as binary outcomes (Yes/No). The study applied a path model in data analysis and accounted for the complex survey design of BRFSS.

Results: About one in five adults with prediabetes had low health literacy. Compared with those without prediabetes, the rate of physical inactivity among those with prediabetes was significantly higher (31.0% vs. 24.6%, p<0.001); the rate of having inadequate sleep was also significantly higher (38.8% vs. 33.5%, p<0.001). The path analysis results showed a significant direct effect of prediabetes, and a significant direct effect of health literacy on health behaviors (all p<0.05). The indirect effect of prediabetes through health literacy on health behaviors was also significant (all p<0.01).

Conclusion: The BRFSS 2016 data showed that the rate of low health literacy and the rate of unhealthy behaviors were higher in adults with prediabetes compared to those without prediabetes. There is a need for programs to address low health literacy among people with prediabetes to assist with comprehending, communicating, and managing health issues.

Background: High blood pressure (BP) is a risk factor for type 2 diabetes (T2D) complications. Urbanicity and community socioeconomic deprivation (CSD) may influence BP control in T2D.

Objective: Evaluate associations of urbanicity and CSD with BP among subjects with T2D early in the disease course, when community factors may be more influential, in a geographically heterogeneous region.

Methods: Using medical records from a large integrated health system, we identified subjects in 37 Pennsylvania counties with new onset T2D, characterized by at least two T2D diagnoses, one T2D medication order, or one T2D diagnosis and an abnormal glycated hemoglobin or glucose value. We obtained systolic (SBP) and diastolic (DBP) BP measurements from the second year following T2D onset. We used linear regression to evaluate associations of urbanicity (urban area [UA], urban cluster [UC], rural) and CSD on SBP and DBP, adjusting for sex, age, race/ethnicity, Medicaid history (socioeconomic status proxy), smoking status, body mass index, and antihypertensive medication use.

Results: Among 16,173 adults with new onset T2D, mean (standard deviation) SBP and DBP were 126.8 (15.0) and 74.9 (9.6), respectively. Rural residence (versus UA) was associated with higher SBP (beta coefficient [95% confidence interval]) (0.99 [0.44, 1.53]) and DBP (0.43 [0.09, 0.77]). UC residence was associated with higher SBP (1.27 [0.68, 1.86]). CSD was not associated with BP.

Conclusion: Consistent with reported T2D disparities, rural residence was associated with higher BP among individuals with T2D. We will next evaluate community factors that may explain rural disparities in BP control in T2D.

Background: Diabetes is an epidemic that is affecting the lives of over 30 million American adults. Lifestyle factors may be linked to the development of diabetes.

Objectives: The objective of this study was to examine prediabetes, type 2 diabetes,

and associated factors among adults in the United States.

Methods: Data for 5,719 American adults who completed the 2015-2016 NHANES were analyzed. Complex sample tables and logistic regression models were used to examine the association between prediabetes, type 2 diabetes, and associated factors after controlling for age, sex, race, and socioeconomic status.

Results: Participants with a BMI classification of overweight and obesity classes 1 through 3 were more likely to have type 2 diabetes or prediabetes than normal weight. Participants who smoked 11 – 20 cigarettes daily were more likely to have type 2 diabetes than those who smoked 1 – 10 cigarettes daily. Participants who consumed alcohol were less likely to have type 2 diabetes than those who did not. Participants who met the weekly recommendations for moderate work-related or vigorous leisure-time physical activity were less likely to have prediabetes than those who have not. Participants who consumed ≄ 51g of sugar daily were less likely to have type 2 diabetes than those who consumed ≀ 50g sugar daily.

Conclusion: Body weight, nutrition, smoking, and alcohol consumption were significantly associated with type 2 diabetes among American adults. Body weight and physical activity were significantly associated with prediabetes among American adults. Future research should examine possible cause and effect relationships between factors.

Background: C-reactive protein (CRP) is an inflammatory biomarker that is related to diabetes development, heart disease, and cancer. Excessive sugar-sweetened beverages (SSB) consumption has been linked to metabolic disorders, diabetes, and chronic inflammation. However, limited research has explored the relationship between SSB intake and adiposity on inflammation among prediabetes. Objectives: To assess the association of sugar intake from SSB intake and elevated CRP among non-diabetic adults with normal/high HbA1c as moderated by abdominal obesity. Methods: 5250 non-diabetic adults were selected from the 2007-2010 NHANES. Sugar intake from SSB was calculated from 24-h dietary interviews and classified into non-intake, medium intake (<40 gram), and high intake (≄41 gram). HbA1c level ranges from 4% to 5.6% and 5.7% to 6.4% were defined as normal HbA1c and prediabetes, respectively. The cutoff value of elevated CRP was >3 mg/L. Waist circumference (WC) was used to reflect abdominal obesity. Analyses were performed using survey-data module to control for the complex survey design. Results: Compared to non-SSB consumers with normal HbA1c, prediabetes who consumed medium or high sugar intake from SSB were at 1.54- and 2.01 times increased risk, respectively, for elevated CRP after adjusting for covariates and WC. Abdominal obesity significantly moderated the effect of high amount of sugar intake from SSB on elevated CRP among prediabetes (p=0.03). Conclusion: Our findings highlight that increased risk of elevated CRP was evident in prediabetes with medium/high amount of sugar intake from SSB, and the risk was greater in prediabetes with abdominal obesity.

background: Diabetes is a major public health problem in NC. A healthy diet and physical activity can help manage this condition.

objectives: To examine the prevalence of healthy eating and physical activity among NC adults with diabetes, and perceived access to healthy food and exercise trails and greenways.

methods: Aggregated NC Behavioral Risk Factor Surveillance System (BRFSS) data (2013, 2015, 2017) were analyzed using SUDAAN. Variables analyzed included: Healthy diet (fruit and vegetable (F&V) consumption ≄5 times/day, perceived access to healthy foods); Exercise (≄150 minutes/week, access/use of trails and greenways); demographic factors and health care access variables. All results were weighted to account for the complex survey design.

results: Adults with diabetes had a significantly lower prevalence of consuming adequate F&V than adults without diabetes (10.5% vs. 15.0%). Perceived access to healthy foods was high (>80%) among both groups. Adults with diabetes were less likely to exercise ≄150 minutes/week compared to those without (42.1% vs. 49.2%). Access to trails and greenways was lower among adults with diabetes, and among those with access, were less likely to use them weekly (28.9% vs. 39.4%). Regression analyses controlling for demographic variables showed a significant effect of diabetes in exercise but not in diet.

conclusion: Adults with diabetes in NC do not participate in healthy lifestyles at recommended levels and have less access to resources for physical activity. Efforts are needed to increase access to these resources and promote healthy eating and exercise to reduce the impact of diabetes in NC.

Glycosylated hemoglobin (HbA1c) is considered to be the best indicator of glycemic control. Poor glycemic control is associated with increased risk of developing diabetic complications. Current guidelines recommend HbA1c testing at least twice a year. The purpose of this study was to examine the relationship between diabetic complications and the frequency of HbA1c monitoring. This study was a cross-sectional study of adults with diabetes from the 2015 Behavioral Risk Factor Surveillance System. Participants with self-reported diabetic complications were identified and the frequency of HbA1c testing was calculated based on responses to the question, “About how many times in the past 12 months has a doctor, nurse or another health care professional checked you for ‘A one C’?" Ordinal logistic regression was used to model the relationship between the outcome, HbA1c testing frequency (0-1, 2, 3, ≄4 measurements) and diabetic complications. Adults with diabetic complications (n=27,411) had higher proportional odds (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.08-1.50) of frequent HbA1c testing compared to those without diabetic complications (n=8,388). Individual diabetic complications – kidney disease (AOR, 1.23; 95% CI, 1.02-1.50), eye disease/retinopathy (AOR, 1.34; 95% CI, 1.12-1.60), and coronary heart disease (AOR, 1.25; 95% CI, 1.03-1.52), were significantly associated with increased frequency of HbA1c testing. These results suggest that adults with diabetes may not comply with recommended monitoring guidelines until complications occur. Interventions should focus on HbA1c monitoring before complications develop to improve diabetic outcomes.

Background: The continuously rising trend in breast cancer incidence in African American postmenopausal women (AAPW) may be associated with the increased prevalence of overall obesity. Decreased adiponectin levels have been observed among women with obesity, which might be related to breast cancer risk. Yet, the interplay of adiponectin and its genetic variants in the association between obesity and breast cancer risk are unclear in this vulnerable population.

Objective: Examine the role of adiponectin pathway single nucleotide polymorphism (SNP) in the association between obesity and breast cancer risk in the Women’s Health Initiative SNP Health Association Resource.

Method: We examined 37 SNP candidates in a total of 7,963 eligible AAPW. Three independent anthropometric measurements including body mass index [BMI], waist-to-hip ratio [WHR], and waist circumference [WC] were used to account for different fat distributions. We used multivariate Cox regression models to estimate adjusted risk measures.

Results: rs11168618 TC genotype (vs. CC) near OR8S1-LALBA was associated with reduced breast cancer risk (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.51 – 0.97). Normal weight showed a greater protective effect (HR 0.39, 95% CI 0.15 – 0.97) compared with overweight (HR 0.52, 95% CI 0.30 – 0.91). The result was consistent in groups with WHR <0.85 and WC <88 cm.

Conclusion: Our findings suggest that AAPW with genetic variants in OR8S1-LALBA of the adiponectin pathways in healthy weight may reduce the risk of breast cancer. By maintaining normal weight, this population may prevent the development of breast cancer through this inflammatory molecular pathway.