The impact of childhood obesity on cardiometabolic health in adulthood has been widely studied. While risk factors for metabolic disease are associated with obesity and begin clustering during ...childhood, research on the effects of obesity on the clinical manifestation of adverse cardiometabolic outcomes before adulthood is limited. Therefore, this dissertation assessed the association between weight status and cardiometabolic disease risk among youth in the United States through three independent and interrelated studies.The primary aim of study one was to synthesize the evidence on the linear association between body mass index (BMI) and cardiometabolic disease risk among youth (2 to 19 years) in the United States (US). The central hypothesis was that increasing BMI would be associated with worsening cardiometabolic profiles in youth. A systematic search of PubMed, Embase, Web of Science, CINAHL Complete, ProQuest Dissertation and Theses Global: Sciences and Engineering Collection, and MedNar was conducted to identify relevant studies published since January 2013. Observational studies of the association between continuous measures of BMI and cardiometabolic risk among youth in the US were included. Two independent reviewers screened records and performed data extraction, risk of bias appraisal, and level of evidence synthesis. A meta-analysis was conducted using random-effects models. Primary outcomes included the pooled association between BMI and systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), glycated hemoglobin A1c (HbA1c), and fasting insulin and glucose. Seven studies (n = 15,424 participants) were included in the systematic review and meta-analysis. BMI was associated with DBP (0.163, 95% CI 0.101, 0.224), HDL (-0.296, 95% CI –0.500, –0.061), LDL (0.151, 95% CI 0.129, 0.172), and TG (0.311, 95% CI 0.029, 0.547). BMI was not associated with SBP (0.349, 95% CI -0.821, 0.955) or insulin (0.497 (95% CI -0.619, 0.948). High heterogeneity was observed across the included studies. Overall, the central hypothesis was supported. Among this racially and ethnically diverse US-based study population, worsening blood pressure and lipid profiles were associated with increasing adiposity.Study two utilized electronic medical record (EMR) systems data to assess the prevalence of severe obesity and cardiometabolic disease risk among pediatric patients from the only tertiary academic medical center in Mississippi. The central hypothesis was that there were differences in the prevalence of weight status and cardiometabolic outcomes among youth by age, sex, race and ethnicity, insurance type, and rural-urban locale. Data were extracted for patients 2 to 19 years with a primary pediatric care encounter between January 1, 2023, and June 30, 2023. Continuous measures were categorized using current guidelines to determine the prevalence of weight status, hypertension, hyperlipidemia, and hyperglycemia. Weight status was explored by race and ethnicity, sex, age, insurance type, and rural-urban commuting area codes. Hypertension was explored by race and ethnicity, sex, and weight status. Associations between sociodemographic characteristics and continuous and categorical outcomes were assessed using multivariable and multinomial regression. There were 38,275 participants (mean age = 8.9 years, standard deviation = 5.3) in the analytic sample (48.7% female; 45.4% non-Hispanic Black NHB). Nearly half (49.9%) of NHB females 12 to 19 years had overweight (19.0 %), obesity (15.9%), or severe obesity (14.9%). Age (β = 0.146, p < 0.001) was positively associated with standardized body mass index (zBMI), with the quadratic term (β = –0.005, p < 0.001) fitting a non-linear moderating association with increasing cross-sectional age. Nearly 40% of all participants had cross-sectional blood pressure (BP) consistent with elevated BP (17.1%), stage I (18.3%) or stage II (3.8%) hypertension. Males had a significantly higher likelihood of elevated BP (β = 1.436, p < 0.001), stage I (β=1.266, p < 0.001), or stage II (β = 1.718, p < 0.001) hypertension compared to females. Overall, the findings of this study suggest an increased risk for cardiometabolic disease in childhood and adolescence that may exacerbate morbidity and mortality in early adulthood.Study three explored the potential measurement bias in using EMR data to explore cardiometabolic risk in clinical populations. The central hypothesis was that using EMR data would restrict the generalizability of study findings to clinical populations within the health system catchment area. This study utilized EMR data to compare the measurement frequency and mean values of BP, lipids, and HbA1c between general and specialty care pediatric patients (3 to 19 years) from the only tertiary academic medical center in Mississippi. This retrospective study showed a significant difference in the measurement frequency of all cardiometabolic risk measures and mean values for zBMI, SBP, and DBP between general and specialty care participants. The findings of this study affirm extreme severe obesity and cardiometabolic risk in this racially diverse specialty pediatric care population in Mississippi. In addition, the findings suggest that, with adjustment for referral biases, EMR data may provide useful population health information, given the limited number and scope of population-based cohort studies in children and adolescents.
Abstract only Background: Data is sparse regarding the utility of social media in engaging southern, rural communities to participate in health research. Community Advisory Board (CAB) members of the ...Mississippi (MS) Core of the Risk Underlying Rural Areas Longitudinal (RURAL) Study suggested the use of the Facebook social media platform to promote the RURAL Study. During the pre-recruitment phase of engagement (6 months prior to initiation of examinations and 3 months prior to official recruitment), RURAL investigators used Facebook posts to help increase awareness of and interest in the RURAL Study. Objective: To use Facebook metrics to identify the types of posts that garnered the most engagement. Methods: The Principal Investigator of the RURAL Study’s MS Core collaborated with the University of MS Medical Center Social Media Coordinator to implement a Facebook page for the Study. The MS team implemented social media posts to promote the RURAL Study. Data on the number of post reactions, comments, and shares, as well as the reach of organic and paid ads, were collected to identify posts with highest engagement. Findings: In Oktibbeha County, the greatest number of Facebook profile visits occurred October 15-November 7, 2022. Facebook posts had the greatest reach between June 24-27 and September 19-30, 2022. Paid ads (boosted posts) produced greater reach than organic ads. In addition, post reactions positively correlated with the number of people reached. Posts with the greatest number of reactions were related to RURAL-sponsored events (e.g., the County Health Fair and the RURAL Open House event). There was significant Facebook activity around popular community events during which the RURAL Study was promoted (e.g., Fannie Lou Hamer event, the Open House event, and the Black Jack Morning Church Service). Although MS Core of RURAL investigators participated in interviews on local TV media prior to recruitment, organic Facebook ads that included links to videos of these interviews did not receive many reactions on the MS Core of the RURAL Study’s Facebook page. Conclusion: Using social media may be an effective tool for reaching communities during the pre-recruitment phase of engagement. Our findings support that paid ads that targeted specific audiences were more effective than organic ads. Facebook posts that documented RURAL’s participation and engagement in community events were more effective than posts about RURAL’s promotion in broadcast media.
Fisetin (3,7,3′,4′-tetrahydroxyflavone) and quercetin (3,5,7,3′,4′-pentahydroxyflavone) are the bioactive plant flavonoids that are potentially useful therapeutic drugs for the treatment of a broad ...spectrum of diseases, including atherosclerosis, cardiovascular disease, obesity, hypertension, and cancer. 3-Hydroxyflavone (3HF) and 7-hydroxyflavone (7HF) are the synthetic chromophores of fisetin and quercetin. We have exploited dual luminescence properties of fisetin and quercetin along with 3-HF and 7HF to examine their efficacy of binding and compare their interactions with DNA, which is one of the macromolecular targets of flavonoids in physiological systems. Following the sequence of the human telomeric DNA 5′-d (CCCTAA-) n /(-TTAGGG) n -5′, two single-stranded DNA oligonucleotides, 5′-d(C3TA2)3C3-3′ and 5′-d(T2AG3)4-3′, and their duplex were used as receptors to study binding by the ligands quercetin, fisetin, and their chromophores. Circular dichroism, differential absorption, UV thermal melting, and size exclusion chromatographic studies indicated the formation of unusual DNA structures (such as C4 and G4 tetraplexes) for both the C- and G-rich single-stranded DNAs. Upon binding to DNA, dramatic changes were observed in the intrinsic fluorescence behavior of the flavonoids. Molecular docking studies were performed to describe the likely binding sites for the ligands. The spectroscopic studies on flavonoid–DNA interactions described herein demonstrate a powerful approach for examining their DNA binding through exploiting the highly sensitive intrinsic fluorescence properties of the flavonoids as their own “reporter” for their interactions with macromolecular targets.
Weight misperception is a common problem among adolescents; however, few studies have examined contributing factors among an exclusively African American population. The purpose of this study was to ...examine factors associated with weight misperception among 12- to 19-year-old participants in the Jackson Heart KIDS Pilot Study (JHS-KIDS).
Data were drawn from JHS-KIDS, a prospective, observational examination of cardiovascular-related risk factors among African American adolescents who were children or grandchildren of participants in the Jackson Heart Study. Adolescent weight misperception - discordance between measured weight status and perceived weight status - was the primary outcome of interest. Self-reported weight control behaviors, parent concerns about adolescents' weight, parent-perceived responsibility for adolescent's weight and daily hassles were the primary independent variables of interest.
The analytic sample was equally divided by females (n=107) and males (n=105) and one third of study participants (33.5%) had discordance between their actual and perceived weight. Results from fully adjusted sex-stratified modified Poisson regression models indicated that weight behavior control was significant among females (PR = .66, 95%CI:1.20-2.30). Parental concerns about child weight were significant for males. Each additional point increase in the parent's concern about their weight score was associated with a 9% increase in the adjusted prevalence of weight misperception among males (95%CI: 1.03-1.16).
The sex-specific patterns in this study highlight heterogeneity among African American adolescents and an urgent need to consider sex and gender when developing targeted interventions for youth who are at high risk for weight misperceptions and unhealthy weight control practices.
The United States is the largest refugee resettlement country in the world. Refugees may face health-related challenges after resettlement in the United States, including higher rates of chronic ...diseases due to problems such as language barriers and difficulty adapting to new food environments. However, reported refugee diet challenges varied, and no systematic examination has been reported. This study examined refugee food intake pre- and postresettlement in the United States and differences in intake across various refugee groups. We systematically reviewed relevant studies that reported on refugee food intake and adaptation to the US food environment. We searched PubMed for literature published between January 1985 and April 2015, including cross-sectional and prospective studies. Eighteen studies met inclusion criteria. Limited research has been conducted, and most studies were based on small convenience samples. In general, refugees increased meat and egg consumption after resettling in the United States. Changes in refugee intake of vegetables, fruits, and dairy products varied by socioeconomic status, food insecurity, past food deprivation experience, length of stay in the United States, region of origin, and age. South Asians were more likely to maintain traditional diets, and increased age was associated with more conservative and traditional diets. Despite the abundance of food in the United States, postresettlement refugees reported difficulty in finding familiar or healthy foods. More research with larger samples and follow-up data are needed to study how refugees adapt to the US food environment and what factors may influence their food- and health-related outcomes. The work could inform future interventions to promote healthy eating and living among refugees and help to reduce health disparities.
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