Rachel Novotny

The Cardiovascular Research Network: A New Paradigm for Cardiovascular Quality and Outcomes Research

Background—A clear need exists for a more systematic understanding of the epidemiology, diagnosis, and management of cardiovascular diseases. More robust data are also needed on how well clinical trials are translated into contemporary community practice and the associated resource use, costs, and outcomes. Methods and Results—The National Heart, Lung, and Blood Institute recently established the Cardiovascular Research Network, which represents a new paradigm to evaluate the epidemiology, quality of care, and outcomes of cardiovascular disease and to conduct future clinical trials using a community-based model. The network includes 15 geographically distributed health plans with dedicated research centers, National Heart, Lung, and Blood Institute representatives, and an external collaboration and advisory committee. Cardiovascular research network sites bring complementary content and methodological expertise and a diverse population of ≈11 million individuals treated through various health care delivery models. Each site’s rich electronic databases (eg, sociodemographic characteristics, inpatient and outpatient diagnoses and procedures, pharmacy, laboratory, and cost data) are being mapped to create a standardized virtual data warehouse to facilitate rapid and efficient large-scale research studies. Initial projects focus on (1) hypertension recognition and management, (2) quality and outcomes of warfarin therapy, and (3) use, outcomes, and costs of implantable cardioverter defibrillators. Conclusions—The Cardiovascular Research Network represents a new paradigm in the approach to cardiovascular quality of care and outcomes research among community-based populations. Its unique ability to characterize longitudinally large, diverse populations will yield novel insights into contemporary disease and risk factor surveillance, management, outcomes, and costs. The Cardiovascular Research Network aims to become the national research partner of choice for efforts to improve the prevention, diagnosis, treatment, and outcomes of cardiovascular diseases.

A Food Store Intervention Trial Improves Caregiver Psychosocial Factors and Children's Dietary Intake in Hawaii

Diet‐related chronic diseases are at epidemic levels in low‐income ethnic minority populations. The purpose of this study is to decrease risk for obesity in children by modifying the food environment and conducting point‐of‐purchase promotions that will lead to changes in psychosocial factors and behaviors associated with healthier food choices among low‐income communities with a preponderance of Native Hawaiians and Pacific Islanders. We implemented an intervention trial over a 9–11‐month period in five food stores in two low‐income multiethnic communities in Hawaii, targeting both children and their adult caregivers. The Healthy Foods Hawaii (HFH) intervention consisted of an environmental component to increase store stocking of nutritious foods, point‐of‐purchase promotions, interactive sessions, and involved local producers and distributors. We evaluated the impact of the program on 116 child–caregiver dyads, sampled from two intervention and two comparison areas before and after intervention implementation. Program impacts were evaluated using multivariable linear regression. The HFH program had a significant impact on caregiver knowledge and the perception that healthy foods are convenient. Intervention children significantly increased their Healthy Eating Index (HEI) score for servings of grains, their total consumption of water, and showed an average 8.5 point (out of 90 total, eliminating the 10 points for variety, giving a 9.4% increase) increase in overall HEI score. A food store intervention was effective in improving healthy food knowledge and perception that healthy foods are convenient among caregivers, and increased the consumption of several targeted healthy foods by their children. Greater intensity, sustained food system change, and further targeting for children are needed to show greater and sustained change in food‐related behaviors in low‐income Native Hawaiian and Pacific Islander communities.

Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index

Background:In the Multiethnic Cohort Study, Japanese Americans (JA) have lower mean body mass index (BMI) compared with Caucasians, but show a higher waist-to-hip ratio at similar BMI values and a greater risk of diabetes and obesity-associated cancers.Objective:We investigated the abdominal, visceral and hepatic fat distribution in these Asian and Caucasian Americans.Design:A cross-sectional sample of 60 female cohort participants (30 JA and 30 Caucasians), of ages 60–65 years and BMIs 18.5–40 kg m−2, underwent anthropometric measurements and a whole-body dual energy X-ray absorptiometry (DXA) scan: a subset of 48 women also had abdominal magnetic resonance imaging (MRI).Results:By design, JA women had similar BMIs (mean 26.5 kg m−2) to Caucasian women (27.1 kg m−2). JA women were found to have a significantly smaller hip circumference (96.9 vs 103.6 cm; P=0.007) but not a significantly lower DXA total fat mass (25.5 vs 28.8 kg; P=0.16). After adjusting for age and DXA total fat mass, JA women had a greater waist-to-hip ratio (0.97 vs 0.89; P<0.0001), DXA trunk fat (15.4 vs 13.9 kg; P=0.0004) and MRI % abdominal visceral fat (23.9 vs 18.5%; P=0.01) and a lower DXA leg fat mass (8.2 vs 10.0 kg; P=<.0001). Their MRI % subcutaneous fat (33.4 vs 30.2%; P=0.21) and % liver fat (5.8 vs 3.8%; P=0.06) did not significantly differ from that of Caucasian women.Conclusions:Our findings build on limited past evidence, suggesting that Asian women carry greater abdominal and visceral fat when compared with Caucasian women with similar overall adiposity. This may contribute to their elevated metabolic risk for obesity-related diseases.

The peak bone mass of Hawaiian, Filipino, Japanese, and white women living in Hawaii

Our study compares the bone mass of Hawaiian, Filipino, Japanese, and white women living in Oahu, Hawaii. Eligible women ranged in age from 25 to 34; all had bone mass measurements at the spine, calcaneus, and proximal and distal radius. Their average bone mineral density (BMD) remained stable with age at all four bone sites, indicating that the age range 25–34 may represent the peak bone mass. Bone mass varied, however, between ethnicities; differences in BMD up to 11% were observed. The Hawaiian women had the greatest BMD, and whites had the second greatest BMD at the spine and calcaneus. The Japanese most frequently had the lowest BMD. Differences in body size partly explained the differences; most ethnic differences were reduced or eliminated after adjusting for height and weight. At the spine, the ethnic differences for BMD were also apparent with BMC and with vertebral area. Hawaiian and white women had greater values than Japanese or Filipino women. Differences at the proximal radius resembled the spine, except that whites had the widest proximal widths. The results were more complex for the distal radius. At the distal radius whites had the lowest BMD of the four ethic groups. The difference between whites and Hawaiians derived from the greater bone mineral content (BMC) of the Hawaiian women. By contrast, the difference between whites and the Japanese and Filipinos derived from the wider distal widths of the white women. Compared with the Japanese and Filipino women, the white women appeared to disperse their BMC at the distal radius across a wider bone width. Such differences in bone distributions might lead to an altered risk of distal radius (wrist) fractures. Within ethnicities there was marked variation among individuals in bone mass. At the extremes, women differed by 50–100% or more within all four ethnic groups.

Calcium intake of Asian, Hispanic and white youth.

Objective: To examine calcium intake and food sources among Asian, white and Hispanic youth, in order to develop and target interventions to improve calcium intake. Methods: Cross-sectional survey with two 24-hour dietary recalls one week apart. Calcium intake was evaluated in 167 male and female adolescents of Asian, Hispanic and white ethnicity, ages 10–18 years, from six states. Main outcome measures were mean daily calcium intake (mg/day). Statistical analyses performed: t tests, Chi-square and analysis of variance for differences by age, ethnicity and gender, multiple regression of factors influencing calcium intake. Results: Overall median calcium intake was 938 mg/day with 868 mg/day for Asians, 1180 mg/day for whites and 896 mg/day for Hispanics. Daily milk intake was the primary predictor of calcium intake with Asian ethnicity and female gender each showing a negative association to calcium intake in multiple regression models. Conclusions: Milk intake was the primary factor positively influencing calcium intake, while Asian ethnicity and female gender negatively influenced calcium intake. Thus, interventions to improve calcium intake should focus on improving milk intake of Asians and females.

Evaluation of a Computerized Food Frequency Questionnaire to Estimate Calcium Intake of Asian, Hispanic, and Non-Hispanic White Youth

The objective of this study was to evaluate a computerized food frequency questionnaire (FFQ) that estimates calcium intake among Asian, Hispanic, and non-Hispanic white youth. A computerized FFQ based on a list of 80 foods with corresponding food photos was evaluated for 4 consecutive weeks. The evaluation study consisted of computerized FFQs during weeks 1 and 4, and 24-hour dietary recalls during each of weeks 2 and 3. Subjects were a convenience sample of Asian (29%), Hispanic (36%), and non-Hispanic white (35%) youth, age 11 to 18 years, living in northern Utah (N=161). Paired t tests, percent agreement, Pearson correlation coefficients of transformed calcium intake values (using ladder of transformation), deattenuated Pearson correlation coefficients, and Spearman correlation coefficients were used to evaluate the computerized FFQ. The correlation of calcium intakes estimated by the first and second computerized FFQ, 1 month apart, was 0.72 (transformed Pearsons r) for the total sample (N=161). Correlations within subgroups were: for males, r=0.59; females, r=0.81; 11- to 14-year-olds, r=0.66; 15- to 18-year-olds, r=0.82; Asians, r=0.73; Hispanics, r=0.76; and non-Hispanic whites, r=0.61. The correlation of calcium intakes estimated by the second computerized FFQ and the mean of two 24-hour dietary recalls was 0.56 (deattenuated, transformed Pearsons r) for the total sample. Correlations were also significant for males (r=0.50), females (r=0.57), 11- to 14-year-olds (r=0.56), 15- to 18-year-olds (r=0.59), Asians (r=0.63), Hispanics (r=0.55), and non-Hispanic whites (r=0.57). This computerized FFQ was found to be reliable in estimating calcium intake among a multiethnic youth population in the United States.

Bone Mineral and Predictors of Bone Mass in White, Hispanic, and Asian Early Pubertal Girls

Differences in bone among racial/ethnic groups may be explained by differences in body size and shape. Previous studies have not completely explained differences among white, Asian, and Hispanic groups during growth. To determine racial/ethnic differences and predictors of bone mass in early pubertal girls, we measured bone mineral content (BMC) in white, Hispanic, and Asian sixth-grade girls across six states in the United States. We developed models for predicting BMC for the total-body, distal radius, total-hip, and lumbar spine for 748 subjects. For each of the bone sites, the corresponding area from dual-energy X-ray absorptiometry (DXA) was a strong predictor of BMC, with correlations ranging 0.78–0.98, confirming that larger subjects have more BMC. Anthropometric measures of bone area were nearly as effective as bone area from DXA at predicting BMC. For total-body, distal radius, lumbar spine, and total-hip BMC, racial/ethnic differences were explained by differences in bone area, sexual maturity, physical activity, and dairy calcium intake. Bone size explained most of the racial/ethnic differences in BMC, although behavioral indicators were also significant predictors of BMC.

Hispanic and Asian Pubertal Girls Have Higher Android/Gynoid Fat Ratio Than Whites

Objective: To examine differences in body size, composition, and distribution of body fat among Hispanic, white, and Asian adolescents.

Vitamin D deficiency and disease risk among aboriginal Arctic populations

Aboriginal populations living above the Arctic Circle are at particularly high risk of vitamin D deficiency due to limited ultraviolet B exposure (related to geographic latitude) and inadequate dietary intake (recently related to decreased traditional food consumption). Major changes in diet and lifestyle over the past 50 years in these populations have coincided with increased prevalence rates of rickets, cancer, diabetes, and obesity, each of which may be associated with vitamin D inadequacy. This review examines the risk factors for vitamin D inadequacy, the associations between vitamin D and disease risk at high geographic latitudes, and the recommendations for improving vitamin D status particularly among aboriginal Arctic populations. Traditional foods, such as fatty fish and marine mammals, are rich sources of vitamin D and should continue to be promoted to improve dietary vitamin D intake. Supplementation protocols may also be necessary to ensure adequate vitamin D status in the Arctic.

Diet and obesity among Chamorro and Filipino adults on Guam

The purpose of this study was to compare the body mass index (BMI) and dietary intakes of Chamorro (n=66) and Filipino (n=61) adults, ages 25-65 years, living in Guam. Participants were recruited via community-based sampling; however, recruitment was targeted to ensure approximately equal numbers from each ethnic group, equal numbers of men and women within each ethnic group, and proportional representation of the main geographic areas of the island. In addition, subjects were recruited and stratified based on the 2000 Guam Census Data to assure proportional distribution by age. Dietary energy density (ED) was calculated as kcal/g and compared by gender, ethnicity, and obesity status. Mean BMI for Chamorros was significantly higher than for Filipinos, and a significantly higher proportion of Chamorros (49%) were obese compared to Filipinos (20%). Chamorros reported higher ED than Filipinos (1.9 kcal/g versus 1.6 kcal/g), although the difference was significant among males only. Non-obese subjects had a lower ED than obese subjects (1.9 versus 2.3 kcal/g). Overweight and obese subjects both reported a significantly higher % energy consumed as sugar-sweetened beverages than healthy weight subjects (8% and 9% versus 3%). Differences in ED may contribute to differences in obesity rates between Chamorros and Filipinos in Guam, particularly among men, and lowering ED may be an appropriate goal for nutrition interventions.