Yichen Jin

Consumption of Low-Calorie Sweeteners among Children and Adults in the United States

BACKGROUND Consumption of low-calorie sweeteners (LCSs) has increased markedly during the past several decades, yet the prevalence of LCS consumption in recent years is currently unknown. OBJECTIVE The aim of this study was to describe LCS consumption in the United States and to characterize consumption by sociodemographic subgroups, source, frequency, eating occasion, and location. DESIGN Cross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2012. The prevalence of LCS consumption was assessed using two 24-hour dietary recalls, while the frequency (number of times per day), occasion (meal vs snack vs alone), and location of LCS consumption (at home vs away from home) was assessed using data from the one, in-person, 24-hour dietary recall. PARTICIPANTS National Health and Nutrition Examination Survey participants (2 years old or older) either in 2009-2010 (n=9,047) or in 2011-2012 (n=7,939). After excluding participants with implausible energy intake (n=44), the final sample size was 16,942. MAIN OUTCOME MEASURES The primary outcome was the proportion of individuals consuming one or more foods, beverages, or packets containing LCSs during at least one of their two dietary recalls. STATISTICAL ANALYSES PERFORMED Data were weighted to provide national estimates and Stata frequency procedures for complex survey design were used for all analyses. RESULTS Our findings were that 25.1% of children and 41.4% adults reported consuming LCSs. Most LCS consumers reported use once daily (80% of children, 56% of adults) and frequency of consumption increased with body weight in adults. LCS consumption was higher in females compared with males among adults, and in obese individuals, compared with overweight and normal-weight individuals. Individuals of non-Hispanic white race/ethnicity also had higher prevalence of consumption compared with non-Hispanic blacks and Hispanics and those in the highest tertile of income had higher LCS consumption compared with individuals of middle or low income across LCS product categories in adults, and for LCS beverages and LCS foods in children. Most LCS consumers reported consuming LCS with meals (64% of adults, 62% of children) and the majority of LCS consumption occurred at home (71% and 72% among adults and children, respectively). CONCLUSIONS LCS consumption is highly prevalent in the United States, among both children and adults. Well-controlled, prospective trials are required to understand the health impact of this widespread LCS exposure.

Cardiovascular health metrics among South Asian adults in the United States: Prevalence and associations with subclinical atherosclerosis.

South Asians, a fast growing ethnic group in the US, have an increased risk for cardiovascular disease compared to the general population. We examined the prevalence and distribution of the American Heart Associations Lifes Simple 7 cardiovascular health (CVH) metrics using data from Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and cross-sectional associations between number of CVH metrics in the ideal range with subclinical atherosclerosis assessed using coronary artery calcium (CAC) measured using cardiac computed tomography and carotid intima media thickness (CIMT) measured using high-resolution B-mode ultrasonography. CAC was modeled as Agatston scores=0, 1-400 and >400; CIMT was examined continuously and as internal CIMT>1.5mm. In the MASALA cohort (N=875; mean age: 55years; 53% men; living in greater San Francisco and Chicago areas; October 2010-March 2013) without prevalent coronary heart disease, no participant had all 7 metrics in ideal range; approximately 20% of the participants had at least 5 metrics in ideal range. Higher number of CVH metrics in the ideal range was inversely associated with subclinical atherosclerosis. A 1 unit increase in the number of CVH metrics in the ideal range was associated with 32% lower odds of CAC=1-400 (vs. CAC=0; OR=0.68, 95% CI: 0.60, 0.78) and 28% lower odds of internal CIMT>1.5mm (OR=72, 95% CI: 0.61, 0.85). These data show the prevalence of CVH metrics among South Asians in the US, and provide empirical evidence on inverse associations of meeting ideal levels for higher number of metrics and subclinical atherosclerosis.

Cardiovascular Health Is Associated With Physical Function Among Older Community Dwelling Men and Women

Abstract Background Age related decline in physical function is a significant concern affecting the quality of life of older individuals. Methods We examined the associations between baseline overall cardiovascular health (CVH), its components, and physical function in 906 men and women from the InCHIANTI cohort. Physical function was assessed using the Short Performance Physical Battery and poor physical function was defined as an Short Performance Physical Battery score less than 10. Overall CVH score, ranging from 0 to 12 in the cohort, was operationalized using adherence to ideal levels for health behaviors including smoking status, physical activity, body mass index, and diet quality; and health factors including blood pressure, plasma cholesterol, fasting blood glucose, with higher scores indicating better CVH. Results Mean age at baseline was 74 (SD = 6.7) years and 55% were women. At baseline and over 9 years, as compared to the lowest tertile of overall CVH score, the highest tertile was associated with a 69% (p < .001) and 63% (p < .001), respectively, lower risk of poor physical function. Among the CVH components, adherence to ideal levels of health behaviors was more strongly and consistently associated with lower odds of poor physical function than health factors. Conclusions Better overall CVH was protective against poor physical function in community-dwelling men and women aged 65 years and older. Improving CVH may be instrumental in the prevention of poor physical function in older adults.

Low-Calorie Sweeteners: Disturbing the Energy Balance Equation in Adolescents?

The aim of this study was to investigate the relationship between low‐calorie sweeteners (LCSs), energy intake, and weight in US youth.

Overall Cardiovascular Health Is Associated With All-Cause and Cardiovascular Disease Mortality Among Older Community-Dwelling Men and Women.

Objective: The objective of this study was to assess the associations between cardiovascular health and all-cause and cardiovascular disease mortality among community-dwelling elderly. Method: Secondary data analysis was performed using data collected as part of the InCHIANTI cohort procedures and included 928 participants (55% female) aged 65 years and older. Overall cardiovascular health was assessed using seven health behaviors and factors, scored 0 to 14, with higher scores indicating better cardiovascular health, modeled categorically as tertiles. Vitality status was ascertained using registry information. Cox proportional hazards models were used to examine the associations between cardiovascular health and all-cause and cardiovascular disease mortality. Results: After an average follow-up of 9.1 years, better overall cardiovascular health (highest tertile) was inversely associated with all-cause (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = [0.51, 0.92]) and cardiovascular disease mortality (HR = 0.61, 95% CI = [0.38, 0.97]) compared with the lowest tertile. Discussion: Cardiovascular health, even in the elderly, is inversely associated with mortality.

Prevalence of Low-calorie Sweetener Intake in South Asian Adults

Background: Consumption of low-calorie sweeteners (LCS) has increased in the US and is associated with cardiometabolic risk. No data exist on LCS consumption in South Asians. Aim: The aim of this study was to assess the prevalence of LCS use across socio-demographic characteristics, chronic disease status, and cardiometabolic risk factors. Methods: Cross-sectional analyses were conducted using data from the Mediators of Atherosclerosis in South Asians Living in America study (N = 892; 47% women; mean age = 55 (standard deviation = 9.4) y). Chi-squared and ANOVA tests were used to compare LCS consumption across socio-demographic characteristics and cardiometabolic risk factors. Results: Twenty-two percent of participants reported LCS use, with higher consumption among men and those with longer residency in the US. LCS use was associated with adiposity and higher odds of hypertension, high cholesterol, and diabetes. Conclusions: LCS use is prevalent among South Asians, emphasizing the need for long-term, prospective studies to investigate its role in incident cardiometabolic risk in an already metabolically vulnerable population.

Associations Between Television Viewing and Adiposity Among South Asians

ObjectiveSedentary behaviors related to television (TV) viewing are associated with adiposity; however, few investigations have focused on South Asians, an ethnicity particularly vulnerable to metabolic perturbations. This study examined the relationships between TV viewing and adiposity in a cohort of middle-aged and older South Asians.MethodData were obtained from Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (N = 906; mean age [standard deviation] = 55 [9.4] years, 46% women). TV viewing hours per week was assessed through questionnaire and classified into tertiles for analysis. Multivariate linear regression models were used to examine the associations between TV viewing and measures of adiposity and body composition including body mass index (BMI), waist circumference, pericardial fat volume, and visceral, subcutaneous, and inter-muscular fat area after adjusting for covariates including intentional exercise.ResultsParticipants who were women, older, with lower education levels, and living longer in the United States watched TV for longer periods of times. Duration of TV viewing was positively associated with BMI (p < 0.001), waist circumference (p < 0.001), visceral fat area (p = 0.001), and pericardial fat volume (p = 0.003) independent of intentional exercise.ConclusionsWhile studies in South Asians with a longitudinal design need to confirm our findings, our cross-sectional results indicate that reduction in TV viewing may be beneficial in reducing adiposity and maintaining a healthy body composition.

Cardiovascular health is associated with disability among older community dwelling men and women

Objective: The aim of this study was to investigate whether an index of overall cardiovascular health (CVH) is associated with disability in older individuals. Method: Data on 925 participants of the InCHIANTI study (Invecchiare in Chianti, aging in the Chianti area, ≥65 years, 55% women) with median follow-up of 9 years were used. CVH score was assessed by smoking status, physical activity, body mass index, diet quality, blood pressure, plasma cholesterol, and fasting blood glucose. Disability was examined using instrumental activities of daily living (IADL disabilities >0 vs. 0) and activities of daily living (ADL disabilities >0 vs. 0). Generalized estimating equations and Cox models assessed relationships between baseline CVH with disability and worsening over 9 years. Results: A 1-point increase in the CVH score was associated with 23% and 17% of lower odds of ADL (p < .001) and IADL (p < .001) disability and was protective of worsening of disability over 9 years. Cox models demonstrated that a 1-point increase in CVH score was associated with lower hazards of both ADL (hazard ratio [HR] = 0.86, p = .005) and IADL (HR = 0.91, p = .007) disability. Discussion: Among older individuals, better CVH was associated with lower risk of disability and worsening over 9 years.