Depressive symptomatology in pregnant adolescents: considerations for care.

PURPOSE OF REVIEW: Adolescents who are pregnant experience higher levels of depressive symptoms than nonpregnant peers and pregnant adults. Clinicians caring for youth are often the first point of clinical contact for pregnant adolescents but report low confidence in assessing and treating reproductive health concerns. In the current review, we outline risk factors for depressive symptoms among pregnant adolescents and provide guidance on best practices in assessment and treatment of depressive symptoms in this pediatric sub-population. RECENT FINDINGS: Depressive symptoms are persistent across pregnancy. In adolescents, they are linked to greater risk of suicidal ideation, suicidal behavior, and nonsuicidal self-injury. Risk factors for prenatal depressive symptoms among adolescents include lower levels of income, history of depression, exposure to childhood maltreatment and/or recent abuse, and/or lifetime exposure to racial/ethnic discrimination. These risk factors likely interact with each other. SUMMARY: Clinicians should assess carefully for depressive symptoms in all pregnant adolescents using a standardized, validated measure supplemented by thoughtful clinical interviewing. Clinicians can educate adolescents on the distinction between symptoms of pregnancy versus symptoms of depression. We encourage clinicians to increase their comfort in providing psychopharmacological treatment, consulting with colleagues in psychiatry, and referring adolescents for psychopharmacological treatment and therapy as needed.

Trends in Pregnancy Rates in an Urban Adolescent Clinic Before and During the COVID-19 Pandemic.

We examined COVID-19 pandemic-related changes on reproductive health care delivery and pregnancy rates in an adolescent clinic. Through a retrospective data collection as part of quality improvement project, we compared the number of pregnancies, visit percentages for newly diagnosed pregnancies, and number/percentage of long acting reversible contraception (LARC) visits. The percentage of visits for newly diagnosed pregnancies during the first 3 months of the COVID-19 pandemic (April-June 2020) increased significantly relative to pre-pandemic percentages while the absolute number of new pregnancies only trended upward. Over the same timeframe, the total number of LARC visits decreased, although they consisted of a higher percentage of all in-person visits than pre-pandemic. After the first few months of the pandemic, these values returned to pre-pandemic levels. The substantial increase in the rate of new pregnancies during the first 3 to 6 months of the COVID-19 pandemic demonstrates the importance of prioritizing access to reproductive health care services for adolescents and young adults.

Genetic assignment of fisheries bycatch reveals disproportionate mortality among Alaska Northern Fulmar breeding colonies.

Global fisheries kill millions of seabirds annually through bycatch, but little is known about population-level impacts, particularly in species that form metapopulations. U.S. North Pacific groundfish fisheries catch thousands of Northern Fulmars (Fulmarus glacialis rodgersii) each year, making fulmars the most frequently caught seabird in federally managed U.S. fisheries. Here, we used genetic stock identification to assign 1,536 fulmars sampled as bycatch to one of four Alaska breeding colonies and quantified the similarity of bycatch locations at sea among colonies. We found disproportionately high bycatch from the Pribilof Islands (6% of metapopulation, 23% of bycatch), and disproportionately low bycatch from Chagulak Island (34% of metapopulation, 14% of bycatch). Overlap between fisheries and colony-specific foraging areas diverge more during the summer breeding season, leading to greater differences in bycatch susceptibility. Contemporary and historical gene flow likely contributes to low genetic differentiation among colonies (FST = 0.003-0.01), yet these values may not represent present connectivity. Our findings illustrate how genetic stock identification can link at-sea threats to colonies and inform management to reduce bycatch from impacted colonies.

Growing Neonatal Advanced Practice Providers via Mentorship Can Fill the Need: Program Description and Tool Kit.

BACKGROUND: The need for neonatal advanced practice providers (APPs) has been described. Hospital training programs for neonatal physician assistants (PAs) have been developed by physicians. No publications exist about programs administered by neonatal APPs for both new graduate neonatal nurse practitioners (NNPs) and neonatal PAs. PURPOSE: The purpose of this work was to mentor, train, and hire neonatal APPs in a program administered by neonatal APPs. METHODS: We developed a 2-pronged approach to attract PAs and new graduate NNPs. Marketing strategies included receptions, information, and mentorship. A 12-month neonatal PA fellowship program included clinical mentorship and weekly didactics. Case-based presentations were provided by neonatal APPs, neonatologists, and allied professionals. The new graduate NNP program included clinical mentorship and monthly meetings with peer support, lectures, and case presentations. Neonatal APPs were clinical mentors. Team-building activities supported mentorship and collaboration among all care providers. FINDINGS: In less than 5 years, 10 PAs and 11 new graduate NNPs have been trained and hired, as well as experienced neonatal APPs hired for this regional neonatology program. For the first time in years, locum tenens neonatal APPs are not required. We have developed a "tool kit" of content, activities, exercises, and evaluations to support successful attainment of expected competencies. IMPLICATION FOR RESEARCH: Future studies can measure retention, satisfaction, and clinical outcomes. IMPLICATION FOR PRACTICE: A successful training program has been implemented to meet the growing demand. We support the values of integrity, collaboration, and equity to facilitate this successful paradigm shift among all neonatal professional team members.

Characteristics of Adolescents with Differing Polycystic Ovary Syndrome Phenotypes.

STUDY OBJECTIVE: To analyze clinical, metabolic, hormonal, and ultrasound characteristics of adolescents with polycystic ovary syndrome phenotypes. DESIGN: We performed a retrospective analysis of quality improvement data. We divided patients according to phenotype on the basis of clinical or biochemical diagnosis of hyperandrogenism (HA), irregular menstruation (IM), and presence or absence of polycystic ovarian morphology (PCOM) on pelvic ultrasound (PUS) images, if obtained. The 5 resulting groups were: (1) HA/IM/normal PUS, n = 28; (2) HA/PCOM, n = 10; (3) IM/PCOM, n = 18; (4) HA/IM/PCOM, n = 40; and (5) HA/IM/no PUS obtained, n = 80. We compared parameters between groups using the nonparametric Wilcoxon rank sum test. SETTING: Boston Children's Hospital, 2012-2016. PARTICIPANTS: One hundred seventy-six girls and young women aged 11-25 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: (1) Clinical, metabolic, and hormonal characteristics; and (2) PUS measurements. RESULTS: Groups with HA had significantly higher acne scores, Ferriman-Gallwey scores, and total and free testosterone concentrations than groups without HA. Significant differences in hemoglobin A1c were found between the IM/PCOM and HA/IM/PCOM groups (5.1% vs 5.3%; P = .01) and the IM/PCOM and HA/IM/no PUS groups (5.1% vs 5.3%; P < .01). In patients who had ultrasound performed, 49/94 (52.1%) met PCOM criteria on the basis of ovarian size, 37/94 (39.4%) on the basis of follicle number, and 27/94 (28.7%) on both; 10/94 (10.5)% had incidental findings on ultrasound, with 2 patients requiring further management. CONCLUSION: Limited differences in clinical, metabolic, and hormonal characteristics exist between adolescents with different phenotypes of polycystic ovary syndrome, and are mostly related to the presence or absence of HA. Of patients with ultrasound examinations, only 2 had clinically actionable incidental findings.

Lessons from seabird conservation in Alaskan longline fisheries.

Although bycatch of seabirds and other long-lived species is a critical conservation issue in world fisheries, case studies documenting significant reductions in the mortality of these low-productivity species in a fishery are rare. We studied progress toward seabird conservation in the Alaskan longline fisheries, one of the largest and most diverse demersal fisheries. We generated annual seabird bycatch rates in 4 target fisheries and all fisheries combined from 23 years of fisheries observer data. We used 0-inflated negative binomial models to evaluate variables influencing seabird bycatch per unit effort (BPUE) in 2 target fisheries. Following adoption of streamer lines, at first voluntarily and then mandatorily, seabird BPUE was reduced by 77-90%, preventing mortality of thousands of birds per year. Despite this, BPUE increased significantly in 2 of 4 target fisheries since streamer lines were adopted. Although night setting yielded significant reductions (74-97%) in seabird BPUE and significant increases (7-11%) in fish catch per unit effort over daytime setting, nighttime setting increased the BPUE of Northern Fulmar (Fulmarus glacialis) by 40% and nontarget fish species by 5-17%. Thus, best practices to prevent seabird mortalities in longline fisheries varied by species assemblage and fishery. Our results inform global efforts toward fisheries bycatch reduction by illustrating that successful conservation requires fishery-specific solutions, strong industry support, constant vigilance in analysis and reporting observer data, and ongoing outreach to fleets, especially to vessels with anomalously high BPUE.

Aprendizajes de la Conservación de Aves Marinas en las Pesquerías con Palangre de Alaska Melvin Resumen Aunque la captura accesoria de aves marinas y otras especies con ciclos de vida largos es un asunto de importancia para la conservación en las pesquerías a nivel global, son raros los estudios de caso que documentan las reducciones significativas de la mortalidad de estas especies de baja productividad en las pesquerías. Estudiamos el progreso hacia la conservación de aves marinas en las pesquerías con palangre en Alaska, una de las pesquerías demersales más grandes y con mayor diversidad. Generamos tasas anuales de capturas accesorias de aves marinas para cuatro pesquerías y todas las pesquerías combinadas a partir de 23 años de datos de observación de pesquerías. Usamos modelos binomiales negativos con inflación 0 para evaluar las variables que influyen sobre la captura accesoria de aves marinas por unidad de esfuerzo (BPUE, en inglés) en dos pesquerías. Después de la adopción de la caña de pescar, al principio voluntariamente y después de manera obligatoria, el BPUE de aves marinas se redujo entre un 77 y 90%, lo que previno la mortalidad de miles de aves por año. A pesar de esto, el BPUE incrementó significativamente en dos de las cuatro pesquerías diana desde que se adoptaron las cañas de pescar. Aunque las puestas nocturnas resultaron en reducciones significativas (74-97%) en el BPUE de aves marinas e incrementos significativos (7-11%) en la captura de peces por unidad de esfuerzo comparadas con las puestas diurnas, las puestas nocturnas incrementaron el BPUE del fulmar boreal (Fulmarus glacialis) en un 40% y entre un 5 y 17% el de las especies de peces cuya captura no es relevante para las pesquerías. Por lo tanto, las mejores prácticas para prevenir la mortalidad de las aves marinas en las pesquerías con palangre variaron dependiendo del grupo de especies y de la pesquería. Nuestros resultados informan a los esfuerzos globales hacia la reducción de la captura accesoria de las pesquerías al ilustrar que la conservación exitosa requiere de soluciones específicas por pesquería, un fuerte apoyo por parte de la industria, una vigilancia constante del análisis y el reporte de los datos de observación, y una participación continua de las flotas, especialmente en el caso de navíos con un BPUE anormalmente alto.

The effects of volume versus intensity of long-term voluntary exercise on physiology and behavior in C57/Bl6 mice.

Cardiovascular exercise (CVE) is associated with healthy aging and reduced risk of disease in humans, with similar benefits seen in animals. Most rodent studies, however, have used shorter intervention periods of a few weeks to a few months, begging questions as to the effects of longer-term, or even life-long, exercise. Additionally, most animal studies have utilized a single exercise treatment group - usually unlimited running wheel access - resulting in large volumes of exercise that are not clinically relevant. It is therefore incumbent to determine the physiological and cognitive/behavioral effects of a range of exercise intensities and volumes over a long-term period that model a lifelong commitment to CVE. In the current study, C57/Bl6 mice remained sedentary or were allowed either 1, 3, or 12 h of access to a running wheel per day, 5 days/weeks, beginning at 3.5-4 months of age. Following an eight-month intervention period, animals underwent a battery of behavioral testing, then euthanized and blood and tissue were collected. Longer access to a running wheel resulted in greater volume and higher running speed, but more breaks in running. All exercise groups showed similarly reduced body weight, increased muscle mass, improved motor function on the rotarod, and reduced anxiety in the open field. While all exercise groups showed increased food intake, this was greatest in the 12 h group but did not differ between 1 h and 3 h mice. While exercise dose-dependently increased working memory performance in the y-maze, the 1 h and 12 h groups showed the largest changes in the mass of many organs, as well as alterations in several behaviors including social interaction, novel object recognition, and Barnes maze performance. These findings suggest that long-term exercise has widespread effects on physiology, behavior, and cognition, which vary by "dose" and measure, and that even relatively small amounts of daily exercise can provide benefits.

Rapidly involuting congenital haemangioma of the liver.

Rapidly involuting congenital haemangiomas (RICHs) are rare benign vascular tumours of infancy. They are generally asymptomatic, but can present with thrombocytopaenia and coagulopathy. Significant complications including life-threatening bleeding, high-output heart failure and liver failure, though rare, can occur. RICHs generally regress by 12-14 months of age and can be managed clinically with symptomatic treatment, watchful waiting and close monitoring of the size of the haemangioma. Medical management (corticosteroids, propranolol) has not shown to be effective, in contrast to infantile haemangioma which will not regress spontaneously and has been noted to respond to medical therapy. Awareness of this diagnosis is important to prevent unnecessary medical and surgical intervention. Here, we present a case of a full-term infant with RICH who presented with thrombocytopaenia and abnormal coagulation profile. The coagulopathy was treated symptomatically, while the lesion was observed with serial ultrasounds and gradually decreased in size.

An update on PCOS in adolescents.

PURPOSE OF REVIEW: Polycystic ovarian syndrome (PCOS) is a common endocrinopathy which can be difficult to treat in adolescents. Fortunately, early identification and treatment can help mitigate some of the metabolic complications. In this review, we reflect on recent literature regarding PCOS diagnosis, associated complications, and treatment options. RECENT FINDINGS: Although there are three well known criteria to diagnose PCOS, they can be difficult to translate to adolescence. Newer diagnostic tools under study include anti-Mullerian hormone and revised ultrasound criteria. More is known about the many complications associated with PCOS, and new treatment options are on the horizon. SUMMARY: PCOS frequently will present during adolescence. These young women may already have symptoms of metabolic comorbidities. Providers caring for these patients must be aware of the many related complications and common treatment options. Newer diagnostic techniques and treatment options are under active study in adults, and may soon be translated to adolescence. A comprehensive approach allows treatment of patients' concerns, and also prevention of metabolic complications.

Relation of Coronary Artery Diameters With Cardiorespiratory Fitness.

Cardiorespiratory fitness is associated with reduced cardiovascular morbidity and mortality when adjusted for traditional risk factors. Mechanisms by which fitness reduces risk have been studied but remain incompletely understood. We hypothesize that higher fitness is associated with larger coronary artery diameters independent of its effect on traditional risk factors. Two independent measurements of the proximal diameters of the left main, left anterior descending, left circumflex, and right coronary arteries were obtained from gated multidetector computed tomography scans in 500 men from the Cooper Center Longitudinal Study (CCLS). Men with coronary artery calcium scores ≥10 were excluded. Fitness was measured with a maximal exercise treadmill test and reported by quintiles and as a function of METs. We then evaluated the relation between coronary artery diameters and fitness using mixed effect regression models. Higher fitness was associated with larger coronary artery diameters after adjustment for body surface area, smoking status, low-density lipoprotein and high-density lipoprotein cholesterol, resting systolic blood pressure, and serum glucose. When examined continuously, each MET increase in fitness was associated with a mean 0.03 ± 0.01 mm larger diameter of the left main, a 0.04 ± 0.01 mm larger diameter of the left anterior descending, a 0.05 ± 0.01 mm larger diameter of the left circumflex, and a 0.07 ± 0.01 mm larger diameter of the right coronary artery (p = 0.002). This correlation between fitness and coronary artery diameters was most prominent for fitness levels above 10 METs. In conclusion, higher fitness is associated with larger coronary artery diameters.

Culturally Effective Care for Refugee Populations: Interprofessional, Interactive Case Studies.

Introduction: Within health sciences education literature, the majority of reported student experiences with refugee populations are limited to traditional, professionally independent, elective courses and extracurricular volunteer opportunities. A simulated patient exercise is a learning opportunity that helps participants engage with material in real time in a realistic environment, demanding higher levels of learning. This session utilized a simulated patient facilitator in interprofessional small groups to explore common health needs and barriers to care among refugee populations. Methods: Health professions students from nine degree programs participated in a refugee health session in interprofessional teams of nine to 10 students to explore patient cases. The session concluded with a debriefing discussing the outcomes of the student-patient interaction, best practices, and exemplary practice models as takeaways. The simulated patient facilitators completed an Observation Checklist to assess students' grasp of learning objectives. Results: Five hundred twenty-four students participated in the refugee session, divided into 61 groups. Observation Checklists were completed for 58 groups (95%). Assessment of student engagement focused on general health needs common to refugee populations: barriers to health care, team and individual roles, bias, consequences of nontreatment, and social determinants of health. Most of the groups (95%) reported engagement between the simulated patient facilitator and the group of student providers. Qualitative data indicated student groups were knowledgeable in each of the overarching learning objectives. Discussion: This session allowed health sciences students to focus on culturally effective patient care for refugee populations as a part of an interprofessional team.

Foraging Strategies of Laysan Albatross Inferred from Stable Isotopes: Implications for Association with Fisheries.

Fatal entanglement in fishing gear is the leading cause of population decline for albatross globally, a consequence of attraction to bait and fishery discards of commercial fishing operations. We investigated foraging strategies of Laysan albatross (Phoebastria immutabilis), as inferred from nitrogen and carbon isotope values of primary feathers, to determine breeding-related, seasonal, and historic factors that may affect the likelihood of association with Alaskan or Hawaiian longline fisheries. Feather samples were collected from live birds monitored for breeding status and breeding success on Midway Atoll in the northwestern Hawaiian Islands, birds salvaged as fisheries-bycatch, and birds added to museum collections before 1924. During the chick-rearing season (sampled April-May), means and variances of stable isotope values of birds with the highest, most consistent reproductive success were distinct from less productive conspecifics and completely different from birds caught in Hawaiian or Alaskan longline fisheries, suggesting birds with higher multi-annual reproductive success were less likely to associate with these fisheries. Contemporary birds with the highest reproductive success had mean values most similar to historic birds. Values of colony-bound, courting prebreeders were similar to active breeders but distinct from prebreeders caught in Alaskan longline fisheries. During the breeding season, δ15N values were highly variable for both contemporary and historic birds. Although some historic birds exhibited extremely low δ15N values unmatched by contemporary birds (< 11.2‰), others had values as high as the highest fishery-associated contemporary birds. During the non-breeding season (sampled July-September), isotopic variability coalesced into a more narrow set of values for both contemporary and historic birds. Our results suggest that foraging strategies of Laysan albatross are a complex function of season, breeding status, and multi-annual breeding success, factors that likely affect the probability of association with fisheries.

Locating and communicating with at-risk populations about emergency preparedness: the vulnerable populations outreach model.

Vulnerable populations tend to have the worst health outcomes during and after disasters; however, these populations are rarely included in the emergency planning process. In Philadelphia, the Department of Public Health and the Office of Emergency Management have reached out to community-based organizations that serve vulnerable populations to include these key stakeholders in emergency planning. In this article, we outline strategies for locating, engaging, and communicating with vulnerable populations about both organizational and personal emergency preparedness. Such strategies include creating a method for bidirectional communication via a free quarterly health newsletter that is distributed to community-based organizations serving vulnerable populations. We also note successes and next steps from engaging vulnerable populations in the planning process in Philadelphia.

Depressive symptoms and metabolic syndrome in preventive healthcare: the Cooper Center longitudinal study.

BACKGROUND: Depression, metabolic syndrome, and reduced cardiorespiratory fitness (CRF) are known to increase the risk of developing diabetes and cardiovascular disease. The association among these factors in a generally healthy, active population with access to health care is not well defined. METHODS: This was a cross-sectional analysis of data collected on 5,125 women and men during preventive care examinations at the Cooper Clinic from 2000 to 2008. The main outcome measures were depressive symptoms as assessed by the Centers for Epidemiologic Studies Depression Scale short form (CES-D-10) questionnaire, presence or absence of metabolic syndrome, and CRF as measured by a maximal exercise treadmill test. RESULTS: Women and men who exhibited depressive symptoms had a statistically higher prevalence of metabolic syndrome compared to those who did not (for women, 15.4% versus 7.2%, P < 0.0001; for men, 31.6% versus 22.8%, P < 0.0001). Individuals with depressive symptoms had an increased frequency of higher waist circumference, higher triglycerides, and lower high-density lipoprotein. Women with depressive symptoms also had marginally higher fasting blood glucose levels. After adjusting for age and smoking status, the odds of metabolic syndrome in women with depressive symptoms was 2.81 [95% confidence interval (CI), 2.01-3.93] times the odds of metabolic syndrome in those without depressive symptoms, and in men with depressive symptoms, the odds were 1.69 (95% CI, 1.42-2.00) times the odds of metabolic syndrome in men without. When controlled for CRF level, the presence or absence of depressive symptoms on the presence of metabolic syndrome is attenuated but remains statistically significant in women. CONCLUSION: Even in a generally healthy population with access to health care, the presence of depressive symptoms was associated with increased metabolic syndrome.

Cardiorespiratory fitness, adiposity, and all-cause mortality in women.

PURPOSE: To determine the prospective associations among cardiorespiratory fitness (CRF), different measures of adiposity, and all-cause mortality in women. METHODS: A total of 11,335 women completed a comprehensive baseline examination between 1970 and 2005. Clinical measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (W/HT), waist-to-hip ratio (W/Hip), percent body fat (%BF), and CRF quantified as duration of a maximal exercise test. Participants were classified by CRF as low (lowest 20%), moderate (middle 40%), and high (highest 40%) as well as by standard clinical cut points for adiposity measures. Hazard ratios (HR) were computed using Cox regression analysis. RESULTS: During a mean follow-up of 12.3 ± 8.2 yr, 292 deaths occurred. HR for all-cause mortality were 1.0, 0.60, and 0.54 for low, moderate, and high fit groups, respectively (P for trend G0.01). Adjusted death rates of overweight/obese women within each adiposity exposure were somewhat higher compared with normal-weight women and approached statistical significance for BMI, %BF, and W/HT (P = 0.08, P = 0.08, and P = 0.07, respectively). When grouped for joint analyses into categories of fit and unfit (upper 80% and lower 20% of CRF distribution, respectively), HR were significantly higher in unfit women within each stratum of BMI compared with fit­normal BMI women. Fit women with high %BF (HR = 1.0), high WC (HR = 0.9), and high W/HT (HR = 1.2) had no greater risk of death compared with fit­normal-weight women (referent). CONCLUSIONS: Low CRF in women was a significant independent predictor of all-cause mortality. Higher CRF was associated with lower mortality within each category of each adiposity exposure. Using adiposity measures as predictors of all-cause mortality in women may be misleading unless CRF is also considered.

Risk of mortality increases with increasing number of abnormal non-ST parameters recorded during exercise testing.

BACKGROUND: Abnormal non-ST segment treadmill parameters are associated with an increased mortality risk. Such measures include fitness, resting heart rate (HR), chronotropic incompetence, and HR recovery. However, whether there is an additive association among these parameters and the risk of mortality is unknown. DESIGN: Prospective observational registry study. METHODS: We assessed the risk of cardiovascular and all-cause mortality in 25 642 individuals as an additive function of the number of these parameters. Abnormal responses were defined as follows: abnormal resting HR as a HR>or=80 bpm, abnormal fitness as an adjusted fitness level in the lowest 20%, chronotropic incompetence as an inability to achieve at least 80% of the predicted HR reserve, and abnormal HR recovery as an HR decline less than 12 bpm 1 min after exercise. RESULTS: During 7.2 years of follow-up, 392 participants died, with 94 from cardiovascular causes. Each parameter was significantly associated with all-cause and cardiovascular mortality (P<0.01) after adjustment for cardiovascular risk factors. There was a significant trend between both all-cause or cardiovascular mortality and the number of abnormal parameters (P<0.05). CONCLUSION: There is a continuum of risk as the number of abnormal parameters increases, suggesting that it may be important to determine their presence and number during exercise testing.

Cardiovascular risk factors and coronary atherosclerosis in retired National Football League players.

A high prevalence of obesity exists in National Football League (NFL) players as determined by body mass index (BMI). It is not established whether increased BMI is associated with a greater prevalence of cardiovascular (CV) risk factors or coronary atherosclerosis in former NFL players than in nonathletes. This study compared CV risk factors and coronary atherosclerosis in retired NFL players to 2 groups of community controls, the population-based Dallas Heart Study and the preventive medicine cohort, the Aerobics Center Longitudinal Study. Retired NFL players (n = 201) were matched for ethnicity, age, and BMI (Aerobics Center Longitudinal Study, age only). CV risk factors were assessed by survey and screening visit. Coronary atherosclerosis was measured by computed tomography as coronary artery calcium (CAC). Compared to population-based controls, retired NFL players had a significantly lower prevalence of diabetes, hypertension, sedentary lifestyle, and metabolic syndrome, yet a higher prevalence of impaired fasting glucose and hyperlipidemia. However, there was no significant difference in the prevalence of detectable CAC (46% vs 48.3%, p = 0.69) or distribution of CAC (0 to 10, 10 to 100, 100 to 400, > or =400, p = 0.11). Comparing retired NFL players to the physically active preventive medicine controls, there was no difference in the amount of CAC. In retired NFL players, age and hyperlipidemia, not body size, were the most significant predictors of CAC. In conclusion, despite their large body size, retired NFL players do not have a greater prevalence of CV risk factors or amount of CAC than community controls.

Comparative relation of general, central, and visceral adiposity measures for coronary artery calcium in subjects without previous coronary events.

It is unclear whether visceral obesity is largely responsible for an increased risk of coronary artery disease. In the present study, 1,054 men underwent coronary artery calcium (CAC) scoring and abdominal computed tomography. Risk factor information, body mass index, waist circumference, and waist-to-hip ratio were collected for all participants. The total fat, visceral fat, and subcutaneous fat areas were also quantified at the level of the umbilicus using computed tomography. We then investigated the association of these obesity parameters with the CAC score. Participants with a CAC score >10 had a larger waist circumference (97 +/- 12 vs 95 +/- 12 cm, p <0.001), a larger total fat area (434 cm(2), interquartile range 339 to 565, vs 415 cm(2), interquartile range 315 to 521; p = 0.005), a larger visceral fat area (200 cm(2), interquartile range 143 to 256, vs 175 cm(2), interquartile range 124 to 225; p <0.001), and a greater waist-to-hip ratio (0.93 +/- 0.07 vs 0.91 +/- 0.07, p <0.001) than those with a CAC score of < or =10. Those with a CAC score >10 also tended to have a greater body mass index and larger subcutaneous fat area. After adjusting for traditional cardiovascular risk factors, however, only a large waist circumference (odds ratio 1.5, 95% confidence interval 1.04 to 2.0), a high total fat area (odds ratio 1.5, 95% confidence interval 1.1 to 2.1), and a high waist-to-hip ratio (odds ratio 1.6, 95% confidence interval 1.2 to 2.3) remained significantly associated with a CAC score >10. In conclusion, the measures of central obesity were more strongly associated with the CAC score than either the parameters assessing overall obesity or other more direct measures of visceral adiposity. These findings suggest that the total amount of central obesity is more important than the relative distribution of visceral versus subcutaneous fat.

Relation of the number of metabolic syndrome risk factors with all-cause and cardiovascular mortality.

The metabolic syndrome (MS) is a constellation of risk factors associated with diabetes and cardiovascular disease. This syndrome consists of at least 3 parameters assessing central obesity, hypertension, high-density lipoprotein cholesterol, triglycerides, and impaired glucose metabolism. Whether persons with 4 or 5 risk factors are at higher risk than those with 3 risk factors is unclear. Also unclear is whether those without the MS but with 1 or 2 risk factors warrant therapy. We assessed cardiovascular and all-cause mortality as a function of the number of these risk factors. We followed 30,365 men for a median follow-up of 13.6 years. During follow-up, 1,449 participants died, 527 from cardiovascular causes. All of the individual parameters defining the MS were significantly associated with both all-cause and cardiovascular mortality (p <0.001). After adjustment for age and the other MS variables, hypertension was the most potent risk factor whereas central obesity and hypertriglyceridemia remained associated with both all-cause and cardiovascular mortality. A highly significant trend was also noted between both all-cause or cardiovascular mortality and the number of risk factors (p <0.001 for trend). Risk increased incrementally, beginning at 1 risk factor for cardiovascular mortality and at 2 risk factors for all-cause mortality. In conclusion, there is a continuum of risk as the number of metabolic syndrome risk factors increases. These findings add to the growing evidence that central obesity can independently and adversely affect health.