Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-20 (of 20 Records) |
Query Trace: Bowman BA [original query] |
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Assessment ofurinary 6-hydroxy-2,4-cyclohexadienyl mercapturic acid as a novel biomarker of benzene exposure
Bowman BA , Lewis EV , Goldy DW , Kim JY , Elio DM , Blount BC , Bhandari D . J Anal Toxicol 2023 47 (7) 597-605 Assessing benzene exposure is a public health priority due to its deleterious health effects and ubiquitous industrial and environmental sources of exposure. Phenyl mercapturic acid (PhMA) is a commonly used urinary biomarker to assess benzene exposure. However, recent work has identified significant interlaboratory variation in urinary PhMA concentrations related to methodological differences. In this study, we present urinary 6-hydroxy-2,4-cyclohexadienyl mercapturic acid (pre-PhMA), a metabolite that undergoes acid-catalyzed dehydration to form PhMA, as a novel and specific urinary biomarker for assessing benzene exposure. We developed and validated the first quantitative liquid chromatography-tandem mass spectrometry assay for measuring urinary concentrations of pre-PhMA. The pH effect on the method of ruggedness testing determined that pre-PhMA is stable across the normal human urine pH range and that neutral conditions must be maintained throughout quantification for robust and accurate measurement of urinary pre-PhMA concentrations. The method exhibited below 2 ng/mL sensitivity for pre-PhMA, linearity over three orders of magnitude, and precision and accuracy within 10%. Urinary pre-PhMA concentrations were assessed in 369 human urine samples. Smoking individuals exhibited elevated levels of pre-PhMA compared to non-smoking individuals. Furthermore, the relationship between benzene exposure and urinary pre-PhMA levels was explored by examining the correlation of pre-PhMA with 2-cyanoethyl mercapturic acid, a smoke exposure biomarker. The urinary biomarkers exhibited a positive correlation (r = 0.720), indicating that pre-PhMA levels increased with benzene exposure. The results of this study demonstrate that urinary pre-PhMA is a rugged and effective novel biomarker of benzene exposure that can be widely implemented for future biomonitoring studies. |
Mitigating matrix effects in LC-ESI-MS/MS analysis of a urinary biomarker of xylenes exposure
Bowman BA , Ejzak E , Reese CM , Blount BC , Bhandari D . J Anal Toxicol 2022 47 (2) 129-135 Liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) with stable isotope labeled internal standards (SIL-IS) is the gold standard for quantitative analysis of drugs and metabolites in complex biological samples. Significant isotopic effects associated with deuterium labeling often causes the deuterated IS to elute at a different retention time from the target analyte, diminishing its capability to compensate for matrix effects. In this study, we systematically compared the analytical performance of deuterated (2H) SIL-IS to non-deuterated (13C and 15N) SIL-ISs for quantifying urinary 2-methylhippuric acid (2MHA) and 4-methylhippuric acid (4MHA), biomarkers of xylenes exposure, with an LC-ESI-MS/MS assay. Analytical method comparison between IS demonstrated a quantitative bias for urinary 2MHA results, with concentrations generated with 2MHA-[2H7] on average 59.2% lower than concentrations generated by 2MHA-[13C6]. Spike accuracy, measured by quantifying analyte-spiked urine matrix and comparing the result to the known spike concentration, determined that 2MHA-[2H7] generated negatively biased urinary results of -38.4% whereas no significant bias was observed for 2MHA-[13C6]. Post-column infusion demonstrated that ion suppression experienced by 2MHA and 2MHA-[13C6] was not equally experienced by 2MHA-[2H7], explaining the negatively biased 2MHA results. Quantitation of urinary 4MHA results between IS exhibited no significant quantitative bias. These results underscore the importance of careful selection of internal standards for targeted quantitative analysis in complex biological samples. |
UPLC-ESI-MS/MS method for the quantitative measurement of aliphatic diamines, trimethylamine N-oxide, and beta-methylamino-l-alanine in human urine
Bhandari D , Bowman BA , Patel AB , Chambers DM , De Jesus VR , Blount BC . J Chromatogr B Analyt Technol Biomed Life Sci 2018 1083 86-92 This work describes a quantitative high-throughput analytical method for the simultaneous measurement of small aliphatic nitrogenous biomarkers, i.e., 1,6-hexamethylenediamine (HDA), isophoronediamine (IPDA), beta-methylamino-l-alanine (BMAA), and trimethylamine N-oxide (TMAO), in human urine. Urinary aliphatic diamines, HDA and IPDA, are potential biomarkers of environmental exposure to their corresponding diisocyanates. Urinary BMAA forms as a result of human exposure to blue-green algae contaminated food. And, TMAO is excreted in urine due to the consumption of carnitine- and choline-rich diets. These urinary biomarkers represent classes of small aliphatic nitrogen-containing compounds (N-compounds) that have a high aqueous solubility, low logP, and/or high basic pKa. Because of the highly polar characteristics, analysis of these compounds in complex sample matrices is often challenging. We report on the development of ion-pairing chemistry based ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS) method for the simultaneous measurement of these biomarkers in human urine. Chromatographic separation was optimized using heptafluorobutyric acid-(HFBA-) based mobile phase and a reversed-phase C18 column. All four analytes were baseline separated within 2.6min with an overall run time of 5min per sample injection. Sample preparation involved 4h of acid hydrolysis followed by automated solid phase extraction (SPE) performed using strong cation exchange sorbent bed with 7N ammonia solution in methanol as eluent. Limits of detection ranged from 0.05ng/mL to 1.60ng/mL. The inter-day and intra-day accuracy were within 10%, and reproducibility within 15%. The method is accurate, fast, and well-suited for biomonitoring studies within targeted groups, as well as larger population-based studies such as the U. S. National Health and Nutrition Examination Survey (NHANES). |
Evidence of dietary improvement and preventable costs of cardiovascular disease
Zhang D , Cogswell ME , Wang G , Bowman BA . Am J Cardiol 2017 120 (9) 1681-1688 We conducted a review to summarize preventable medical costs of cardiovascular disease (CVD) associated with improved diet, as defined by the 2020 Strategic Impact Goal of the American Heart Association. We searched databases of PubMed, Embase, CINAHL and ABI/INFORM to identify population-based studies published from January 1995 to December 2015 on CVD medical costs related to excess intake of salt/sodium or sugar-sweetened beverages, and inadequate intake of fruits and vegetables, fish/fish oils/omega-3 fatty acids, or whole grains/fiber/dietary fiber. Based on the American Heart Association's secondary dietary metrics, we also searched the literature on inadequate intake of nuts and excess intake of processed meat and saturated fat. For each component, we evaluated the CVD cost savings if consumption levels were changed. The cost savings were adjusted into 2013 US dollars. Among 330 studies focusing on diet and economic consequences, 16 studies evaluated CVD costs associated with 1 or more dietary components: salt/sodium (n = 13), fruits and vegetables (n = 1), meat (n = 1), and saturated fat (n = 3). In the United States, reducing individual sodium intake to 2,300 mg/day from the current level could potentially save $1,990.9/person per year for hypertension treatment, based on a simulation study. Increasing consumption of fruits and vegetables from <0.5 cup/day to >1.5 cups/day could save $1,568.0/person per year in treatment costs for CVD, based on a cohort study. Potential CVD cost savings associated with diet improvement are substantial. Interventions for reducing sodium intake and increasing fruit and vegetable consumption could be viable means to alleviate the increasing national medical expenditures. |
Prevalence of cardiovascular risk factors and strokes in younger adults
George MG , Tong X , Bowman BA . JAMA Neurol 2017 74 (6) 695-703 Importance: While stroke mortality rates have decreased substantially in the past 2 decades, this trend has been primarily limited to older adults. Increasing trends in stroke incidence and hospitalizations have been noted among younger adults, but there has been concern that this reflected improved diagnosis through an increased use of imaging rather than representing a real increase. Objectives: To determine whether stroke hospitalization rates have continued to increase and to identify the prevalence of associated stroke risk factors among younger adults. Design, Setting, and Participants: Hospitalization data from the National Inpatient Sample from 1995 through 2012 were used to analyze acute stroke hospitalization rates among adults aged 18 to 64 years. Hospitalization data from 2003 to 2012 were used to identify the prevalence of associated risk factors for acute stroke. Acute stroke hospitalizations were identified by the principal International Classification of Diseases, Ninth Revision, Clinical Modification code and associated risk factors were identified by secondary International Classification of Diseases, Ninth Revision, Clinical Modification codes for each hospitalization. Main Outcomes and Measures: Trends in acute stroke hospitalization rates by stroke type, age, sex, and race/ethnicity, as well as the prevalence of associated risk factors by stroke type, age, and sex. Results: The 2003-2004 set included 362339 hospitalizations and the 2011-2012 set included 421815 hospitalizations. The major findings in this study are as follows: first, acute ischemic stroke hospitalization rates increased significantly for both men and women and for certain race/ethnic groups among younger adults aged 18 to 54 years; they have almost doubled for men aged 18 to 34 and 35 to 44 years since 1995-1996, with a 41.5% increase among men aged 35 to 44 years from 2003-2004 to 2011-2012. Second, the prevalence of stroke risk factors among those hospitalized for acute ischemic stroke continued to increase from 2003-2004 through 2011-2012 for both men and women aged 18 to 64 years (range of absolute increase: hypertension, 4%-11%; lipid disorders, 12%-21%; diabetes, 4%-7%; tobacco use, 5%-16%; and obesity, 4%-9%). Third, the prevalence of having 3 to 5 risk factors increased from 2003-2004 through 2011-2012 (men: from 9% to 16% at 18-34 years, 19% to 35% at 35-44 years, 24% to 44% at 45-54 years, and 26% to 46% at 55-64 years; women: 6% to 13% at 18-34 years, 15% to 32% at 35-44 years, 25% to 44% at 45-54 years, and 27% to 48% at 55-65 years; P for trend < .001). Finally, hospitalization rates for intracerebral hemorrhage and subarachnoid hemorrhage remained stable, with the exception of declines among men and non-Hispanic black patients aged 45 to 54 with subarachnoid hemorrhage (13.2/10000 to 10.3/10000 hospitalizations and 15.8/10000 to 11.5/10000 hospitalizations, respectively). Conclusions and Relevance: The identification of increasing hospitalization rates for acute ischemic stroke in young adults coexistent with increasing prevalence of traditional stroke risk factors confirms the importance of focusing on prevention in younger adults. |
Plasma trans-fatty acid concentrations continue to be associated with serum lipid and lipoprotein concentrations among US adults after reductions in trans-fatty acid intake
Yang Q , Zhang Z , Loustalot F , Vesper H , Caudill SP , Ritchey M , Gillespie C , Merritt R , Hong Y , Bowman BA . J Nutr 2017 147 (5) 896-907 Background: High intakes of trans-fatty acids (TFAs), especially industrially produced TFAs, can lead to unfavorable lipid and lipoprotein concentrations and an increased risk of cardiovascular disease. It is unknown how this relation might change in a population after significant reductions in TFA intake.Objective: This study, which used a new analytical method for measuring plasma TFA concentrations, clarified the association between plasma TFA and serum lipid and lipoprotein concentrations before and after the US FDA enacted TFA food-labeling regulations in 2006.Methods: Data were selected from the NHANES of 1999-2000 and 2009-2010. Findings on 1383 and 2155 adults, respectively, aged ≥20 y, were evaluated. Multivariable linear regressions were used to examine the associations between plasma TFA concentration and lipid and lipoprotein concentrations. The outcome measures were serum concentrations of total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglycerides and the ratio of TC to HDL cholesterol.Results: The median plasma TFA concentration decreased from 80.6 mumol/L in 1999-2000 to 37.0 mumol/L in 2009-2010. Plasma TFA concentration continued to be associated with serum lipid and lipoprotein concentrations after significant reductions in TFA intake in the population. For example, by comparing the lowest with the highest quintiles of TFA concentration in 1999-2000, adjusted mean (95% CI) LDL-cholesterol concentrations increased from 118 mg/dL (112, 123 mg/dL) to 135 mg/dL (130, 141 mg/dL) (P-trend < 0.001). The corresponding values for 2009-2010 were 102 mg/dL (97.4, 107 mg/dL) and 129 mg/dL (125, 133 mg/dL) for LDL cholesterol (P-trend < 0.001). Differences between the highest and lowest quintiles were consistent across age groups, sexes, races/ethnicities, and other covariates.Conclusions: Despite a 54% reduction in plasma TFA concentrations in US adults from 1999-2000 to 2009-2010, concentrations remained significantly associated with serum lipid and lipoprotein concentrations. There does not appear to be a threshold under which the association between plasma TFA concentration and lipid profiles might become undetectable. |
Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey
Terry AL , Cogswell ME , Wang CY , Chen TC , Loria CM , Wright JD , Zhang X , Lacher DA , Merritt RK , Bowman BA . Am J Clin Nutr 2016 104 (2) 480-8 BACKGROUND: Twenty-four-hour urine sodium excretion is recommended for monitoring population sodium intake. Because of concerns about participation and completion, sodium excretion has not been collected previously in US nationally representative surveys. OBJECTIVE: We assessed the feasibility of implementing 24-h urine collections as part of a nationally representative survey. DESIGN: We selected a random half sample of nonpregnant US adults aged 20-69 y in 3 geographic locations of the 2013 NHANES. Participants received explicit instructions, started and ended the urine collection in a urine study mobile examination center, and answered questions about their collection. Among those with a complete 24-h urine collection, a random one-half were asked to collect a second 24-h urine sample. Sodium, potassium, chloride, and creatinine excretion were analyzed. RESULTS: The final NHANES examination response rate for adults aged 20-69 y in these 3 study locations was 71%. Of those examined (n = 476), 282 (59%) were randomly selected to participate in the 24-h urine collection. Of these, 212 persons [75% of those selected for 24-h urine collection; 53% (equal to 71% x 75% of those selected for the NHANES)] collected a complete initial 24-h specimen and 92 persons (85% of 108 selected) collected a second complete 24-h urine sample. More men than women completed an initial collection (P = 0.04); otherwise, completion did not vary by sociodemographic characteristics, body mass index, education, or employment status for either collection. Mean 24-h urine volume and sodium excretion were 1964 +/- 1228 mL and 3657 +/- 2003 mg, respectively, for the first 24-h urine sample, and 2048 +/- 1288 mL and 3773 +/- 1891 mg, respectively, for the second collection. CONCLUSION: Given the 53% final component response rate and 75% completion rate, 24-h urine collections were deemed feasible and implemented in the NHANES 2014 on a subsample of adults aged 20-69 y to assess population sodium intake. This study was registered at clinicaltrials.gov as NCT02723682. |
Dietary sodium and cardiovascular disease risk - measurement matters
Cogswell ME , Mugavero K , Bowman BA , Frieden TR . N Engl J Med 2016 375 (6) 580-6 Hypertension is a common and major risk factor for the leading U.S. killer, cardiovascular disease. Reducing excess dietary sodium can lower blood pressure, with a greater response among persons with hypertension. Nine of 10 Americans consume excess dietary sodium, defined as more than 2300 mg per day. Many leading medical and public health organizations recommend reducing dietary sodium to a maximum of 2300 mg per day on the basis of evidence indicating a public health benefit. Yet this benefit has been questioned, mainly on the basis of studies suggesting that low sodium intake is also associated with an increased risk of cardiovascular disease. In science, conflicting evidence from studies with methods of different strengths is not uncommon. Studies that measure sodium intake vary widely in their methods and should be judged accordingly. Accurate measurement matters. Paradoxical findings based on inaccurate sodium measurements should not stall efforts to improve the food environment in ways that enable consumers to reduce excess sodium intake. Gradual, stepwise sodium reduction, as recommended by the Institute of Medicine, remains an achievable, effective, and important public health strategy to prevent tens of thousands of heart attacks and strokes and save billions of dollars in health care costs annually. |
Vital Signs: Predicted heart age and racial disparities in heart age among U.S. adults at the state level
Yang Q , Zhong Y , Ritchey M , Cobain M , Gillespie C , Merritt R , Hong Y , George MG , Bowman BA . MMWR Morb Mortal Wkly Rep 2015 64 (34) 950-8 INTRODUCTION: Cardiovascular disease is a leading cause of morbidity and mortality in the United States. Heart age (the predicted age of a person's vascular system based on their cardiovascular risk factor profile) and its comparison with chronological age represent a new way to express risk for developing cardiovascular disease. This study estimates heart age and differences between heart age and chronological age (excess heart age) and examines racial, sociodemographic, and regional disparities in heart age among U.S. adults aged 30-74 years. METHODS: Weighted 2011 and 2013 Behavioral Risk Factor Surveillance System data were applied to the sex-specific non-laboratory-based Framingham risk score models, stratifying the results by age and race/ethnic group, educational and income level, and state. These results were then translated into age-standardized heart age values, mean excess heart age was calculated, and the findings were compared across groups. RESULTS: Overall, average predicted heart age for adult men and women was 7.8 and 5.4 years older than their chronological age, respectively. Statistically significant (p<0.05) racial/ethnic, sociodemographic, and regional differences in heart age were observed: heart age among non-Hispanic black men (58.7 years) and women (58.9 years) was greater than other racial/ethnic groups, including non-Hispanic white men (55.3 years) and women (52.5 years). Excess heart age was lowest for men and women in Utah (5.8 and 2.8 years, respectively) and highest in Mississippi (10.1 and 9.1 years, respectively). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: The predicted heart age among U.S. adults aged 30-74 years was significantly higher than their chronological age. Use of predicted heart age might 1) simplify risk communication and motivate more persons to live heart-healthy lifestyles and better comply with recommended therapeutic interventions, and 2) motivate communities to implement programs and policies that support cardiovascular health. |
Improving population blood pressure control for brain and heart health
George MG , Hong Y , Bowman BA . Public Health Rep 2015 130 (4) 302-306 Heart disease is the leading cause of death and disability-adjusted life years (DALYs) in the United States and the world. Stroke is the fifth-leading cause of death in the United States, the second-leading cause of death globally,1 and the third-leading cause of DALYs.2,3 Both heart disease and stroke are largely preventable by controlling risk factors such as hypertension, hyperlipidemia, diabetes, obesity, excessive alcohol intake, and tobacco smoking. However, in the United States and worldwide, interventions to control these risk factors often are poorly or incompletely implemented. Many interventions fail because they require sustained adherence to treatment even in the absence of symptoms or long-term adherence to healthy lifestyle behaviors, which may be challenging amid a busy work and home life. | Hypertension, the leading risk factor for heart disease and stroke, is known as the “silent killer” because it often doesn't produce symptoms until a major event such as a heart attack or a stroke occurs. Nearly one in three (approximately 70 million) U.S. adults has hypertension.4 It is the leading chronic condition among Medicare patients (more than 55% of beneficiaries are diagnosed with it), and it is the leading comborbid factor among those with multiple chronic conditions.5,6 It is not just a disease of the elderly: one in three adults aged 40–59 years and more than 7% of adults aged 18–39 years have hypertension.7 Notably, of adults who have hypertension, only slightly more than half have it controlled,8 and more than 14 million Americans with hypertension are not even aware they have it.4 Hypertension is the most important risk factor for stroke. Up to half of all strokes may be due to uncontrolled hypertension;9 as such, it is a natural target for improving cardiovascular health in the United States and worldwide. The continued decline in mortality from acute stroke in recent years is a remarkable achievement10 and is likely due in large part to improved hypertension control10 as the result of tremendous efforts in public health strategies and advances in clinical treatment. Yet, stroke persists as the second-leading cause of death worldwide,1 a fact that underscores the need for even better hypertension prevention, detection, and control globally. |
Use of urine biomarkers to assess sodium intake: challenges and opportunities
Cogswell ME , Maalouf J , Elliott P , Loria CM , Patel S , Bowman BA . Annu Rev Nutr 2015 35 349-87 This article summarizes current data and approaches to assess sodium intake in individuals and populations. A review of the literature on sodium excretion and intake estimation supports the continued use of 24-h urine collections for assessing population and individual sodium intake. Since 2000, 29 studies used urine biomarkers to estimate population sodium intake, primarily among adults. More than half used 24-h urine; the rest used a spot/casual, overnight, or 12-h specimen. Associations between individual sodium intake and health outcomes were investigated in 13 prospective cohort studies published since 2000. Only three included an indicator of long-term individual sodium intake, i.e., multiple 24-h urine specimens collected several days apart. Although not insurmountable, logistic challenges of 24-h urine collection remain a barrier for research on the relationship of sodium intake and chronic disease. Newer approaches, including modeling based on shorter collections, offer promise for estimating population sodium intake in some groups. Expected final online publication date for the Annual Review of Nutrition Volume 35 is July 17, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates. |
Considering trends in sodium, trans fat, and saturated fat as key metrics of cardiometobolic risk reduction
Posner SF , Bowman BA , Collins JL . Prev Chronic Dis 2014 11 E230 The 2 articles by Urban and colleagues published this week in Preventing Chronic Disease report 15-year trends in sodium, trans fat, and saturated fat, 3 food components associated with increased risk for cardiovascular disease and obesity, in frequently ordered meal items (French fries, cheeseburgers, grilled chicken sandwiches, and regular cola) from leading US national fast food chain restaurants (1,2). These longitudinal findings track these 3 food components in foods that are frequently consumed by Americans. In recent surveys, almost half of Americans report eating fast food at least weekly (http://www.gallup.com/poll/163868/fast-food-major-part-diet.aspx), and similarly, nearly half report drinking soda daily (http://www.gallup.com/poll/156116/Nearly-Half-Americans-Drink-Soda-Daily.aspx). The findings by Urban et al confirm a substantial reduction in the content of trans fat and saturated fat in French fries but not in cheeseburgers or chicken sandwiches. Changes were inconsistent in sodium, saturated fat, and calories among food products, with the exception of sodas, where there was an increase in portion size. The authors conclude that, unlike the reduction observed in artificial trans fat in French fries, the content of sodium, saturated fat, and calories in the selected foods did not change much. Taken together, these findings indicate that little improvement has been made in the quality or energy density of popular fast food products and suggest the need for interventions to improve population health. | It is important to consider these findings in the larger context as public health researchers, practitioners, and policy makers develop and implement interventions to reduce intake of excessive calories, saturated fat, and artificial trans fat. Cheeseburgers, French fries, and a soda represent a quintessential part of American culture. Banter about them was central to the Saturday Night Live skit made famous by the late John Belushi. Similarly, songs made popular by performers such as Jimmy Buffett, Charlie Pride, the Gang of Four, and the Village People are all about having a cheeseburger, French fries, and a soda. These staples of the American diet are unlikely to disappear. However, central to American food choices is an unacceptably high prevalence of diet-related risk factors that compromise the health of Americans and contribute to the high costs of chronic disease. During the period examined by Urban and colleagues, the late 1990s through 2013, the US prevalence of chronic disease risk factors such as overweight, obesity, and hypertension have remained high, cardiovascular disease remains the leading cause of death, and prevalence of prediabetes and diabetes continues to increase (3). The continued popularity of fast food restaurants and continued high prevalence of diet-related risk factors remind public health researchers, practitioners, and policy makers that there is much that needs to be done. |
Predicted 10-year risk of developing cardiovascular disease at the state level in the U.S
Yang Q , Zhong Y , Ritchey M , Loustalot F , Hong Y , Merritt R , Bowman BA . Am J Prev Med 2014 48 (1) 58-69 BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the U.S. State-specific predicted 10-year risk of developing CVD could provide useful information for state health planning and policy. PURPOSE: To estimate state-specific 10-year risk of developing CVD. METHODS: Using the updated non-laboratory-based Framingham CVD Risk Score (RS), this study estimated 10-year risk of developing CVD; coronary heart disease (CHD); and stroke, stratified by demographic factors and by state among 2009 Behavioral Risk Factors Surveillance System participants aged 30-74 years. Data analysis was completed in June 2014. RESULTS: The age-standardized mean CVD, CHD, and stroke RSs for adults aged 30-74 years were 14.6%, 10.4%, and 2.3% among men, respectively, and 7.5%, 4.5%, and 1.8% among women. RSs increased significantly with age and were highest among non-Hispanic blacks, those with less than high school education, and households with incomes <$35,000. State-specific age-standardized CVD, CHD, and stroke RS ranged, among men, from lows in Utah (13.2%, 9.6%, and 2.1%, respectively) to highs in Louisiana (16.2%, 11.7%, and 2.6%), and among women, from lows in Minnesota (6.3%, 3.8%, and 1.5%) to highs in Mississippi (8.7%, 5.3%, and 2.1%). CONCLUSIONS: The predicted 10-year risk of developing CVD varies significantly by age, gender, race/ethnicity, educational attainment, household income, and state of residence. These results support the development and implementation of targeted prevention programs by states to address the risk of developing CVD, CHD, and stroke among their populations. |
Trends in mortality rates by subtypes of heart disease in the United States, 2000-2010
Ritchey MD , Loustalot F , Bowman BA , Hong Y . JAMA 2014 312 (19) 2037-9 Despite considerable information on overall heart disease (HD) and coronary HD (CHD) mortality trends,1 less is known about trends for other HD subtypes. This study examines the contributions of HD subtypes to overall HD mortality trends during 2000–2010. |
Vital Signs: sodium intake among U.S. school-aged children - 2009-2010
Cogswell ME , Yuan K , Gunn JP , Gillespie C , Sliwa S , Galuska DA , Barrett J , Hirschman J , Moshfegh AJ , Rhodes D , Ahuja J , Pehrsson P , Merritt R , Bowman BA . MMWR Morb Mortal Wkly Rep 2014 63 (36) 789-97 BACKGROUND: A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. METHODS: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010. RESULTS: U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%). IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals. |
Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA
Bauer UE , Briss PA , Goodman RA , Bowman BA . Lancet 2014 384 (9937) 45-52 With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors-including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia-that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessible and direct care, and focus the health-care system on improving population health. |
Sodium reduction: an important public health strategy for heart health
Mugavero KL , Gunn JP , Dunet DO , Bowman BA . J Public Health Manag Pract 2014 20 S1-5 High intake of dietary sodium is associated with elevated blood pressure, which increases the risk of heart disease and stroke.1 Heart disease and stroke are the first and fourth leading causes of death in the United States2; from a public health perspective, this makes control of hypertension an important issue. | To address this, the Million Hearts initiative (led by the US Department of Health and Human Services), Dietary Guidelines for Americans, Healthy People 2020, and guidelines from numerous health organizations recommend reducing the amount of sodium consumed in the diet.3 Most sodium consumed by Americans comes from processed and restaurant foods. Because these sources make up a large part of the American diet and because consumers have little control over the level of sodium in these foods, it is often difficult for consumers to reduce their sodium intake.4 Many of the ingredients and food products served in schools, work sites, and group meal sites such as senior citizen centers contain high levels of sodium. Even when food purchasers and food service staff try to offer healthier food options, lower-sodium ingredients and products may not be easily available and accessible. |
Thiamine deficiency, beriberi, and maternal and child health: why pharmacokinetics matter
Bowman BA , Pfeiffer CM , Barfield WD . Am J Clin Nutr 2013 98 (3) 635-6 In this issue of the Journal, Coats et al (1) describe short-term thiamine pharmacokinetics in nursing women from Cambodia who received a therapeutic course of oral thiamine for 5 d. Before supplementation, the mothers and infants were biochemically thiamine deficient. Treatment normalized thiamine status in the mothers but not in the infants, although thiamine concentrations in breast milk increased rapidly with supplementation. The authors characterized thiamine status in the mothers and their breastfed infants before and after thiamine administration and compared their findings with blood samples from healthy nursing American mothers who were age-matched to their Cambodian counterparts. The data provide important insights on the nutritional pathophysiology of thiamine depletion, repletion, and therapeutics and a sobering reminder that nutritional deficiency disease, including beriberi, persists as an important cause of morbidity and mortality globally. Several aspects of the study are worth further consideration, including the study design, the analytic approach used to assess thiamine status, and implications for global maternal and child health. | | This study adds to the limited literature on pharmacokinetic data for thiamine; most of the previously published data come from healthy, well-nourished subjects (2). Coats et al used a standard approach to examine thiamine disposition in 16 healthy nursing Cambodian women from a district in Prey Vang Province, where previous work showed endemic thiamine deficiency among mothers and infants (1, 3). The thiamine dose used (100 mg thiamine hydrochloride tablet/d for 5 d, 500 mg total), although far above the Recommended Dietary Allowance (1.4 mg/d for lactating women) and higher than the usual therapeutic regimen for “mild” thiamine deficiency (5–30 mg/d in single or divided doses for 1 mo), was similar to doses typically used for severe deficiency [≤300 mg/d (4)] and within the range used in a previous pharmacokinetics study (2). The present study shows high maternal bioavailability of this pharmacologic dose but only modest improvements in the thiamine status of the infants after 5 d of maternal treatment. The authors appropriately note that supplementation for longer periods or with higher or more frequent doses should be considered and, most importantly, that symptomatic infants should be treated directly (1). |
Recent economic evaluations of interventions to prevent cardiovascular disease by reducing sodium intake
Wang G , Bowman BA . Curr Atheroscler Rep 2013 15 (9) 349 Excess intake of sodium, a common problem worldwide, is associated with hypertension and cardiovascular disease (CVD), and hypertension is a major risk factor for CVD. Population-wide efforts to reduce sodium intake have been identified as a promising strategy for preventing hypertension and CVD, and such initiatives are currently recommended by a variety of scientific and public health organizations. By reviewing the literature published from January 2011 to March 2013, we summarized recent economic analyses of interventions to reduce sodium intake. The evidence, derived from estimates of resultant blood pressure decreases and thus decreases in the incidence of CVD events, supports population-wide interventions for reducing sodium intake. Both lowering the salt content in manufactured foods and conducting mass media campaigns at the national level are estimated to be cost-effective in preventing CVD. Although better data on the cost of interventions are needed for rigorous economic evaluations, population-wide sodium intake reduction can be a promising approach for containing the growing health and economic burden associated with hypertension and its sequelae. |
Economic analysis of nutrition interventions for chronic disease prevention: methods, research, and policy
Wong JB , Coates PM , Russell RM , Dwyer JT , Schuttinga JA , Bowman BA , Peterson SA . Nutr Rev 2011 69 (9) 533-549 Increased interest in the potential societal benefit of incorporating health economics as a part of clinical translational science, particularly nutrition interventions, led the Office of Dietary Supplements at the National Institutes of Health to sponsor a conference to address key questions about the economic analysis of nutrition interventions to enhance communication among health economic methodologists, researchers, reimbursement policy makers, and regulators. Issues discussed included the state of the science, such as what health economic methods are currently used to judge the burden of illness, interventions, or healthcare policies, and what new research methodologies are available or needed to address knowledge and methodological gaps or barriers. Research applications included existing evidence-based health economic research activities in nutrition that are ongoing or planned at federal agencies. International and US regulatory, policy, and clinical practice perspectives included a discussion of how research results can help regulators and policy makers within government make nutrition policy decisions, and how economics affects clinical guideline development. |
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