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Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the US. Weight loss and lifestyle modifications, including increases in physical activity (PA), are the primary therapeutic recommendations for managing NAFLD. However, little is known about longitudinal physical activity patterns and NAFLD prevalence among a racially diverse population of adults. This study aimed to (1) identify distinct physical activity trajectories from young to middle adulthood and (2) examine the associations between physical activity trajectories and NAFLD prevalence in middle-aged adults. Methods: The analytic sample included 2833 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Physical activity was self-reported at eight examinations over 25 years (1985/1986 to 2010/2011), and separately scored for moderate- (MPA) and vigorous-intensity (VPA) physical activity. NAFLD was defined as liver attenuation values ≤51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010/2011). Group-based trajectory modeling was used to identify MPA and VPA trajectories over 25 years. Modified Poisson regression models were used to estimate the risk ratios (RR) of NAFLD across the PA trajectories, adjusted for year 25 sex, age, CARDIA study center, race, education, smoking status, dietary pattern, and alcohol consumption. Results: We identified three distinct MPA and VPA trajectories. MPA: ‘very low stable’ (53%), ‘low stable’ (39%), and ‘moderate increasing’ (8%). VPA: ‘low stable’ (57%), ‘moderate stable’ (36%), and ‘high decreasing’ (7%). Year 25 NAFLD prevalence was 24%. Relative to participants with ‘moderate increasing’ MPA over time, those with lower levels of MPA had adjusted risk ratios of 1.11 (95% CI 0.87-1.43) for ‘low stable’ and 1.11 (95% CI 0.86-1.42) for ‘very low stable.’ Relative to participants with ‘high decreasing’ VPA over time, those with lower levels of VPA had adjusted risk ratios of 1.26 (95% CI 0.95-1.69) for ‘moderate stable’ and 1.62 (95% CI 1.21-2.16) for ‘low stable.’ Conclusions: Our results suggest a higher risk of NAFLD in middle age for those with low levels of VPA from young to middle adulthood relative to those with the highest levels of VPA over time, with evidence of dose-response. Sustaining VPA throughout adulthood may be efficacious in the prevention of NAFLD, highlighting the importance of targeted delivery of prevention and management programs aimed at modifying lifestyle risk factors to reduce NAFLD risk.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is often unrecognized and untreated despite its high prevalence (~25% of adults) and implications for cardiometabolic diseases. We examined the potential for NAFLD to modify the associations between BMI and waist circumference (WC) with changes in cardiometabolic risk. Hypothesis: The associations of BMI and WC with CMR risk are modified by NAFLD. Methods: We analyzed data from Years 25 (2010/11) and 30 (2015/6) of the CARDIA cohort. NAFLD status was determined by noncontrast CT with a liver attenuation cut-off Results: Our final sample size was 2366 (mean age: 50.1 y, males: 42.6%, Black race: 47.2%) with a NAFLD prevalence of 23% (n=539). Year 25 mean (± sd) CMR for those with and without NAFLD was -0.21 ± 0.58 and 0.50 ± 0.60, respectively. NAFLD status considerably modified the association of both BMI (interaction pwithout NAFLD compared to those with NAFLD (see Table). Within each BMI and WC category, CMR change was higher for those with NAFLD relative to those without NAFLD. Conclusion: NAFLD status modifies the association between BMI and WC with CMR changes. These findings have implications for routine clinical screening guidelines and risk stratification.

Few studies have reported the cost and cost-effectiveness of workplace interventions to reduce sedentary time. The purpose of this study was to complete an economic evaluation of a multilevel intervention to reduce sitting time and increase light-intensity physical activity (LPA) among employees.We conducted a retrospective within-trial cost and cost-effectiveness analysis (CEA) to compare a 12-month multilevel intervention with (STAND+) and without (MOVE+) a sit-stand workstation, across 24 worksites (N=630 employee participants) enrolled in a cluster randomized clinical trial. We estimated the intervention costs using activity-based costing strategy. The intervention costs were further expressed as per person and per worksite. CEA was conducted using an incremental cost-effectiveness ratio (ICER) metric, expressed as costs for additional unit of sitting time (minute/day), LPA (minutes/day), cardiometabolic risk score, and quality-adjusted life years (QALY) increased/decreased at 12 months. We assessed the cost analysis and CEA from the organizational (ie, employer) perspective with a one-year time horizon.Total intervention costs were $134 and $72 per person, and $3939 and $1650 per worksite for the STAND+ (N worksites = 12; N employees = 354) and MOVE+ (N worksites = 12; N employees = 276) interventions, respectively. The ICER was $1 (95% CI $0.8-1.4) for each additional minute reduction of workplace sitting time (standardized to 8-hour workday); and $4656 per QALY gained at 12 months. There was a modest and non-significant change of loss of work productivity improvement (-0.03 hours, 95% CI -4.16-4.09 hours), which was associated with a $0.34 return for every $1 invested.The multi-level intervention with sit-stand workstations has the potential to be widely implemented to reduce workplace sitting time. Future research into work productivity outcomes in terms of cost-benefits for employers is warranted.

Introduction: Substantial cross-sectional evidence exists supporting an association between high body mass index (BMI) during childhood and increased cardiometabolic risk factors. However, less is known about longitudinal associations of child BMI trajectories with biomarkers of cardiometabolic risk. The objective of this study was to (1) identify distinct BMI trajectories during childhood from ages 2-11 years and (2) evaluate the association of these BMI trajectories with biomarkers of cardiometabolic risk at ages 7-11 years. Methods: The analytic sample included 338 children living in low-income and racially/ethnically diverse households who participated in the NET-Works randomized intervention trial and the NET-Works 2 prospective follow-up study. BMI was measured at baseline (when children were 2-4 years of age) and again at 1-, 2-, 3- and 5-year follow-up visits. Percent of the 95 th percentile of BMI (%BMIp95) was the BMI metric calculated at each time point. At the 5-year follow-up visit, children (aged 7 to 11 years) completed assessments for carotid to anterior tibial artery pulse wave velocity (PWV), C-reactive protein (CRP), leptin, adiponectin, and oxidized low-density lipoprotein (oxLDL). Group-based trajectory modeling was used to identify child %BMIp95 trajectory groups. Adjusted linear regressions evaluated the associations between %BMIp95 trajectory groups and PWV, CRP, leptin, adiponectin, and oxLDL. Results: We identified two trajectory groups: (1) 75% of children had a moderate-decreasing trajectory (baseline BMI was below the 95th percentile of BMI and followed a moderate-decreasing trajectory over time), and (2) 25% had a marked-increasing trajectory (baseline BMI was above the 95th percentile of BMI and followed a steep increase over time). Relative to children in the moderate-decrease trajectory group, children in the marked-increase trajectory group had higher mean adjusted CRP (3.3 mg/L, 95% CI [1.6, 4.9]) and leptin (62.5 ng/mL, 95% CI [44.0, 80.9]), and lower levels of adiponectin (-1.4 μg/mL, 95% CI [-2.5, -0.1]). Differences in PWV and oxLDL were small and not statistically significant. Conclusions: Two unique BMI trajectories were observed among children living in low-income and racially/ethnically diverse households. Compared to children with steady BMI decrease over time, those with steady BMI increase over time had a higher baseline BMI and adverse inflammatory and adipokine profiles later in childhood. However, we found no evidence of differences in arterial stiffness, which could develop later in adolescence or adulthood. This study provides additional objective evidence supporting the importance of early-life tracking of BMI using the %BMIp95 metric and lifestyle interventions to reduce the risk of obesity and emerging cardiometabolic risk during childhood.

Objective:To investigate the possible associations between the food environment and dietary intake in the Mexican population.Design:Four databases (PubMed, PsychInfo, Web of Science and SCIelo) were used to retrieve relevant articles using an open timeframe. Articles were reviewed if they contained a systematic measure (i.e. food checklist) of the food environment (e.g. food availability) and dietary intake.Setting:Urban and rural communities in Mexico.Participants:Population-based studies of Mexican communities.Results:Twenty studies that assessed at least one food environment level, and at least one dietary outcome, were reviewed. Findings from these studies showed that changes in the Mexican food environment seem to be associated with higher availability of energy-dense foods. Energy-dense foods can be linked to a high consumption in household, environment and community food environments. When both nutrient-dense and energy-dense foods were present, individuals were more likely to consume foods with added sugars, fats and salt options than nutrient-dense items.Conclusions:The various levels of the food environment (i.e. household, school, community) exposed participants to energy-dense foods. Although nutrient-dense foods were present in all three levels, individuals were more likely to consume energy-dense food items. Not all three levels of the food environment are well represented in the urban and rural settings. Most studies on the community food environment were done in rural areas, whereas most studies on the school food environment were done in urban settings. Additional rigorously designed studies are needed to document the relationship between the food environment and dietary intake in the Mexican population.

Purpose We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease risk factors. Methods Data were from 1668 participants (X[Combining Overline]age = 45.9 ± 3.5 yr, 58.0% female, 39.9% black) who participated in year 20 (2005-2006) of the Coronary Artery Risk Development in Young Adults Fitness Study. The ActiGraph 7164 estimated participants' mean minutes per day of vigorous-intensity PA (VPA), moderate-intensity PA (MPA), and light-intensity PA (LPA) over 7 d. Three sequential 10-s 12-lead ECG strips were used to derive standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Mediators representing glycemic control indices included fasting glucose, fasting insulin, and 2-h oral glucose tolerance, with other mediators being traditional cardiovascular disease risk factors. Multiple linear regression assessed independent associations of PA intensity with HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV association attributable to physiological mediators. Results Participants averaged 2.7 ± 6.2 min·d, 33.0 ± 22.0 min·d, and 360.2 ± 83.8 min·d of VPA, MPA, and LPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. After adjustment for demographic and lifestyle behaviors, VPA was associated with both HRV metrics (SDNN: std beta = 0.06 [0.03, 0.10]; rMSSD: std beta = 0.08 [0.05, 0.12]) and LPA with rMSSD only (std beta = 0.05 [0.01, 0.08]). Fasting insulin and glucose mediated 11.6% to 20.7% of the association of VPA and LPA with HRV, with triglycerides also potentially mediating these associations (range, 9.6%-13.4%). Conclusions Accelerometer-estimated VPA was associated with higher (i.e., improved) HRV. Light-intensity PA also demonstrated a positive association. Mediation analyses suggested these associations may be most attributable to glucose-insulin dynamics.

Although many US adults report trying to lose weight, little research has examined weight loss goals as a motivator for reducing workplace sitting and increasing physical activity. This exploratory analysis examined weight goals and the association with changes in workplace sitting, physical activity, and weight.Employees (Generalized linear mixed models revealed that within STAND+, LWG and OWG had similar sitting time through 12 months. However, LWG sat significantly more than OWG at 24 months. Within MOVE+, sitting time decreased after introduction of sit-stand workstations for LWG and OWG, although LWG sat more than OWG. Change in physical activity was minimal and weight remained stable in all groups.Patterns of change in workplace sitting were more favorable in OWG relative to LWG, even in the absence of notable weight change. Expectations of weight loss might be detrimental for reductions in workplace sitting. Interventionists may want to emphasize non-weight health benefits of reducing workplace sitting.

BACKGROUND: This analysis helps clarify the individual and joint effects of moderate to vigorous physical activity (MVPA) in concert with significant life events (eg, divorce, marriage, job change or loss, pregnancy, etc) on weight following a behavioral weight loss intervention. METHODS: Data from the Tracking Study weight loss trial were utilized to perform a 4-way decomposition of moderation and mediation of life events (≥ 1 vs 0) and MVPA (low

Background: Prolonged sedentary time is associated with adverse health outcomes, after controlling for the role of moderate-to-vigorous physical activity. We previously reported on a four-week randomized trial using a sit-stand desk (SSD) intervention that decreased sedentary time at work without changing activity level during non-work hours. Purpose: The purpose of this study was to measure the impact of the SSD on sitting time and activity level one year after the original intervention. Methods: A pre-post design was used where the control period from the original study was regarded as “pre” and the measurements made in the follow-up study as “post.” The follow-up study was conducted in the same office workers over a two-week period in June 2013. Results: Fifteen out of the 23 participants took part in the follow-up study. Self-reported sitting time during work-hours was decreased by 22% (95% CI: 15% to 29%; p

OBJECTIVES: The fit of measured variables into a social-ecological model of correlates of physical activity is rarely tested. In this study, we examined the factor structure of correlates of moderate/vigorous physical activity (MVPA) within a hypothesized social-ecological model. METHODS: We measured 46 possible personal, social and environmental correlates of MVPA in 2779 adolescents participating in the Project EAT-2010 study. Confirmatory (CFA) and exploratory factor analyses (EFA) were used to determine the factor structure. Associations of factor scores with self-reported MVPA were calculated with linear regression. RESULTS: A 6-factor CFA model did not show adequate fit. Eight factors were identified using EFA (Root Mean Square Error [RMSEA] 90% CI: 0.053 to 0.055; CFI = 0.82). A factor representing the mix of personal and social correlates showed the strongest association with MVPA. CONCLUSIONS: The 8-factor model supports independent clustering of possible environmental correlates of MVPA, but indicates that social and personal correlates may not cluster independently. The factor most strongly correlated with MVPA represented a mix of personal and social correlates. Future work will be needed to better understand how mechanisms for developing physical activity work within and across levels of the social-ecological framework.

BackgroundThe impact of coronavirus disease-2019 (COVID-19) on psychosocial and behavioral responses of the non-healthcare workforce is unknown. This study investigated these outcomes in this population during the pandemic while also evaluating transmission prevention behavior implementation at the workplace.MethodsWe deployed the baseline questionnaire of a prospective online survey from November 2020-February 2021 to U.S.-based employees. The survey included questions on psychosocial and behavioral responses in addition to transmission prevention behaviors (e.g., mask wear). Select questions asked employees to report perceptions and behaviors ‘before’ and ‘during’ the COVID-19 pandemic. Data were analyzed descriptively and stratified by work from home (WFH) percentage.ResultsIn total, 3,607 employees completed the survey from eight companies. Most participants (70.0%) averaged ≥90% of their time WFH during the pandemic. Employees reported increases in stress (54.0%), anxiety (57.4%), fatigue (51.6%), and feeling unsafe (50.4%) from before to during the pandemic, while feeling a lack of companionship (60.5%) and isolation from others (69.3%). Productivity was perceived to decrease, and non-work screen time and alcohol consumption to increase, for 43.0%, 50.7%, and 25.1% of employees, respectively, from before to during the pandemic. Adverse changes were worse among those with lower WFH percentages. Most employees reported wearing a mask (98.2%), washing hands regularly (95.7%), and physically distancing (93.6%) when at workplace.ConclusionResults suggested worsened psychosocial and behavioral outcomes from before to during the COVID-19 pandemic and higher transmission prevention behavior implementation among non-healthcare employees. Observations provide novel insight into how the COVID-19 pandemic has impacted non-healthcare employees.

OBJECTIVE: To examine the effect on continuously monitored blood glucose (CGM) among participants with impaired fasting glucose (IFG) who used a height-adjustable desk while working. METHODS: The study was a repeated measures pilot study in overweight or obese women who had IFG (blood glucose [BG] >100 mg/dL) and a sedentary job. Blood glucose was monitored with CGM devices during two 1-week periods at work; 1 week in the seated position and 1 week using alternate bouts of sitting and standing (by adjusting their desks) throughout the workday. RESULTS: Ten women completed the study. Sedentary time significantly predicted BG independently of diet and overall physical activity (P=.02). Dietary carbohydrates, protein, and fat were significant predictors of BG (P

Chemotherapy remains the standard of care for most cancers worldwide, however development of chemoresistance due to the presence of the drug-effluxing ATP binding cassette (ABC) transporters remains a significant problem. The development of safe and effective means to overcome chemoresistance is critical for achieving durable remissions in many cancer patients. We have investigated the energetic demands of ABC transporters in the context of the metabolic adaptations of chemoresistant cancer cells. Here we show that ABC transporters use mitochondrial-derived ATP as a source of energy to efflux drugs out of cancer cells. We further demonstrate that the loss of methylation-controlled J protein (MCJ) (also named DnaJC15), an endogenous negative regulator of mitochondrial respiration, in chemoresistant cancer cells boosts their ability to produce ATP from mitochondria and fuel ABC transporters. We have developed MCJ mimetics that can attenuate mitochondrial respiration and safely overcome chemoresistance in vitro and in vivo. Administration of MCJ mimetics in combination with standard chemotherapeutic drugs could therefore become an alternative strategy for treatment of multiple cancers., Drug efflux through ABC transporters is a common mechanism leading to chemoresistance in cancer. Here, the authors show that mitochondrial respiration provides ATP to allow ABC transporters activity so mitochondrial respiration inhibition overcomes chemoresistance in preclinical cancer models.

Background Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk. Methods Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months. Results Worksites (N = 24; academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) and employees (N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was − 59.2 (CI: − 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (− 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat. Conclusions Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized. Trial registration ClinicalTrials.gov Identifier: NCT02566317. Registered 2 October 2015, first participant enrolled 11 January 2016.

We assembled an ancestrally diverse collection of genome-wide association studies of type 2 diabetes (T2D) in 180,834 cases and 1,159,055 controls (48.9% non-European descent). We identified 277 loci at genome-wide significance (p-8), including 237 attaining a more stringent trans-ancestry threshold (p-9), which were delineated to 338 distinct association signals. Trans-ancestry meta-regression offered substantial enhancements to fine-mapping, with 58.6% of associations more precisely localised due to population diversity, and 54.4% of signals resolved to a single variant with >50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying foundations for functional investigations. Trans-ancestry genetic risk scores enhanced transferability across diverse populations, providing a step towards more effective clinical translation to improve global health.

OBJECTIVES: Diet beverages are calorie free beverages sweetened with non-nutritive sweeteners. People with diabetes are the highest per-capita consumers of diet beverages, tending to consume them as a replacement for sugar sweetened beverages. This behavior is endorsed by dietetic and scientific organizations and diet beverages are marketed synonymously with better health. The underlying concern is the lack of data to support or refute this concept. To begin addressing this gap we examined the association between diet beverage intake and incident chronic kidney disease (CKD) in a population at high risk for CKD. METHODS: We pooled data from the Atherosclerosis Risk in Communities study (years 1987–2014), Cardiovascular Health Study (1989–2014), Jackson Heart Study (2000–2012), and Multi-Ethnic Study of Atherosclerosis (2000–2013) to conduct a prospective study of the association of diet beverage intake with the incidence of CKD among participants with clinically ascertained type 2 diabetes (T2D) without prevalent CKD and with valid dietary data (n = 3250). CKD was defined using serum creatinine to define estimated glomerular filtration (eGFR) via the CKD-EPI creatinine equation. Incident CKD was defined as (eGFR 0 and

We evaluated the associations between accelerometer-estimated physical activity (PA) intensity and heart rate variability (HRV) and examined mediation of these associations by glycemic control indices and other cardiovascular disease risk factors.Data were from 1668 participants (X[Combining Overline]age = 45.9 ± 3.5 yr, 58.0% female, 39.9% black) who participated in year 20 (2005-2006) of the Coronary Artery Risk Development in Young Adults Fitness Study. The ActiGraph 7164 estimated participants' mean minutes per day of vigorous-intensity PA (VPA), moderate-intensity PA (MPA), and light-intensity PA (LPA) over 7 d. Three sequential 10-s 12-lead ECG strips were used to derive standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Mediators representing glycemic control indices included fasting glucose, fasting insulin, and 2-h oral glucose tolerance, with other mediators being traditional cardiovascular disease risk factors. Multiple linear regression assessed independent associations of PA intensity with HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV association attributable to physiological mediators.Participants averaged 2.7 ± 6.2 min·d, 33.0 ± 22.0 min·d, and 360.2 ± 83.8 min·d of VPA, MPA, and LPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. After adjustment for demographic and lifestyle behaviors, VPA was associated with both HRV metrics (SDNN: std beta = 0.06 [0.03, 0.10]; rMSSD: std beta = 0.08 [0.05, 0.12]) and LPA with rMSSD only (std beta = 0.05 [0.01, 0.08]). Fasting insulin and glucose mediated 11.6% to 20.7% of the association of VPA and LPA with HRV, with triglycerides also potentially mediating these associations (range, 9.6%-13.4%).Accelerometer-estimated VPA was associated with higher (i.e., improved) HRV. Light-intensity PA also demonstrated a positive association. Mediation analyses suggested these associations may be most attributable to glucose-insulin dynamics.

We investigated the effects of regular walking in green and suburban environments on heart rate variability (HRV) and blood pressure (BP) in middle-aged adults. Twenty-three adults participated in a non-randomized crossover experiment comprised of once-weekly 50-min moderate-intensity walking sessions. Separated by a two-week washout period, participants walked for three weeks in each of two treatment conditions (green and suburban) in a local arboretum and suburban sidewalks of Chaska, MN. Eleven participants completed green walking first and 12 suburban walking first. Walks were split into 15-min intra-walk phases, with phases representing each walk’s beginning, middle, and final 15-min. Repeated measures linear mixed models evaluated (1) HRV phase differences between treatments and HRV change within treatments, and (2) pre- and post-walk BP differences between treatments and pre- to post-walk BP changes. Intra-walk phase analyses revealed higher HRV during green walking vs. suburban walking during phase 2 (p < 0.0001) and phase 3 (p = 0.02). Less HRV reduction was seen between intra-walk phases 1 and 2 during green vs. suburban walking (p = 0.02). Pre- to post-walk changes revealed decreased mean systolic BP for both green (p = 0.0002) and suburban (p = 0.003) walking conditions, but not for diastolic BP. Post-walk BP results were similar after both green walking and suburban walking. In summary, walking sessions in a green environment elicited greater beneficial HRV responses compared to a suburban environment. Additionally, walking in either environment, green or suburban, promoted reductions in systolic BP.

Multicomponent interventions that use sit-stand workstations (SSW) to reduce workplace sitting time have been largely successful. However, the long-term maintenance (i.e., >12 months) of this behavior change is relatively unknown. We aimed to evaluate the 24-month maintenance of reductions in workplace sitting time, along with the effects of introducing the SSW after 12 months of multicomponent intervention only. We used data from Stand and Move at Work, a two-arm multi-site group randomized trial of 24 worksites (12 worksites per arm; N=630, 74% female, 45±11 years of age). Worksites in the STAND+ arm received 12 months of a multilevel (i.e., worksite policy, environmental, and individual-level strategies) intervention to increase light-intensity physical activity, along with a SSW, to increase standing time. Worksites in the MOVE+ arm (i.e., comparator) received the same multilevel intervention but were not provided with the SSW until after the intervention ended at 12 months. Sitting time was assessed for 7 consecutive days using the activPAL3c micro accelerometer at baseline, 12, and 24 months. Results are presented below in table form. In STAND+ , sitting time at 24 months, relative to baseline, was significantly reduced and similar in magnitude of change to what was observed at 12 months. In MOVE+ , sitting time at 24 months (a year after the SSW was introduced), relative to baseline, was significantly reduced but markedly smaller in magnitude of change than observed during the STAND+ active intervention period (i.e., 0 to 12 months). These results support the use of SSW coupled with a multicomponent intervention for optimal and long-term maintenance of reductions in workplace sitting time. Hierarchical regression models were adjusted for worksite clustering, age, sex, and baseline BMI.

Long-term effects of workplace sedentary behavior interventions on cardiometabolic risk are poorly understood. Stand and Move at Work was a multi-site group randomized trial in 24 worksites (N=630, 74% female, 45±11 years of age) of office-based employees in Phoenix, AZ and Minneapolis/St. Paul, MN. Worksites in the STAND+ study arm received 12 months of a multilevel (i.e., worksite policy, environmental, and individual-level strategies) intervention to increase light-intensity physical activity along with a sit-stand workstation (SSW) to increase standing time. Worksites in the MOVE+ study arm received the same multilevel intervention but were not provided the SSW until after the intervention ended at 12 months. The STAND+ arm, but not the MOVE+ arm, had significant reductions in sedentary time over the 12-month intervention. However, 12-month improvements in cardiometabolic risk factors were only observed among a subgroup with dysglycemia (prediabetes or diabetes). Here we report the long-term follow-up of these changes, 12 months after the end of the trial (24 months). Results are shown in the Table. The effects at 12 months were largely sustained at 24 months. Although limited by the small sample size in this subgroup, long-term meaningful and sustained improvement in blood glucose, triglycerides, systolic blood pressure, and weight may be observed from a multilevel workplace sedentary behavior intervention that includes sit-stand workstations.

Introduction: We estimated cross-sectional associations between accelerometer-estimated light (LPA), moderate (MPA), and vigorous (VPA) intensity physical activity (PA) and heart rate variability (HRV), and tested mediation of these associations by glycemic control indices, blood lipids, and blood pressure. Hypothesis: PA is positively and independently associated with higher (improved) HRV. Glycemic measures are partial physiological mediators of these associations. Methods: Data were from 1,668 participants (X -age = 46 ± 4 yrs, 58% F, 40% black) in Year 20 (2005-06) of the Coronary Artery Risk Development in Young Adults (CARDIA) Fitness Study. The ActiGraph 7164 estimated participants’ mean min/d of LPA, MPA, and VPA over 7d. Three sequential 10-sec 12-lead ECG strips provided standard deviation of all normal RR intervals (SDNN) and root mean square of all successive RR intervals (rMSSD) HRV. Physiological mediators included fasting glucose and insulin as well as 2-hr oral glucose tolerance (OGTT), fasting triglycerides (TG), HDL-C, and systolic blood pressure (BP). Multiple linear regression, controlling for demographic and lifestyle confounders, assessed independent associations of PA with SDNN and rMSSD HRV per 1-SD. Mediation analyses computed the proportion of the PA-HRV associations attributable to physiological mediators. Results: Participants averaged 360.2 ± 83.8, 33.0 ± 22.0, and 2.7 ± 6.2 min/d of LPA, MPA, and VPA, respectively, with mean values for SDNN (32.6 ± 22.4 ms) and rMSSD (34.0 ± 24.8 ms) similar. VPA was associated with both HRV metrics (SDNN: std = .06 [.03, .10]; rMSSD: std = .08, [.05, .12]) and LPA with rMSSD only (std = .05, [.01, .08]). Fasting glucose and insulin mediated between 11.6%-20.7% of the association of VPA and LPA with HRV (Table). Triglycerides also mediated these associations (range: 9.6%-13.4%; Table). Conclusions: Accelerometer-estimated VPA and LPA were positively associated with higher HRV. These associations may be due most to glycemia and insulinemia.

Introduction: Reviewing gaps in self-monitoring during weight loss interventions may help identify individuals demonstrating signs of disengagement in behaviors, including moderate to vigorous physical activity (MVPA), associated with weight loss maintenance. This study examined the associations of different aspects of self-monitoring during a weight loss intervention with 24-month MVPA and weight. Methods: Secondary data analysis from the Tracking Study, a trial comparing weight-tracking frequency during a lifestyle weight loss program, was conducted. Self-monitoring logs from n =339 participants were used to define 4 characteristics and 4 specific gap lengths: short (1-4 weeks), medium (5-8 weeks), long (9-12 weeks), and extra long (>12 weeks). Self-reported MVPA and staff-measured weight were measured at baseline, 6, 12, 18, and 24 months. Generalized estimating equation modeling examined the association between self-monitoring characteristics and reported MVPA and weight. Results: Participants with gaps in self-monitoring as early as the second week of the intervention reported less MVPA and weighed more at 24 months. Furthermore, consistent tracking of MVPA was associated with higher reported MVPA and lower weight. Conclusions: Behavior tracking provides important information about behavioral disengagement early in the intervention process. Future work should test intervention augmentations to improve behavior change when disengagement is detected.

Purpose: To review enrollment strategies, participation barriers, and program reach of a large, 2-year workplace intervention targeting sedentary behavior. Approach: Cross-sectional, retrospective review. Setting: Twenty-four worksites balanced across academic, industry, and government sectors in Minneapolis/Saint Paul (Minnesota) and Phoenix (Arizona) regions. Participants: Full-time (≥30+ h/wk), sedentary office workers. Methods: Reach was calculated as the proportion of eligible employees who enrolled in the intervention ([N enrolled/(proportion of eligible employees × N total employees)] × 100). Mean (1 standard deviation) and median worksite sizes were calculated at each enrollment step. Participation barriers and modifications were recorded by the research team. A survey was sent to a subset of nonparticipants (N = 57), and thematic analyses were conducted to examine reasons for nonparticipation, positive impacts, and negative experiences. Results: Employer reach was 65% (56 worksites invited to participate; 66% eligible of 56 responses; 24 enrolled). Employee reach was 58% (1317 invited to participate, 83% eligible of 906 responses; 632 enrolled). Postrandomization, on average, 59% (15%) of the worksites participated. Eighteen modifications were developed to overcome participant-, context-, and research-related participation barriers. Conclusion: A high proportion of worksites and employees approached to participate in a sedentary behavior reduction intervention engaged in the study. Interventions that provide flexible enrollment, graded participant engagement options, and adopt a participant-centered approach may facilitate workplace intervention success.

Background:Interventions to raise population physical activity generally show modest effects; one possible reason is that trends and determinants of moderate to vigorous physical activity (MVPA) differ between population subgroups. This study examined differences in trends and determinants of reported MVPA by ethnicity/race and sex in a 15-year longitudinal study.Methods:Participants (n = 2092) in the Project Eating and Activity in Teens and Young Adults study were surveyed on MVPA behavior and potential determinants from adolescence to young adulthood. Generalized estimating equations were used to model age trends in MVPA and associations with determinants.Results:Mean MVPA declined by 2.1 hours per week over 15 years of follow-up from adolescence to young adulthood. Asian males reported the lowest levels of MVPA at each age. Nonwhite females reported less MVPA than white females at each age. The association of body mass index (BMI) with MVPA differed by sex and ethnicity/race. Asian males and females showed lower levels of MVPA at both low and high BMI.Conclusions:Interventions to increase MVPA may need to begin earlier among Asian men and nonwhite women than among other groups. Asian adolescents with lower BMI show lower MVPA and may benefit from additional intervention efforts compared with Asian adolescents with normal BMI.

ObjectiveTo assess the accuracy of nutrient intake calculations from leading nutrition tracking applications (apps).DesignNutrient intake estimates from thirty 24 h dietary recalls collected using Nutrition Data System for Research (NDSR) were compared with intake calculations from these recalls entered by the researcher into five free nutrition tracking apps. Apps were selected from the Apple App Store based on consumer popularity from the list of free ‘Health and Fitness’ apps classified as a nutrition tracking apps.SubjectsDietary recall data collected from thirty lower-income adults.ResultsCorrelations between nutrient intake calculations from NDSR and the nutrition tracking apps ranged from 0·73 to 0·96 for energy and macronutrients. Correlations for the other nutrients examined (Na, total sugars, fibre, cholesterol, saturated fat) ranged from 0·57 to 0·93. For each app, one or more mean nutrient intake calculations were significantly lower than those from NDSR. These differences included total protein (P=0·03), total fat (P=0·005), Na (P=0·02) and cholesterol (P=0·005) for MyFitnessPal; dietary fibre (P=0·04) for Fitbit; total protein (P=0·0004), total fat (P=0·008), Na (P=0·002), sugars (P=0·007), cholesterol (P=0·0006) and saturated fat (P=0·005) for Lose It!; Na (P=0·03) and dietary fibre (P=0·005) for MyPlate; and total fat (P=0·03) for Lifesum.ConclusionsFindings suggest that nutrient calculations from leading nutrition tracking apps tend to be lower than those from NDSR, a dietary analysis software developed for research purposes. Further research is needed to evaluate the validity of the apps when foods consumed are entered by consumers.

Purpose: This study describes the association between frequency of bicycling for active transportation and modifiable cardiometabolic risk factors in the Minneapolis–Saint Paul (MSP) metropolitan area. Design: We conducted an online survey from a convenience sample of likely bicycle commuters. Setting: Participants were e-mailed invitations including a link to the online survey. Participants: Participants (n = 1450, 15.6% response rate) were residents of the 7-county MSP metropolitan area aged 20 to 64 years. Measures: Participants reported frequency of commute and destination cycling from April to September and October to March, prevalent cardiometabolic risk factors, and demographic covariates. Analysis: We performed logistic regressions for associations between average weekly transportation bicycling and self-reported prevalent obesity, high blood pressure, high cholesterol, low high-density lipoprotein cholesterol, and high triglycerides. We used Poisson regression for the count of cardiometabolic risk factors. All models were adjusted for age, sex, race, smoking, alcohol consumption, and other physical activity, with random intercepts by zip code. Results: Self-reported bicycling frequency is associated with significantly lower odds of prevalent obesity, hypertension, and high triglycerides. Three bicycling trips per week is associated with 20% fewer (95% confidence interval: 12%-28%) cardiometabolic risk factors. Conclusion: Bicycling frequency is inversely associated with cardiometabolic risk factors. These results provide empirical support for the promotion of active transportation as public health policy.

College students demonstrate poor physical activity (PA) and dietary behaviors. We evaluated the feasibility of a combined smartwatch and theoretically based, social media-delivered health education intervention versus a comparison on improving college students&rsquo, health behaviors/outcomes. Thirty-eight students (28 female, Xage = 21.5 &plusmn, 3.4 years) participated in this two-arm, randomized 12-week pilot trial (2017&ndash, 2018). Participants were randomized into: (a) experimental: Polar M400 use and twice-weekly social cognitive theory- and self-determination theory-based Facebook-delivered health education intervention, or (b) comparison: enrollment only in separate, but content-identical, Facebook intervention. Primary outcomes pertained to intervention feasibility. Secondary outcomes included accelerometer-estimated PA, physiological/psychosocial outcomes, and dietary behaviors. Intervention adherence was high (~86%), with a retention of 92.1%. Participants implemented health education tips 1&ndash, 3 times per week. We observed experimental and comparison groups to have 4.2- and 1.6-min/day increases in moderate-to-vigorous PA (MVPA), respectively, at six weeks&mdash, partially maintained at 12 weeks. In both groups, similarly decreased body weight (experimental = &minus, 0.6 kg, comparison = &minus, 0.5 kg) and increased self-efficacy, social support, and intrinsic motivation were observed pre- and post-intervention. Finally, we observed small decreases in daily caloric consumption over time (experimental = &minus, 41.0 calories, 143.3). Both interventions were feasible/of interest to college students and demonstrated initial effectiveness at improving health behaviors/outcomes. However, smartwatch provision may not result in an additional benefit.

This study investigated the acute effects of repeated walking sessions within green and suburban environments on participants&rsquo, psychological (anxiety and mood) and cognitive (directed-attention) outcomes. Twenty-three middle-aged adults (19 female) participated in a non-randomized crossover study comprised of once-weekly 50-min moderate-intensity walking sessions. Participants walked for three weeks in each of two treatment conditions: green and suburban, separated by a two-week washout period. Eleven participants completed green walking first and 12 suburban walking first. For each walk, we used validated psychological questionnaires to measure pre- and post-walk scores for: (1) mood, evaluated via the Positive and Negative Affect Schedule (PANAS), (2) anxiety, assessed by the State-Trait Anxiety Inventory (STAI-S), and (3) directed-attention, measured using the visual Backwards Digit Span test (BDS). Repeated measures linear mixed models assessed pre- to post-walk changes within-treatment conditions and post-walk contrasts between-treatment conditions. Results indicated that anxiety decreased after green walking and increased after suburban walking (&minus, 1.8 vs. +1.1 units, respectively, p = 0.001). For mood, positive affect improved after green walking and decreased after suburban walking (+2.3 vs. &minus, 0.3 units, respectively, p = 0.004), and negative affect decreased after green walking and remained similar after suburban walking (&minus, 0.5 vs. 0 units, respectively, p = 0.06). Directed-attention did not improve from pre- to post-walk for either condition. Our results suggested that green walking may be more effective at reducing state anxiety and increasing positive affect compared to suburban walking.

SUMMARYMeta-analyses of genome-wide association studies (GWAS) have identified >240 loci associated with type 2 diabetes (T2D), however most loci have been identified in analyses of European-ancestry individuals. To examine T2D risk in East Asian individuals, we meta-analyzed GWAS data in 77,418 cases and 356,122 controls. In the main analysis, we identified 298 distinct association signals at 178 loci, and across T2D association models with and without consideration of body mass index and sex, we identified 56 loci newly implicated in T2D predisposition. Common variants associated with T2D in both East Asian and European populations exhibited strongly correlated effect sizes. New associations include signals in/near GDAP1, PTF1A, SIX3, ALDH2, a microRNA cluster, and genes that affect muscle and adipose differentiation. At another locus, eQTLs at two overlapping T2D signals act through two genes, NKX6-3 and ANK1, in different tissues. Association studies in diverse populations identify additional loci and elucidate disease genes, biology, and pathways.Type 2 diabetes (T2D) is a common metabolic disease primarily caused by insufficient insulin production and/or secretion by the pancreatic β cells and insulin resistance in peripheral tissues1. Most genetic loci associated with T2D have been identified in populations of European (EUR) ancestry, including a recent meta-analysis of genome-wide association studies (GWAS) of nearly 900,000 individuals of European ancestry that identified >240 loci influencing the risk of T2D2. Differences in allele frequency between ancestries affect the power to detect associations within a population, particularly among variants rare or monomorphic in one population but more frequent in another3,4. Although smaller than studies in European populations, a recent T2D meta-analysis in almost 200,000 Japanese individuals identified 28 additional loci4. The relative contributions of different pathways to the pathophysiology of T2D may also differ between ancestry groups. For example, in East Asian (EAS) populations, T2D prevalence is greater than in European populations among people of similar body mass index (BMI) or waist circumference5. We performed the largest meta-analysis of East Asian individuals to identify new genetic associations and provide insight into T2D pathogenesis.

Introduction: Heart rate variability (HRV) assesses the sympathetic and parasympathetic innervation of the heart. Lower HRV indicates greater sympathetic tone and is associated with adverse cardiovascular outcomes. During exercise, factors like activity intensity influence HRV. Yet, an environment’s inherent anxiety-/stress-promoting characteristics may also affect HRV. Hypothesis: Given nature’s calming characteristics, we hypothesized green (i.e., nature-based) walking would promote higher HRV and less HRV reduction than suburban walking. Methods: Twenty-four middle-aged adults (20 female; 49.3 ± 6.7 yrs; BMI: 30.7 ± 7.9 kg/m 2 ) participated in this nine-week crossover study comprised of once-weekly 50-minute moderate-intensity walking sessions. Participants walked for three weeks in each of two treatment conditions: (1) green walking: nature-based walking on trails of local arboretum; and (2) suburban walking: walking on sidewalks of a local suburb’s downtown area. Half were assigned to suburban walking in the first treatment period, and half completed green walking first. A two-week washout separated treatments. The Zephyr BioHarness 3 assessed HRV—reported as standard deviations of normal-to-normal RR intervals in milliseconds (ms) while also tracking activity intensity. For analysis, walks were split into 15-minute intra-walk phases with the first, second, and third phases representing each walk’s beginning, middle, and end. Five-minute pre- and post-walk sitting phases for HRV were also created. Linear mixed models with repeated measures evaluated HRV phase differences between treatments and HRV change between phases by treatment. Results: Lower HRV was observed during the pre-walk sitting phase in the green (56.5 ms) vs. the suburban walking treatment (62.4 ms; p = 0.04); however, a sequence effect was present ( p = 0.02). Due to lower walking intensity during green walking (0.31 g vs. 0.27 g; p < 0.01), activity intensity was a covariate in all intra-walk analyses. Intra-walk phase analyses revealed higher green vs. suburban walking HRV during the second (29.1 ms vs. 24.2 ms, respectively; p < 0.01) and third (33.9 ms vs. 23.8 ms, respectively; p = 0.03) phases. Further, less HRV reduction was seen between the first and second intra-walk phases during green (-7.6 ms) vs. suburban walking (-12.4 ms; p = 0.05). Between-treatment HRV differences were not found for the post-walk sitting phase. No sequence effects were observed for the intra-walk or post-walk phases. Finally, no carryover effects were observed—suggesting adequate washout between treatments. Conclusions: Green walking elicits higher HRV and less HRV reduction vs. suburban walking. Activity intensity did not explain these observations. Fully powered longer-term trials should rigorously evaluate green walking’s potential anxiety-/stress-reducing characteristics.

Whole grain consumption may influence insulin through beneficial effects on satiety and body weight, intestinal absorption, or the action of specific nutrients or constituents.We examined the associations of whole grain intake, assessed by a diet history interview at baseline (year 0) and year 7, with body mass index (BMI), waist-hip ratio (WHR), and fasting insulin in 3,627 Black and White adults in the Coronary Artery Risk Development in Young Adults Study (CARDIA). We estimated year 0 and year 7 cross-sectional associations accounting for correlation between years using repeated measures regression.After adjustment for age, education, energy intake, CARDIA field center, physical activity, alcohol consumption, and cigarette smoking, whole grain consumption was unrelated to WHR and inversely related to body mass index only in Whites at year 7. Whole grain consumption was inversely related to fasting insulin in Whites at year 0 and Black men and Whites at year 7. Mean differences for year 7 fasting insulin between the least vs. most frequent categories of whole grain consumption (0-2 vs.9 times/week) were 2.2, 1.0 and 1.0The independent inverse relationship between whole grain consumption and fasting insulin levels may have important public health implications in light of the low consumption of whole grains and the increasing prevalence of obesity and diabetes in the US.

Background Isotemporal substitution examines the effect on health outcomes of replacing sedentary time with light‐intensity physical activity or moderate‐to‐vigorous intensity physical activity; however, existing studies are limited by cross‐sectional study designs. Methods and Results Participants were 1922 adults from the CARDIA (Coronary Artery Risk Development in Young Adults) study. Linear regression examined the associations of sedentary, light‐intensity physical activity, and moderate‐to‐vigorous intensity physical activity at year 20 (2005–2006) with waist circumference, blood pressure, glucose, insulin, triglycerides, high‐density lipoprotein cholesterol, and a composite risk score at year 30 (2015–2016). Models then examined change in activity with change in cardiometabolic risk over the same 10‐year period. Replacing 30 min/day of sedentary time with 30 min/day of light‐intensity physical activity at year 20 was associated with a lower composite risk score (−0.01 SD [95% CI, −0.02, −0.00]) at year 30, characterized by lower waist circumference (0.15 cm [95% CI, −0.27, 0.02]), insulin (0.20 μU/mL [95% CI, −0.35, −0.04]), and higher high‐density lipoprotein cholesterol (0.20 mg/dL [95% CI, 0.00, 0.40]; all P MVPA from year 20 to year 30, when replacing an equivalent increase in sedentary time, was associated with a decrease in the composite risk score (−0.08 [95% CI, −0.13, −0.04]) over the same 10 years, characterized by a decrease in waist circumference (1.52 cm [95% CI, −2.21, −0.84]), insulin (−1.13 μU/mL [95% CI, −1.95, −0.31]), triglycerides (−6.92 mg/dL [95% CI, −11.69, −2.15]), and an increase in high‐density lipoprotein cholesterol (1.59 mg/dL [95% CI, 0.45, 2.73]; all P Conclusions Replacement of sedentary time with light‐intensity physical activity or moderate‐to‐vigorous intensity physical activity is associated with improved cardiometabolic health 10 years later.

The relationship between perceived neighborhood contentedness and physical activity was evaluated in the Add Health study population. Wave I includes 20,745 respondents (collected between 1994 and 1995) and wave II includes 14,738 (71 %) of these same students (collected in 1996). Multinomial logistic regression was used to evaluate this relationship in both wave I and wave II of the sample. Higher levels of Perceived Neighborhood Contentedness were associated with higher reports of physical activity in both males and females and in both waves. For every one-point increment in PNS, males were 1.3 times as likely to report being highly physically active than low (95 % CI 1.23–1.37) in wave 1 and 1.25 times as likely in wave 2 (95 % CI 1.17–1.33). Females were 1.17 (95 % CI 1.12–1.22) times as likely to report being highly active than low and 1.22 times as likely in wave 2 (95 % CI 1.17–1.27) with every one-point increment. PNC appears to be significantly associated with physical activity in adolescents. Involving the community in the development of intervention programs could help to raise the contentedness of adolescents in these communities.

Background: Growing evidence suggests that dairy products may have beneficial cardiometabolic effects. The current guidelines, however, limit the intake of full-fat dairy products. Objective: We investigated the association of dairy consumption, types of dairy products, and dairy fat content with metabolic syndrome (MetSyn). Methods:We analyzed baseline data of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of 15,105 adults aged 35‐74 y. We excluded participants with known diabetes, cardiovascular diseases, or other chronic diseases, and those who had extreme values of energy intake, leaving 9835 for analysis. Dairy consumption was assessed by a food-frequency questionnaire. We computed servings per day for total and subgroups of dairy intake. We computed a metabolic risk score (MetScore) as the mean z score of waist circumference, systolic blood pressure, HDL cholesterol (negative z score), fasting triglycerides, and fasting glucose. We performed multivariable linear regression to test the association of servings per day of dairy products with MetScore. Results: In analyses that adjusted for demographics, menopausal status, family history of diabetes, dietary intake, nondietary lifestyle factors, and body mass index, we observed a graded inverse association for MetScore with total dairy (20.044 6 0.01, P = 0.009 for each additional dairy servings per day) and full-fat dairy (20.126 6 0.03, P < 0.001) but not with low-fat dairy intake. Associations were no longer present after additional adjustments for dairy-derived saturated fatty acids. Conclusions: Total and especially full-fat dairy food intakes are inversely and independently associated with metabolic syndrome in middle-aged and older adults, associations that seem to be mediated by dairy saturated fatty acids. Dietary recommendations to avoid full-fat dairy intake are not supported by our findings. JN utrdoi: 10.3945/jn.115.220699.