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The Balance Study is a randomized controlled trial designed to reduce cardiovascular disease (CVD) risk in 200 American Indian (AI) participants with metabolic syndrome who reside in southwestern Oklahoma. Major risk factors targeted include weight, diet, and physical activity. Participants are assigned randomly to one of two groups, a guided or a self-managed group. The guided group attends intervention meetings that comprise education and experience with the following components: diet, exercise, AI culture, and attention to emotional wellbeing. The self-managed group receives printed CVD prevention materials that are generally available. The duration of the intervention is 24 months. Several outcome variables will be compared between the two groups to assess the effectiveness of the intervention program.

BACKGROUND: Cadmium (Cd) is a toxic metal classified as a human carcinogen by the International Agency for Research on Cancer. OBJECTIVE: We evaluated the association of long-term Cd exposure, as measured in urine, with cancer mortality in American Indians from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study during 1989-1991. METHODS: The Strong Heart Study was a prospective cohort study of 3,792 men and women 45-74 years of age who were followed for up to 20 years. Baseline urinary Cd (U-Cd) was measured using inductively coupled plasma mass spectrometry. We assessed cancer events by annual mortality surveillance. RESULTS: The median (interquintile range) U-Cd concentration was 0.93 (0.55, 1.63) Hg/g creatinine. After adjusting for sex, age, smoking status, cigarette pack-years, and body mass index, the adjusted hazard ratios (HRs) comparing the 80th versus the 20th percentiles of U-Cd were 1.30 (95% CI: 1.09, 1.55) for total cancer, 2.27 (95% CI: 1.58, 3.27) for lung cancer, and 2.40 (95% CI: 1.39, 4.17) for pancreatic cancer mortality. For all smoking-related cancers combined, the corresponding HR was 1.56 (95% CI: 1.24, 1.96). Cd was not significantly associated with liver, esophagus and stomach, colon and rectum, breast, prostate, kidney, or lymphatic and hematopoietic cancer mortality. On the basis of mediation analysis, we estimated that the percentage of lung cancer deaths due to tobacco smoking that could be attributed to Cd exposure was 9.0% (95% CI: 2.8, 21.8). CONCLUSIONS: Low-to-moderate Cd exposure was prospectively associated with total cancer mortality and with mortality from cancers of the lung and pancreas. The implementation of population-based preventive measures to decrease Cd exposure could contribute to reducing the burden of cancer. CITATION: Garcia-Esquinas E, Pollan M, Tellez-Plaza M, Francesconi KA, Goessler W, Guallar E, Umans JG, Yeh J, Best LG, Navas-Acien A. 2014. Cadmium exposure and cancer mortality in a prospective cohort: the Strong Heart Study. Environ Health Perspect 122:363-370; http://dx.doi. org/10.1289/ehp.1306587, Introduction Cadmium (Cd) is a widespread metal that is highly toxic to humans. Cd pollution in soil, air, and water is ubiquitous because of Cd use in industrial products (e.g., [...]

Inflammation may play a role in increased risk of heart failure (HF) that is associated with obesity, metabolic syndrome (MS), and diabetes. This study investigated associations between inflammatory markers, MS, and incident HF in a population with a high prevalence of diabetes, obesity, and MS. The cohort consisted of 3098 American Indians without prevalent cardiovascular disease who had C-reactive protein (CRP) and fibrinogen measured at the Strong Heart Study phase II examination. Independent associations between inflammatory markers, MS, and HF were analyzed by Cox hazard models. During a mean follow-up of 11 years, 218 participants developed HF. After the adjustment for cardiovascular risk factors, fibrinogen, (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.15-1.59) but not CRP (HR, 1.25; 95% CI, 0.97-1.32) remained a significant HF predictor. In individuals without diabetes, concomitant presence of MS and elevated CRP or fibrinogen increased HF risk (for MS and CRP: HR, 2.02; 95% CI, 0.95-4.31; for CRP and fibrinogen: HR, 1.75; 95% CI, 0.83-3.72). In a population with a high prevalence of obesity, MS, and diabetes, elevated CRP and fibrinogen increased HF risk. These associations are attenuated by the adjustments for conventional risk factors suggesting that inflammation acts in concert with metabolic and clinical risk factors in increasing HF risk. [ABSTRACT FROM AUTHOR]

Determines body fat percentage estimates using an inexpensive bioelectrical impedance analysis device in the United States. Importance of body composition analysis in health-related physical fitness test battery; Use of field methods for estimating body composition; Correlation of skinfold-derived body fat percentage with densitometry.

Community mortality surveillance for 1984–1988 was conducted by researchers of the StrongHeart Study, which examined the incidence, prevalence, and risk factors of cardiovascular disease in three American Indian populations, aged 45–74 years, in Arizona, Oklahoma, and South/North Dakota. All-cause and cardiovascular disease mortality rates were determined through the useof death certificate data. Cardiovascular disease deaths were confirmed by independent systematic review of medical records. In all three populations, men had higher all-cause and cardiovascular disease mortality rates than did women. Oklahoma exhibited slightly lower 5-year, age-adjusted, all-cause mortality (96/1,000) than did Arizona (107/1,000) and South/North Dakota (114/1,000). The leading cause of death among both sexes in Oklahoma and in South/North Dakota was cardiovascular disease. Diabetes mellitus led among Arizona women. The other major causes of death were cancer, liver disease including cirrhosis, and injury. When compared with the rates in each state, average annual all-cause mortality rates were higher for the American Indian populations in almost every age group. The all-cause annual mortality rates in the three Indian populations were close to rates in the US black population and higher than the rates of the entire US population and of US whites. This trend was amplified in the 45-to 64-year age group. Only in the 65- to 74-year age group did mortality rates in the Indian population approach those of the US population.Cardiovascular disease mortality rates were close to the US averages in Arizona and Oklahoma, but they were more than two times higher in South/North Dakota among those between 45 and 64 yearsof age. Thus, American Indians in Arizona, Oklahoma, and South/North Dakota exhibit high all-cause mortality rates. In particular, the South/North Dakota population cardiovascular disease death rate appears to present a potential target for community-based programs to intervene on known risk factors to promote healthy lifestyles. Am J Epidemiol 1998; 147:995–1008. [ABSTRACT FROM PUBLISHER]

Background: American Indians have a very high prevalence of metabolic syndrome that increases their risk of developing cardiovascular disease and type 2 diabetes. Dietary habits are of central importance in the prevention and treatment of metabolic syndrome., Objective: The main objective of this article was to describe dietary intake among American Indians with metabolic syndrome and compare it to several dietary recommendations. A secondary objective was to identify certain barriers to dietary adherence experienced by this population., Methods: A total of 213 participants with metabolic syndrome were enrolled in the Balance Study, a randomized controlled trial with two intervention groups: Guided Group and Self-Managed Group. Dietary intake was assessed using the Block Food Frequency questionnaire. Dietary intakes were evaluated against the Dietary Guidelines for Americans., Results: Intakes of saturated fats, cholesterol, and sodium were higher and intakes of dietary fiber, calcium, magnesium, potassium, vitamin A, vitamin D, and vitamin E were lower than recommended. Additionally, intake of many food groups was noticeably low. Economic factors seem to be related to low adherence to dietary recommendations., Conclusion: Results showed low adherence by the participants to dietary recommendations for key nutrients and food groups related to risk factors for metabolic syndrome, type 2 diabetes, and cardiovascular disease. Economic factors are related to this low adherence. These findings illustrate a need to develop innovative, focused, and perhaps individualized health promotion strategies that can improve dietary habits of American Indians with metabolic syndrome.