OBJECTIVE:Obesity, defined by body mass index (BMI) ≥30 kg/m2, is a risk factor for functional limitations in people with knee osteoarthritis (OA). However, function varies among such individuals. Our objective was to evaluate the implications of obesity subtypes on longitudinal patterns of physical functioning in people with or at risk for knee OA. METHODS:We included participants from the Multicenter Osteoarthritis Study (MOST) with a BMI ≥30 kg/m2 and dual-energy x-ray absorptiometry-measured body composition. Three obesity subtypes were defined: (1) obesity with low muscle mass (OLM) and high fat mass; (2) obesity with cardiometabolic comorbidities (OCC) but without low muscle mass; and (3) uncomplicated obesity (UO), that is, neither OLM nor OCC. We examined the relation of these three obesity subtypes to self-reported Western Ontario and McMaster Osteoarthritis Index physical function at baseline and seven years using linear regression at both time points and to their longitudinal functional trajectory patterns using multinomial logistic regression. RESULTS:Of the baseline sample (N = 1,211 individuals, 63% female, mean age 61.2 ± SD 7.6 years, mean BMI 35.0 ± SD 4.5 kg/m2), 49.1% were UO, 34.4% OLM, and 16.5% OCC. Compared to UO, the OLM and OCC groups had worse physical function at baseline. Five distinct trajectories of functioning were identified over seven years, with 23%, 38.5%, 26%, 4.5%, and 8% of the sample in groups 1 to 5, respectively. Compared to UO, OLM and OCC groups had higher odds of being in the persistent poorest functioning trajectory (odds ratio 1.9, 2.6, respectively). CONCLUSION:Individuals with obesity and concurrent low muscle or cardiometabolic comorbidities have persistent worse functioning over a seven-year period compared to those with obesity alone. Distinguishing obesity subtypes may enable personalized interventions to delay or avoid extended mobility disability.

Objectives To understand the impact of lifestyle changes on osteoarthritis outcomes during the COVID-19 pandemic in a group of older Midwestern adults.Methods We conducted a cross-sectional mailed survey in May of 2022 among participants of the Multicenter Osteoarthritis Study (MOST) in participants that completed their prior clinic visit. We assessed the perceived changes in health behaviors and barriers/facilitators to healthy eating and physical activity from before to during the COVID-19 pandemic. We used a generalized estimating equation to model knee-level pain increase from a previous survey, as a function of demographic variables and changes in behavioral factors.Results We surveyed 502 MOST participants. There were significant differences in perceived health-related behaviors and barriers/facilitators to healthy eating and physical activity associated with knee-level pain increase during the COVID-19 pandemic. After multivariable-adjustment, increased knee-level pain was positively associated with previous frequent knee pain and use of weight control products.Conclusion Changes in perceived health-related behaviors and barriers/facilitators to healthy eating and physical activity, along with previous osteoarthritis disease status, may impact knee pain in older adults. These results may be informative to promote health among older adults with and without osteoarthritis during future times of generalized stress.

BACKGROUND AND OBJECTIVES:Urinary incontinence (UI) has not been examined in relation to perceptions of age discrimination (ageism). This study examined whether UI, absorbent product use, and confidence gained from absorbent product use are associated with ageism in later adulthood. RESEARCH DESIGN AND METHODS:Cross-sectional data were collected from 680 community-dwelling female and male participants. Participants were aged 55-73 years; 62% were women. In 2023-2024, UI, absorbent product use, confidence gained from absorbent product use, and ageism were assessed. Ageism variables (frequency across 7 settings, number of settings, perceived stress of discrimination) were regressed on frequency and severity of UI, absorbent product use frequency, and (among those who used absorbent products) confidence gained from product use. Covariates included age, gender, race, and education. RESULTS:A one standard deviation (SD) greater frequency of UI (Beta = 0.25, 95% CI = 0.18, 0.33), severity of UI (Beta = 0.19, 95% CI = 0.12, 0.27), and frequency of absorbent product use (Beta = 0.12, 95% CI = 0.04, 0.20) were each associated with more frequent exposure to age discrimination across settings. A similar pattern was observed for the number of settings in which participants experienced age discrimination. Frequency and severity of UI and absorbent product use frequency were not associated with perceived stress of discrimination. Confidence gained from absorbent product use was not associated with ageism variables. DISCUSSION AND IMPLICATIONS:Longitudinal research is needed to test whether UI-related characteristics are prospectively associated with ageism. Programs and policies are needed to address discriminatory behaviors toward aging individuals in different settings.

OBJECTIVE:We examined the extent to which fat mass may contribute to the risk of incident radiographic knee osteoarthritis (ROA) beyond body weight alone. METHODS:Participants from the Multicenter Osteoarthritis (MOST) Study with DXA body composition and no ROA in ≥1 knee at baseline were included. Incident ROA (KL grade ≥2 or knee replacement) was assessed at 7 years. We created sex-specific weight categories (<70,70-79.9,80-89.9, ≥90 kg in females, <90,90-99.9, ≥100 kg in males), computed % fat mass quartiles, and then evaluated the relation between quartiles (lowest as referent) to risk of ROA in each weight category. We then scaled and standardized % fat mass in a combined model to assess the overall relationship between relative fat mass and ROA risk. RESULTS:We included 1611 individuals (60% female, mean age 61.7 years, BMI 29.6 kg/m2, 2646 knees). Incident ROA developed in 27.6% of knees after 7 years. In females only, risk for ROA increased in those with the highest % fat mass relative to lowest in their weight category (Q4 vs Q1, RR 1.29, 95% CI 1.02, 1.64). Spline analyses identified a J- or U-shaped pattern of % fat mass on incident ROA in females and males, with predicted probabilities only differing by 10-20% across the fat mass percentiles. CONCLUSIONS:A higher relative fat mass did not influence increased risk of incident ROA in males, but there was a potential threshold effect in females. Overall, total body mass (weight) appears to be driving risk for ROA rather than a distinct influence of relative fat mass.

Prevalence of metabolic syndrome (MetS) defined as 3 or more cardiometabolic risk factors has grown to 43% among US adults. Lifestyle interventions produce benefits, but with limited sustainability. To determine whether a 6-month habit-based lifestyle program adds benefit to education and activity monitoring for sustained MetS remission at 24 months. The Enhancing Lifestyles in Metabolic Syndrome (ELM) study was a single-blind, individually randomized clinical trial of participants with MetS recruited from July 2019 to January 2022 at 5 locations in the US and followed up for 24 months. Eligible participants were motivated for lifestyle change and were contacted using electronic medical records and social or mass media; those who did not meet medical or logistical criteria were excluded. In all, 14 817 adults were screened during a 2.5 year period. Data were analyzed from March 2024 to May 2025. All participants received education and an activity monitor. Those in the intervention group also received 19 small group in-person meetings during 6 months, which sought to establish the following habits as part of their daily routine: vegetables at meals, brisk walks, sensory awareness, and emotion regulation. Repetition of these habits was encouraged by attention to participants’ experience of immediate benefits and peer support. The comparator group received 24 evidence-based educational mailings monthly during the 24 months. MetS remission at 24 months determined by blinded laboratory evaluation and clinical examination. Secondary outcomes were cardiometabolic and lifestyle risk factors at 6 and 24 months. The analysis included 618 participants (mean [SD] age, 55.5 [11.0] years; 468 female [74.7%] and 150 male [24.3%] individuals), of whom 306 (49.5%) were randomized to the intervention and 312 (50.5%) to the comparator. The 24-month follow-up period was completed by 517 participants (83.7%). Obesity, measured by body mass index, was present in 513 participants (83%). At 6 months, the proportion achieving MetS remission was 24.8% in intervention group and 17.9% in comparator (adjusted odds ratio, 1.64; 95% CI, 1.07-2.53; P = .03), supported by improvements in waist circumference, triglycerides, fasting glucose, body mass index, weight, hemoglobin A 1c , MetS severity, perceived stress, vegetable intake, moderate-intensity physical activity, daily steps, sensory awareness, and the habits of daily brisk walks and vegetables at meals. At 24 months, the proportion achieving sustained MetS remission was 27.8% (85 of 306 participants) in intervention group and 21.2% (66 of 312) in the comparator (adjusted odds ratio, 1.46; 95% CI, 1.01-2.14; P < .05), supported by sustained improvement in fasting glucose, vegetable intake, daily steps, sensory awareness, and the habit of daily brisk walks. This randomized clinical trial found that sustained MetS remission after treatment may be possible by promoting simple habits through a behavior-based lifestyle program focused on immediate benefits. ClinicalTrials.gov Identifier: NCT04036006

BACKGROUND AND OBJECTIVES:Depressive symptoms (DS) are associated with lower physical function among older adults, and similar associations have been shown in middle-aged adults. However, studies have overlooked the role of antidepressant medications. METHODS:We conducted a cross-sectional analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Function study. Analysis included measured physical performance and self-reported function. Elevated DS were defined by the Center of Epidemiological Studies Depression (CESD) as ≥16. Participants were grouped by level of DS (DS-: <16, DS+: ≥16) and antidepressant use (med-: none, med+: any) into one of four categories: DS-/med-, DS-/med+, DS+/med-, and DS+/med+. Multiple linear regression was used to examine associations between DS and antidepressant use with physical function in middle age. RESULTS:Participants (n = 2021; 60 ± 4 years, 58.1% female, 44.4% Black race) were categorized to the DS/medication groups as follows: DS-/med-: 73.8%, DS-/med+: 8.3%, DS+/med-: 11.9%, and DS+/med+: 6.0%. Both physical performance and self-reported function scores were highest in the DS-/med- group. Compared to the DS-/med- group (reference), regression coefficients in the fully adjusted model for performance score were -0.73, -0.94, and -0.47 in the DS-/med+, DS+/med-, and DS+/med+ groups, respectively (all p < 0.01, except the DS+/med + group). Compared to the DS-/med- group, regression coefficients in the fully adjusted model for self-reported function score were -1.95, -3.86, and -4.91 in the DS-/med+, DS+/med-, and DS+/med+ groups, respectively (all p < 0.01). CONCLUSIONS:Compared to individuals with low/no DS and no antidepressant medication use all other groups had lower physical performance and self-reported physical function.

BACKGROUND:Assessing maximal oxygen consumption (VO2max), the gold standard for assessing cardiorespiratory fitness, is often impractical in large-scale studies. We derived sex-specific VO2 max and graded exercise test duration (GXTd) prediction equations from 6-minute walk test (6MWT) performance. METHODS:Data were from 564 Coronary Artery Risk Development in Young Adults (CARDIA) participants (mean age: 61.5 years; 58% women; 40% Black) who completed the 6MWT and symptom-limited modified Balke treadmill graded exercise test at the Year 35 (2021-2022) follow-up exam. Sex-stratified samples were randomly split (2/3 for training, 1/3 for testing) to derive and evaluate prediction equations. Stepwise linear regression identified predictors of VO2max and GXTd from 6MWT distance. Sex-specific VO2max CARDIA equations were compared with Burr and FRIEND equations. Models' accuracies were evaluated by comparing the predicted values to measured values using Student's t-test and Pearson correlation coefficients (r). Bland-Altman plots used to evaluate agreement between measured and predicted values. RESULTS:Sex-specific VO2max CARDIA equations explained 53% and 57% of the variance in men and women, respectively, with strong correlations between measured and predicted values (r = 0.73 and 0.78). The Burr and FRIEND equations showed larger biases and weaker correlations compared with the CARDIA equations. The GXTd equations explained 59% and 62% of the variance in men and women, with strong correlations (r = 0.71 and 0.72) and no significant mean differences between observed and predicted. CONCLUSIONS:The CARDIA prediction equations for VO2max and GXTd from 6MWT enhance accuracy and accessibility, providing a practical tool for large-scale studies and clinical assessments, particularly in aging populations.

Background Historical data indicate men develop coronary heart disease (CHD) 10 years before women. However, whether this sex gap persists in a contemporary sample amid changing cardiometabolic risk profiles, and whether differences exist for other cardiovascular disease (CVD) subtypes (ie, stroke, heart failure), is not known. Methods Data are from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective multicenter cohort study. US adults aged 18 to 30 years enrolled in 1985 to 1986 and were followed through August 2020. Sex differences in the cumulative incidence functions of premature CVD (onset <65 years), overall and for each subtype (CHD, heart failure, stroke), were compared using Gray’s test. Results Among 5112 participants (54.5% female, 51.6% Black) with a mean age of 24.8 years (SD: 3.7) at enrollment and a median follow‐up of 34.1 years (interquartile range, 33.8–35.7), men had a significantly higher cumulative incidence of CVD, CHD, and heart failure (P<0.05 for all), with no difference in stroke (P=0.63). Men reached 5% incidence of CVD 7.0 years earlier than women (50.5 versus 57.5 years, P<0.001). CHD was the most frequent CVD subtype, and men reached 2% incidence 10.1 years earlier than women (P<0.001). Men and women reached 2% stroke and 1% heart failure incidence at similar ages. Ten‐year CVD event rates diverged at an index age of 35. Conclusions Men developed CVD earlier than women, with the greatest difference observed for CHD. Sex differences in CVD risk emerged at age 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health.

Background Disrupted circadian rhythms are associated with cardiometabolic disease. We examined associations between rest‐activity rhythms and cardiometabolic disease by race. Methods In cross‐sectional analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) sleep ancillary study (2020–2023), 861 participants wore wrist actigraphy for 7 days. Sleep Regularity Index and rest‐activity rhythm measures were calculated: interdaily stability, intradaily variability, relative amplitude, and most active 10‐hour and least active 5‐hour period start times. Cardiometabolic disease markers included body mass index, waist circumference, blood pressure, hypertension, fasting glucose, estimated insulin resistance, and diabetes. Linear regression models with interaction terms evaluated effect modification by race. Results Among 354 Black and 507 White participants, the most consistent associations were between anthropometric markers and rest‐activity rhythms. Except for most active 10‐hour start, remaining indices and Sleep Regularity Index were associated with body mass index with β coefficients ranging from −1.74 to 0.86, consistent with our hypothesis that weaker rest‐activity rhythms relate to larger body mass index. There was some effect modification by race (P<0.01), with relative amplitude showing stronger associations with body mass index in White (β=−2.63 [95% CI, −3.34 to −1.93]) versus Black (β=−1.24 [95% CI, −1.97 to −0.50]) participants. Patterns, including effect modification for relative amplitude, were similar for waist circumference. Disrupted circadian indices were associated with glycemic markers, with findings generally consistent by race. Associations between rest‐activity rhythms and blood pressure were less consistent overall and by race. Conclusions Less robust rest‐activity rhythms and irregular sleep were associated with less favorable anthropometric and glycemic markers but weakly associated with blood pressure, with few racial differences.

OBJECTIVES:Work environments have received little attention as a potential determinant of lower urinary tract symptoms (LUTS). A small literature among women, and an even smaller literature among men, suggests that occupations with manual labor demands are associated with greater likelihood of experiencing LUTS. Job strain, defined as low decision latitude in combination with high psychological demands, was found not to be associated with LUTS in one sample of women. Associations of occupation and job strain with LUTS among men were examined using Coronary Artery Risk Development in Young Adults cohort study data. METHODS:Occupation was assessed 7 times beginning when men were aged 18-30 years (1985-1986 through 2005-2006). Job strain and its components (psychological job demands, decision latitude) were assessed in 1987-1988 and 1995-1996. In 2012-2013, LUTS were assessed. LUTS category (severe or moderate versus mild or none) was regressed on job strain and occupation variables in separate analyses, adjusting for age, race, and self-reported benign prostatic hyperplasia (BPH) (n = 858). RESULTS:Differences in LUTS and job characteristics were observed between Black and White men. Neither job strain nor occupation were associated with men's LUTS, both before and after adjustment for BPH. CONCLUSIONS:Among this population-based sample of United States men, assessed aspects of occupations across early and midlife adulthood were not associated with men's LUTS at midlife. This is in contrast to some population-based research on occupations among Chinese and Korean men. Additional research is needed to understand whether specific occupations and work characteristics are associated with men's LUTS.

STUDY OBJECTIVES:To determine the degree to which clinical, psychosocial, and lifestyle factors are associated with racial disparities in sleep health. METHODS:The sleep ancillary to the Coronary Artery Risk Development in Young Adults (CARDIA) study included 7 days of wrist actigraphy, home sleep apnea testing, and questionnaires. The CARDIA study collected clinical (body mass index, hypertension, diabetes, cardiovascular disease, heart failure, chronic kidney disease), psychosocial (education, household size, depressive symptoms), and lifestyle (smoking, alcohol, physical activity) information in black and white adults over 35 years. Sleep characteristics included: sleep duration, sleep percentage, fragmentation, sleep timing, sleep regularity, rest activity rhythms, insomnia severity, and sleep apnea (apnea-hypopnea index ≥15). In cross-sectional and longitudinal analyses, we calculated how much the racial difference in sleep was reduced after adjusting for each risk factor domain (expressed as % reduction). RESULTS:There were 899 participants aged 53-69 years; 41 per cent were black and 63.4 per cent were women. Most sleep characteristics were significantly worse in the black participants. In cross-sectional analyses, the clinical domain resulted in the largest reduction in racial differences, ranging from 4.2 per cent for sleep duration to 118.9 per cent for sleep apnea. In longitudinal analyses, the clinical domain resulted in the largest reduction in racial differences, ranging from 5.2 per cent to 65.5 per cent. Psychosocial factor adjustment had largest reduction in racial differences in sleep percentage (by 17.8 per cent) and sleep regularity (by 23.4 per cent). CONCLUSIONS:These findings suggest that clinical and to a lesser degree psychosocial domains should be the foci of future work aimed at understanding and ultimately reducing racial sleep disparities. Statement of Significance Research describes poorer sleep health among black adults compared to white adults in the United States. We aimed to identify whether clinical, psychosocial, and lifestyle characteristics were associated with racial sleep disparities in an observational study of 899 adults aged 53-69 years. We included several dimensions of sleep based on wrist actigraphy and a home sleep apnea test. The clinical characteristics were associated with the largest reduction in racial differences in sleep health, suggesting that health-related factors may account for some racial differences in sleep. Psychosocial factors, such as education, household size, and depressive symptoms, were also associated with racial differences in some sleep measures. Future research should test whether improvements in these domains can improve sleep heath and reduce disparities.

Marginalized individuals like sexual and gender minority (SGM) people may experience accelerated biologic aging due to stigma and structural discrimination. We used Coronary Artery Risk Development in Young Adults (CARDIA) cohort data to assess this hypothesis. We first identified SGM individuals using Year 35 sexual orientation and gender identity data, then compared Year 15 (2000-01) or 20 (Y20, 2005-06) epigenetic aging biomarkers between SGM and straight cisgender participants using linear models adjusting for socio-demographics and behavior. Epigenetic markers included intrinsic epigenetic aging acceleration (IEAA), extrinsic EAA, PhenoAge acceleration, and GrimAge acceleration. Our sample (n = 817) was 18.4% SGM. SGM and straight cisgender participants had similar age, sex, and race distributions. Unadjusted and adjusted analyses showed no significant differences between groups except for SGM adults having higher Y20 IEAA in adjusted models compared to straight cisgender adults. Longitudinal models also showed higher rate of change in IEAA in SGM adults. Given the potential of selection bias driving significant results, we used simulations to explore which scenarios can produce observed findings. Our simulations suggest that the observed Y20 IEAA difference is unlikely if there was indeed no disparity. It is also possible that the estimate was an underestimate of the true disparity due to selection from differential survival between the two groups. Our analysis showed no strong evidence of accelerated aging in SGM. Future studies to address limitations are needed.

OBJECTIVE:Current evidence has demonstrated associations of vasomotor symptoms (VMS) with cardiovascular disease risk factors and subclinical atherosclerosis. However, the relationship between VMS and incident heart failure (HF) is unknown. We evaluated the associations of VMS occurrence over the study duration and VMS intensity at baseline with incident HF in a large cohort of middle-aged Black and White women. METHODS:We included 2,026 middle-aged Black and White women from the Coronary Artery Risk Development in Young Adults study who participated in the 2000-2001 study exam (baseline). VMS intensity was categorized as moderate-to-severe for participants who reported VMS that bothered or limited their activities a lot, and mild for those who reported VMS that bothered or limited their activities a little or not at all. HF events were recorded till the end of follow-up in 2022. Cox proportional hazards models were used for analysis. RESULTS:The mean (SD) age of participants was 40.2 (3.7) years. Out of 518 women who experienced VMS at baseline, 107 reported moderate-to-severe VMS. Thirty-two women developed fatal or nonfatal HF over a median (IQR) follow-up of 22.8 (22.5-23.0) years. Neither VMS occurrence during follow-up, moderate-to-severe or mild VMS intensity at baseline were significantly associated with HF incidence, hazard ratios (95% CI): 0.58 (0.23-1.42), 0.62 (0.17-2.25) and 0.45 (0.12-1.69), respectively. However, our analysis was limited by a few HF events, which restricted our ability to make definite conclusions. CONCLUSION:VMS occurrence and VMS intensity were not significantly associated with HF incidence among middle-aged women, possibly due to limited statistical power.

Background The rate of hypertension hospitalizations is increasing among US adults. Individuals with low socioeconomic position are more likely to have high blood pressure (BP), which may increase their risk of hypertension hospitalization and adverse post-discharge outcomes. Methods We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which enrolled 5115 adults aged 18 to 30 years from 4 urban US communities in 1985-1986. Hospitalizations were identified by self-report during study exams and annual interviews, with hypertension hospitalizations determined through medical record review, through August 2020. Socioeconomic position included education, family income, having private health insurance, and neighborhood deprivation assessed at the last study visit prior to the hypertension hospitalization. Uncontrolled BP (≥140/90 mmHg) was determined at the first CARDIA study visit after hypertension hospitalization. Results Overall, 67 CARDIA participants were hospitalized for hypertension. The hazard ratio of hypertension hospitalization among participants who had less than high school vs high school or more education was 3.12 [95% CI, 1.78-5.48], whose family income was <$25,000 vs ≥$25,000 was 2.43 [95% CI, 1.44-4.11], who had no private vs private insurance was 2.58 [95% CI, 1.56-4.28] and those in tertile 3 vs tertile 1 of neighborhood deprivation index (most vs least deprived) was 3.06 [95% CI, 1.23-7.58]. Among 46 participants who attended a CARDIA study visit following hospital discharge, 23 (50%) had uncontrolled BP. Conclusion Adults with low socioeconomic position were more likely to be hospitalized for hypertension. Uncontrolled BP was common following hypertension hospitalization.

To identify unique trajectories of reproductive events across the life course and determine if childhood socioeconomic position (SEP) or childhood maltreatment, independently or jointly, are associated with trajectory membership. We used data from the Coronary Artery Risk Development in Young Adults study (n = 2787). We fit group-based trajectory models for self-reported reproductive events (complicated/uncomplicated pregnancies, irregular menses, contraceptive use) to assign individuals to a reproductive events trajectory. We determined associations with self-reported childhood maltreatment and childhood SEP and their interactions using Poisson regression with robust standard errors controlling for baseline age and self-reported race (Black or White). We identified 3 trajectories (n1 = 1039; n2 = 778; n3 = 970). Group 3 had the youngest age at first pregnancy (mean 20.3 years vs. 28.3 and 31.7 for groups 2 and 1, respectively), highest parity, and lowest risk of complications. Individuals reporting childhood maltreatment and low SEP had 1.48 times the risk of belonging to group 3 versus group 2 (1.48 (1.28, 1.71) compared to those reporting neither. Childhood maltreatment and low childhood SEP were both associated with belonging to an earlier childbearing group.