Background:Life's Essential 8 (LE8) provides a framework to assess and improve cardiovascular health, ultimately reducing cardiovascular disease (CVD) risk. However, the role of LE8 metrics in addressing CVD disparities associated with social determinants of health (SDoH) remains unclear. Methods:This cohort study employed the National Health and Nutrition Examination Survey (2005-2018) data. Logistic regression models, Cox proportional hazard models, and multiple mediation analysis were used to assess the associations of the SDoH score with CVD morbidity (self-reported diagnosis of congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, and stroke), CVD mortality, and mortality (mortality data were derived from the NHANES Public-Use Linked Mortality File), as well as the contributions of LE8 metrics to the associations. Results:The top four reported unfavorable SDoH were low education level (21.5%), income-to-poverty ratio <3 (17.5%), no private health insurance (13.0%), and unemployment (11.5%). Unfavorable SDoH exposure was associated with higher CVD morbidity [odds ratio (OR) and 95% confidence interval (CI): 2.36 (2.18, 2.55) and CVD mortality [hazard ratio (HR) and 95%CI: 2.70 (2.24, 3.24)]. LE8 metrics accounted for approximately 30.4% (95%CI: 26.2%, 34.7%), 23.0% (95%CI: 19.3%, 28.3%), and 24.0% (95%CI: 20.6%, 28.8%) of the association between SDoH and CVD morbidity, CVD mortality, and all-cause mortality, respectively, with nicotine exposure, physical activity, and sleep health being the main LE8 contributors. Differences in the distribution of SDoH components, as well as the contribution of LE8 to the association between SDoH and CVD risk were observed across race/ethnicity groups. Conclusions:Our findings highlight the effectiveness for public health interventions targeting SDoH to improve LE8 metrics and ultimately reducing CVD morbidity and mortality. Future research should also explore the impact of non-LE8 factors and racial/ethnic differences in developing comprehensive CVD prevention strategies among U.S. adults.

BACKGROUND:Early introduction of allergenic foods to infants starting 4-6-months of age has been shown to effectively prevent the development of food allergies. This project examines the practices and barriers among parents and caregivers toward feeding infants allergenic foods. METHODS:A cross-sectional online survey was conducted from January to March 2024 with primary focus on the Midwest area of the United States. The survey was advertised through local health departments and social media platforms. Parental practices on feeding allergenic foods to their infants, as well as perceived barriers were collected. Descriptive and inferential statistical analyses were used to summarize participant demographics, parental willingness and feelings toward allergenic food introduction, and the actual practices. Thematic analysis was employed to identify qualitative data such as parental concerns and barriers. RESULTS:The study included 563 valid responses from parents and caregivers of children aged 5 years or younger. The surveyed infants were predominantly white (84.9%) and female (58.1%), with a mean age of 7.5 months. Among families who had introduced solid foods to their infants (n = 529), eggs (72%) and wheat (63%) had the highest introduction rates by age one, while shellfish (44%) and sesame (52%) had the lowest. Only 55.9% of families reported receiving guidance from healthcare providers on allergenic food introduction. Thematic analysis revealed concerns about inconsistent advice, fear of allergic reactions, cultural beliefs, social media influence, and safety concerns such as choking hazards and inconsistent allergen labeling. CONCLUSION:Parents and caregivers exhibited caution in feeding allergenic foods to their infants by age one. Barriers included lack of awareness, cultural practices, conflicting guidance, and social media influences.

Exposure to ambient fine particulate matter (PM2.5) was found to produce vascular injury, possibly by activating platelets within days after exposure. The aim of this study was to investigate the modulatory effects of dietary saturated fatty acids on platelet mitochondrial respiratory parameters following short-term inhalational exposure to PM2.5. A total of 22 healthy male volunteers were recruited from the Research Triangle area of North Carolina. Platelets were isolated from fresh whole blood samples and mitochondrial respiratory parameters were measured using an extracellular flux analyzer. Intake of saturated fat was averaged from multiple 24-hr dietary recalls. Daily ambient PM2.5 concentrations were obtained from ambient air quality monitoring stations. Correlation and ANOVA were used in data analyses, along with the pick-a-point method and the Johnson-Neyman technique for probing moderation. After controlling for age and omega-3 index, the intake of dietary saturated fatty acids after reaching 9.3% or higher of the total caloric intake significantly moderated the associations between PM2.5 exposure and several platelet mitochondrial respiratory parameters. In conclusion, dietary saturated fatty acids above 9.3% of total caloric intake influenced the relationship between short-term PM2.5 exposure and platelet mitochondrial respiration. Further research is needed to understand these associations and their implications for cardiovascular health.

Background:A newly developed omega-3 questionnaire (O3Q) designed to capture habitual intakes of omega-3 fatty acids was previously validated based on the whole blood levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and Omega-3 Index, but lacks comparison with existing "gold standard" dietary tools. Objective:To compare the estimated habitual intakes of omega-3 fatty acids from three dietary assessment tools including O3Q and two other commonly used methods (24-hour recall and Diet History Questionnaire). Methods:A correlational study of estimated omega-3 intakes from the O3Q, multiple 24-hour recalls, and Diet History Questionnaire collected from an observational study (n = 49) were compared to corresponding whole blood levels of EPA, DHA, and Omega-3 Index. The 49 participants included in this study completed the O3Q, Diet History Questionnaire, and at least one 24-hour recall during the observational study. Any incomplete data sets (missing one of the three kinds of dietary assessments) were excluded. Spearman's correlation evaluated the relationship between estimated omega-3 intake from each diet assessment method and biomarkers. Stepwise multiple linear regression examined associations of estimated dietary intakes of EPA+DHA from the three intake methods and the Omega-3 Index level. Results:The estimated intakes from the O3Q had higher correlation coefficients with the corresponding blood biomarkers (EPA, rs=0.75; DHA, rs=0.74; Omega-3 Index, rs=0.77; p <0.001 for all) compared to the DHQ (EPA, rs=0.53; DHA, rs=0.41; Omega-3 Index, rs=0.45; p <0.001 for all) and 24 hr diet recall (EPA, rs=0.61; DHA, rs=0.45; Omega-3 Index, rs=0.55; p <0.001 for all). The regression analysis only demonstrated the O3Q as the significant dietary assessment predictor of the Omega 3-Index level (β = 0.66, p <0.001). Conclusions:The O3Q is the preferred tool to evaluate habitual Omega-3 fatty acids intake and estimate Omega-3 index and outperforms using multiple 24-hour recalls or the Diet History Questionnaire for these specific dietary variables.

Rationale: Exposure to air pollution is associated with adverse respiratory effects. Polyunsaturated omega 3 (n-3) fatty acids (FAs) appear to attenuate the health effects of air pollution. Objectives: This panel study evaluated whether n-3 FA intake and blood levels of polyunsaturated omega 6 (n-6) FAs can modulate the associations between respiratory effects and short-term exposure to ambient air pollution in healthy adults. Methods: Sixty-two healthy adults were enrolled into either high or low n-3 FA groups on the basis of n-3 FA intake and erythrocyte n-3 FA concentrations. Low and high n-6 FA groups were dichotomized on the basis of blood n-6 FA levels. Participants underwent three to five testing sessions separated by at least 7 days. At each session, the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and plasma markers of inflammation (IL-6 [interleukin-6]) and oxidative stress (ox-LDL [oxidized low-density lipoprotein]) were measured. Associations between the ambient ozone and fine particulate matter (PM) (PM with an aerodynamic diameter <= 2.5 mu m [PM2.5]) levels and the lung function and blood markers were assessed by using mixed-effect models stratified by FA levels. Results: Average levels of ozone (40.8 +/- 11.1 ppb) and PM(2.)5 (10.2 +/- 4.1 mu g/m(3)) were below national ambient air quality standards during the study period. FVC was positively associated with ozone at a lag of 0 days (lag0) in the high n-3 FA group, whereas the association was null in the low n-3 FA group (for an interquartile range increase in ozone of 1.8% [95% confidence interval (CI): 0.5% to 3.2%] vs. 0.0% [95% CI: 21.4% to 1.5%]); however, the association shifted to being negative at lag4 (21.9% [95% CI: 23.2 to 20.5] vs. 0.2% [95% CI: 21.2% to 1.5%]) and lag5 (21.2% [95% CI: 22.4% to 0.0%] vs. 0.9% [95% CI: 20.4% to 2.3%]). A similar pattern was observed in the low n-6 FA group compared with the high n-6 FA group (lag0: 1.7% [95% CI: 0.3% to 3.0%] vs. 0.5% [95% CI: 20.9% to 2.0%] and lag4: 21.4% [95% CI: 22.8% to 0.0%] vs. 20.5% [95% CI: 21.8% to 0.9%]). The associations between FEV1 and ozone and between FVC and PM2.5 also followed a similar pattern. Elevated ozone levels were associated with an immediate decrease in ox-LDL in the high n-3 FA group at lag0 (-12.3% [95% CI: -24.8% to 0.1%]), whereas therewas no change in the lown-3 FAgroup (-7.5% [95% CI: -21.4% to 6.5%]) and there was a delayed increase in IL-6 in the high n-3 FA group compared with the low n-3 FA group (lag4: 66.9% [95% CI: 27.9% to 106.0%] vs. 8.9% [95% CI: -31.8% to 49.6%], lag5: 58.2% [95% CI: 22.4% to 94.1%] vs. -7.4% [95% CI: -48.8% to 34.0%], and lag6: 45.8% [95% CI: 8.7% to 82.9%] vs. -8.5% [95% CI: -49.7% to 32.6%]). Conclusions: We observed lag-dependent associations between short-term ambient air pollutants and lung function that were differentially modulated by n-3 and n-6 FAs, suggesting that n-3 and n-6 FAs counteract the respiratory response to low levels of ambient air pollution in healthy adults.

Background: Obesity is a growing epidemic among university students, and the high levels of stress reported by this population could contribute to this issue. Singular relationships between perceived stress; engagement in restrained, uncontrolled, and emotional eating; sleep; dietary risk; and body mass index (BMI) have been reported in the current body of literature; however, these constructs interact with each other, and the complex relationships among them are infrequently examined. Therefore, the aim of the present study was to explore the complex relationships between these constructs using mediation and moderation analyses stratified by gender. Methods: A cross-sectional study, enrolling university students from the United States (U.S.), the Netherlands, South Korea, Malaysia, Ireland, Ghana, and China, was conducted between October 2020 and January 2021 during the COVID-19 pandemic. Perceived stress; maladaptive eating behaviors including restrained, uncontrolled, and emotional eating; sleep duration and quality; dietary risk; and BMI were assessed using validated questionnaires, which were distributed through an online platform. Results: A total of 1392 students completed the online survey (379 male, 973 female, and 40 who self-identified as “other”). Uncontrolled and emotional eating mediated the relationship between perceived stress and dietary risk for both males and females; higher sleep quality weakened this relationship among female students but not males. Emotional eating mediated the relationship between perceived stress and BMI for both males and females, but higher sleep quality weakened this relationship only among females. Conclusions: Our findings suggest that students in higher education are likely to benefit from interventions to reduce uncontrolled and emotional eating. Programs that improve sleep quality, especially during highly stressful periods, may be helpful.

Background: Over one-third of the U.S. population is exposed to unsafe levels of ozone (O-3). Dietary supplementation with fish oil (FO) or olive oil (OO) has shown protection against other air pollutants. This study evaluates potential cardiopulmonary benefits of FO or OO supplementation against acute O-3 exposure in young healthy adults. Methods: Forty-three participants (26 +/- 4 years old; 47% female) were randomized to receive 3 g/day of FO, 3 g/day OO, or no supplementation (CTL) for 4 weeks prior to undergoing 2-hour exposures to filtered air and 300 ppb O-3 with intermittent exercise on two consecutive days. Outcome measurements included spimmetry, sputum neutmphil percentage, blood markers of inflammation, tissue injury and coagulation, vascular function, and heart rate variability. The effects of dietary supplementation and O-3 on these outcomes were evaluated with linear mixed-effect models. Results: Compared with filtered air, O-3 exposure decreased FVC, FEV1, and FEV1/FVC immediately post exposure regardless of supplementation status. Relative to that in the CTL group, the lung function response to O-3 exposure in the FO group was blunted, as evidenced by O-3-induced decreases in FEV1 (Normalized CTL - 0.40 +/- 0.34 L, Normalized FO - 0.21 +/- 0.27 L) and FEV1 /FVC (Normalized CTL - 4.67 +/- 5.0 %, Normalized FO - 1.4 +/- 3.18 %) values that were on average 48% and 70% smaller, respectively. Inflammatory responses measured in the sputum immediately post O-3 exposure were not different among the three supplementation groups. Systolic blood pressure elevations 20-h post O-3 exposure were blunted by OO supplementation. Conclusion: FO supplementation appears to offer protective effects against lung function decrements caused by acute O-3 exposure in healthy adults.

Abstract Objectives Food allergy has become a serious public health concern as the prevalence of food allergies has increased significantly recently. Health caregivers have responsibilities to their patients with food allergies and their perception and awareness of the topic may impact the way they treat their patients. This project investigated how health-related majors students perceived food allergies at Bowling Green State University (BGSU) in Ohio. Methods A total of 133 survey responses were collected in November 2021, student majors include Food and Nutrition, Nursing, Pre-Medicine/Physician Assistant, Other Clinical Care Related (i.e., Clinical Psychology, Communication Sciences and Disorders, and Medical Laboratory Science), and Others (i.e., Biology, Health Care Administration, and Gerontology). Results Among them, 15% have food allergy themselves, 14.3% live with someone with food allergy, and 70.7% live without food allergy problems. More than 75% participants agreed that “food allergy is a serious problem in the U.S.”. This research shows an association between the major and their responses to the “Food allergy causes people to be treated differently” (c2(133, 16) = 26.977, P = 0.042). In the questions about “worry about for themselves or for children”, the participants without food allergy problems worried less than those with food allergy (c2(133, 8) = 22.211, P = 0.005; c2(133, 8) = 16.706, P = 0.033, respectively). Further, “most important strategies to help people with food allergies” was answered differently among majors. Conclusions In conclusion, education for food allergies is important for health major students to understand how food allergy influences patient treatment and to prepare their careers. Also, public education on food allergy benefits daily life for everyone. Funding Sources Bowling Green State University Center for Undergraduate Research and Scholarship.

Background: The coronavirus disease 2019 (COVID-19) pandemic has increased the already high levels of stress that higher education students experience. Stress influences health behaviors, including those related to dietary behaviors, alcohol, and sleep; yet the effects of stress can be mitigated by resilience. To date, past research studying the connections between dietary behaviors, alcohol misuse, sleep, and resilience commonly investigated singular relationships between two of the constructs. The aim of the current study was to explore the relationships between these constructs in a more holistic manner using mediation and moderation analyses. Methods: Higher education students from China, Ireland, Malaysia, South Korea, Taiwan, the Netherlands, and the United States were enrolled in a cross-sectional study from April to May 2020, which was during the beginning of the COVID-19 pandemic for most participants. An online survey, using validated tools, was distributed to assess perceived stress, dietary behaviors, alcohol misuse, sleep quality and duration, and resilience. Results: 2254 students completed the study. Results indicated that sleep quality mediated the relationship between perceived stress and dietary behaviors as well as the relationship between perceived stress and alcohol misuse. Further, increased resilience reduced the strength of the relationship between perceived stress and dietary behaviors but not alcohol misuse. Conclusion: Based on these results, higher education students are likely to benefit from sleep education and resilience training, especially during stressful events.

Exposure to ambient fine particulate matter (PM2.5) is associated with platelet activation and increased mitochondrial respiration. The impact of dietary saturated fat on the circulating platelets is not understood. This project aimed to determine whether dietary saturated fatty acids moderate mitochondrial respiratory function in circulating platelets after short-term exposure to PM2.5. Platelets were isolated from 22 healthy male volunteers (mean age ± SD, 37 ± 8.2) in a panel study and measured for mitochondrial oxygen consumption rates using an extracellular flux analyzer. Intakes of saturated fat were determined from 24 hr dietary recalls the day before the assay. Daily ambient PM2.5 concentrations during the study period were obtained from ambient air quality monitoring stations. Data were fitted with a moderation model, where the level of ambient PM2.5 was the independent variable, saturated fat intake was the moderator, and mitochondrial respiratory functions in circulating platelets were the dependent variables. After controlling for age, dietary consumption of saturated fat moderated the mitochondrial oxygen consumption rates of non-mitochondrial respiration, basal respiration, maximum respiration, ATP production, and spare respiratory capacity after exposure to ambient PM2.5 with 2 days lag. Specifically, the negative associations between the above mentioned mitochondrial respiratory measurements and PM2.5 levels reached statistical significance (95% Confident Intervals did not include 0) in subjects with a high intake of total saturated fat. Further, results for individual saturated fatty acid showed similar patterns, specifically that negative association between mitochondrial oxygen consumption rates of non-mitochondrial respiration, basal respiration and ATP production and levels of exposed PM2.5 was moderated by intakes of short-chain (C4:0), medium-chain (C6:0, C8:0, C10:0, C12:0), long-chain (C14:0, C16:0) saturated fatty acids. Taken together, these preliminary findings suggest that consumption of saturated fat moderates platelet mitochondrial respiration after exposure to PM2.5. THIS ABSTRACT OF A PROPOSED PRESENTATION DOES NOT NECESSARILY REFLECT EPA POLICY. This project was supported by the U.S. EPA Intramural Research Program.

Introduction: Exposure to ambient nitrogen dioxide (NO 2 ) is associated with adverse respiratory and cardiovascular outcomes. Supplementation of omega-3 polyunsaturated fatty acids (PUFA) has shown health benefits against exposure to air pollution. Hypothesis: Dietary omega-3 PUFA intake offers cardiovascular and respiratory benefits against short-term exposure to ambient NO 2 in healthy adults. Methods: Sixty-two healthy participants were enrolled into low or high omega-3 groups based on their habitual dietary omega-3 PUFA intake. Each participant was repeatedly assessed for blood lipids, markers of coagulation and fibrinolysis, vascular function, heart rate variability (HRV), and lung function up to five times separated by at least 7 days between October 2016 and September 2019. Daily ambient NO 2 concentrations were obtained from nearby air quality monitoring stations. The associations between NO 2 concentrations and the measured biomarkers were evaluated using the linear mixed-effects models stratified by the omega-3 intake levels. Results: In the high omega-3 group, an IQR increase in NO 2 concentrations was associated with reductions in total cholesterol at lag2 [-2.6% (-4.4, -0.9)], LDL at lag2 [-3.1% (-5.5, -0.7)], and HDL at lag1 [-2.4% (-4.4, -0.3)] and lag2 [-2.0% (-3.8, -0.1)]; increases in flow-mediated dilatation of brachial artery at lag1[5.7% (0.1, 11.2)] and lag2 [5.7% (0.8, 10.6)]; decreases in plasma levels of endothelin-1at lag3 [-25.6% (-50.0, -1.2)] and lag4 [-22.9% (-45.9, -0.01)]; decreased high frequency (HFn) of HRV [-7.2% (-13.6, -0.8)] and increased LF/HF ratio [13.4% (0.2, 28.3)] at lag3; as well as increased lung function. In the low omega-3 group, blood lipids, vascular function biomarkers and lung function were not significantly associated with NO 2 exposure. However, NO 2 exposure was associated with elevations in coagulation markers (von Willebrand Factor and D-dimer) and a decrease in very-low frequency of HRV at lag0 in the low omega-3 group. Conclusions: The results imply that high dietary omega-3 PUFA intake may offer benefits to cardiovascular and respiratory health in response to exposure to low-level ambient NO 2 in healthy adults. THIS ABSTRACT OF A PROPOSED PRESENTATION DOES NOT NECESSARILY REFLECT EPA POLICY.

Introduction: Iron is in oxygen transport which is important for athletic performance. Many female distance runners struggle to maintain adequate iron status through diet alone and rely on iron supplementation. Methods: Interviews were conducted with eight members of the Women’s Cross Country team at a Division I university to assess dietary patterns and behaviors related to iron status. This information, along with food records and serum ferritin levels, were analyzed qualitatively for trends with a focus on iron intake, total energy intake, and food components that enhance and inhibit iron absorption. Results: All participants took an iron supplement at the time of the study. All but one had experienced poor iron status currently or in the past. Most participants did not meet dietary iron, Vitamin E, or estimated energy requirements. Half of the participants expressed an attempt to increase iron intake in response to higher training loads. Half attempted to increase intake in response to a low ferritin result or iron deficiency symptoms. Conclusions: Consistently low energy and iron intake among participants indicated the likelihood of a relationship with poor iron status and/or reliance on supplementation. The most common motivation for increasing iron intake was the prevention of symptoms.

The COVID-19 pandemic has altered the landscape of higher education, forcing institutes across the globe to lock down campuses and shift instructional methods. To determine the impact of these changes on students, 644 currently enrolled higher education students across seven countries (USA, the Netherlands, Ireland, South Korea, China, Malaysia, and Taiwan) were asked to report their pandemic-related concerns. Qualitative responses were translated and indexed by theme, with students reporting major concerns in the areas of education, safety, mental health, employment stability/finances, future, and relationships. Minor themes of travel/getting out, politics, economy, and misinformation were also reported. The results of this study provide broadly endorsed international information on student needs for support and continuity of learning. These findings can be used by institutes of higher education to inform policy and procedure, including but not limited to mental health and risk communication, during the present pandemic and future emergency or disaster situations.

BACKGROUND:Short-term exposure to ambient nitrogen dioxide (NO2) is associated with adverse respiratory and cardiovascular outcomes. Supplementation of omega-3 polyunsaturated fatty acids (PUFA) has shown protection against exposure to fine particulate matter. This study aims to investigate whether habitual omega-3 PUFA intake differentially modify the associations between respiratory and cardiovascular responses and short-term exposure to ambient NO2.METHODS:Sixty-two healthy participants were enrolled into low or high omega-3 groups based on their habitual omega-3 PUFA intake. Each participant was repeatedly assessed for lung function, blood lipids, markers of coagulation and fibrinolysis, vascular function, and heart rate variability (HRV) in up to five sessions, each separated by at least 7 days. This study was carried out in the Research Triangle area of North Carolina, USA between October 2016 and September 2019. Daily ambient NO2 concentrations were obtained from an area air quality monitoring station on the day of outcome assessment (Lag0), 4 days prior (Lag1-4), as well as 5-day moving average (5dMA). The associations between short-term exposure to NO2 and the measured indices were evaluated using linear mixed-effects models stratified by omega-3 levels and adjusted by covariates including relative humidity and temperature.RESULTS:The average concentration of ambient NO2 during the study periods was 5.3±3.8 ppb which was below the National Ambient Air Quality Standards (NAAQS). In the high omega-3 group, an interquartile range (IQR) increase in short-term NO2 concentrations was significantly associated with increased lung function [e.g. 1.2% (95%CI: 0.2%, 2.2%) in FVC at lag1, 2.6% (95%CI: 0.4%, 4.8%) in FEV1 at 5dMA], decreased blood lipids [e.g. -2.6% (95%CI: -4.4%, -0.9%) in total cholesterol at lag2, -3.1% (95%CI: -6.1%, 0.0%) in HDL at 5dMA, and -3.1% (95%CI: -5.5%, -0.7%) in LDL at lag2], improved vascular function [e.g. 8.9% (95%CI: 0.6%, 17.2%) increase in FMD and 43.1% (95%CI: -79.8%, -6.3%) decrease in endothelin-1 at 5dMA], and changed HRV parameters [e.g. -7.2% (95%CI: -13.6%, -0.8%) in HFn and 13.4% (95%CI: 0.2%, 28.3%) in LF/HF ratio at lag3]. In the low omega-3 group, an IQR increase in ambient NO2 was associated with elevations in coagulation markers (von Willebrand Factor, D-dimer) and a decrease in HRV (very-low frequency); however, null associations were observed between short-term NO2 exposure and changes in lung function, blood lipids, and vascular function.CONCLUSIONS:The results in this study imply that dietary omega-3 PUFA consumption may offer respiratory and vascular benefits in response to short-term exposure of healthy adults to NO2 levels below the NAAQS.TRIAL REGISTRATION:ClinicalTrials.gov ( NCT02921048 ).