Reis, Jared P.

Background: The prevalence of non-alcoholic fatty liver disease (NAFLD) in U.S. adults is over 30%, yet the role of lifestyle factors in the etiology of NAFLD remains understudied. We examined the associations of physical activity, by intensity and type, and television viewing with prevalent NAFLD. Methods: Cross-sectional analysis of a population-based sample of 2726 Black (49%) and White (51%) adults (Mean (SD) age, 50 (3.6) years; 57.3% female) from the CARDIA study. Exposures were aerobic activity by intensity (moderate, vigorous; hours/week); activity type (aerobic, muscle-strengthening; hours/week); and television viewing (hours/week), examined concurrently in all models and assessed by validated questionnaires. Our outcome was NAFLD (liver attenuation < 51 Hounsfield Units), measured by non-contrast computed tomography, after exclusions for other causes of liver fat. Covariates were sex, age, race, study center, education, diet quality, smoking status, alcohol consumption, and body mass index or waist circumference. Results: 648 participants had NAFLD. In the fully adjusted modified Poisson regression model, the risk ratios per interquartile range of each exposure were moderate-intensity aerobic activity, 1.10 (95% CI, 0.97–1.26); vigorous-intensity aerobic activity, 0.72 (0.63–0.82); muscle-strengthening activity, 0.89 (0.80–1.01); and television viewing, 1.20 (1.10–1.32). Relative to less active participants with higher levels of television viewing, those who participated in ≥2 h/week of both vigorous-intensity aerobic and muscle-strengthening activity and <7 h/week of television viewing had 65% lower risk of NAFLD (risk ratio = 0.35, 95% CI = 0.23–0.51). Conclusion: Adults who follow public health recommendations for vigorous-aerobic and muscle-strengthening activity, as well as minimize television viewing, are considerably less likely to have NAFLD than those who do not follow the recommendations and who have relatively high levels of television viewing.

Introduction: The prevalence of nonalcoholic fatty liver disease (NAFLD) in US adults is over 25%, yet the etiology of lifestyle factors in the development of NAFLD remains understudied. We examined the independent and joint associations among aerobic physical activity (PA) intensity (moderate, vigorous) and PA type (aerobic, muscle strengthening), television viewing (TV), and odds of NAFLD. Hypothesis: Higher levels of aerobic and muscle strengthening PA are associated with lower odds of NAFLD, and higher levels of TV are associated with higher odds of NAFLD. Methods: We analyzed data from Year 25 of the CARDIA cohort study. Our exposures (moderate and vigorous aerobic and muscle strengthening PA, TV; hr/wk) were assessed using validated questionnaires. Our outcome (NAFLD) was measured using non-contrast computed tomography. We constructed multivariable logistic regression models to examine the independent and joint associations between PA (moderate or vigorous aerobic and strength), TV, and odds of NAFLD. Covariates were sex, age, race, study center, education, diet, smoking status, alcohol consumption, and waist circumference. Results: 2726 participants (648 with NAFLD) were analyzed (mean (SD) age, 50.1 (3.6) years; 49% Black; 43% male). Fully adjusted odds ratios per IQR-standardized continuous PA and TV were: moderate aerobic PA (IQR = 4.3), 0.93 (95% CI, 0.81-1.07); vigorous aerobic PA (IQR = 1.9), 0.63 (95% CI, 0.55-0.73); muscle strengthening PA (IQR = 3.3), 0.80 (95% CI, 0.07-0.92); and TV (IQR = 14.0), 1.20 (95% CI, 1.10-1.32). Only vigorous aerobic PA remained statistically significant after waist circumference adjustment, 0.83 (95% CI, 0.70-0.98). A PA-TV index model (Figure) indicated the combination of higher vigorous aerobic and muscle strengthening PA and lower TV resulted in an odds ratio of 0.23 (95% CI, 0.15-0.37). Conclusion: Concurrent higher levels of vigorous aerobic PA (≥2 hr/wk), muscle strengthening PA (≥2 hr/wk), and lower levels of TV (<7 hr/wk) were associated with 77% lower odds of NAFLD.

Abstract Vascular contributions to cognitive impairment and dementia (VCID) are characterized by the aging neurovascular unit being confronted with and failing to cope with biological insults due to systemic and cerebral vascular disease, proteinopathy including Alzheimer's biology, metabolic disease, or immune response, resulting in cognitive decline. This report summarizes the discussion and recommendations from a working group convened by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke to evaluate the state of the field in VCID research, identify research priorities, and foster collaborations. As discussed in this report, advances in understanding the biological mechanisms of VCID across the wide spectrum of pathologies, chronic systemic comorbidities, and other risk factors may lead to potential prevention and new treatment strategies to decrease the burden of dementia. Better understanding of the social determinants of health that affect risks for both vascular disease and VCID could provide insight into strategies to reduce racial and ethnic disparities in VCID.

Introduction: Alcohol use is common in the United States. Most studies describe a J-shaped relationship between alcohol consumption and cognitive function: frequent heavy consumption alters brain functions and decreases cognitive performance; regular light and moderate consumption may have protective impact. We are unaware of any reports utilizing longitudinally collected data to derive a cumulative exposure of alcohol use and assess its association with cognitive function. Hypothesis: Cumulative 30-year exposure to alcohol has a J-shaped association with mid-life cognitive function. Methods: We included 3,068 participants aged 18-30 years at the baseline examination (1985-86) and having up to 8 follow-up exams at 2- to 5-year intervals including at 30 years (2015-16). Cumulative “drink-years” exposure to alcohol was estimated at each exam by multiplying the usual number of drinks/day reported by the number of years since last exam, and then summing across exams. We used multivariable adjusted linear regression models to assess the independent associations of number of drink-years with 6 measures of cognitive function studied at Year 30: Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), Stroop Test, Montreal Cognitive Assessment (MoCA), Category Fluency Test, and Letter Fluency Test. We used inverse probability of censoring weighting to account for potential informative censoring. Linear regression models estimated standardized mean test scores for the cumulative alcohol use categories (drink-years: >0 and <15, 15-29.9, 30+). Too few participants were available for assessment of higher categories of use. Results: Compared with never drinking, the 3 categories of cumulative exposure were unassociated with any of the cognitive function measures. Conclusions: Cumulative 30-year alcohol use is not associated with cognitive function in middle-aged adults in the CARDIA study.