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AbstractBackgroundCerebral small vessel disease (cSVD), as defined by neuroimaging characteristics such as white matter hyperintensities (WMHs), cerebral microhemorrhages (CMHs), and lacunar infarcts, is highly prevalent and has been associated with dementia risk and other clinical sequelae. Although risk factors for cSVD have been identified, little is known about the biological processes and molecular mediators that influence cSVD development and progression.MethodsWithin the Atherosclerosis Risk in Communities (ARIC) study, we used SomaScan Multiplexed Proteomic technology to relate 4,877 plasma proteins to concurrently measured MRI‐defined cSVD characteristics, including WMHs, CMHs, and lacunar infarcts, in late‐life (n=1508; mean age: 76). Candidate protein associations with WMH volume were replicated in the Cardiovascular Health Study (n=765; mean age: 73) and Baltimore Longitudinal Study of Aging (n=902; mean age: 66). Cohort‐specific effect estimates were pooled using a fixed‐effect, inverse variance weighted meta‐analysis. Within 4228 non‐demented older adults in ARIC, we examined the association of WMH‐associated proteins with eight‐year dementia risk (641 incident dementia cases) using multivariate Cox proportional hazard models. All multivariate regression models were adjusted for demographic, kidney function, and cardiovascular risk variables.ResultsThis proteome‐wide analysis of older adults identified 13 WMH‐associated plasma proteins involved in synaptic function, endothelial integrity, and angiogenesis (Figures 1a, 2a). Nine of these proteins replicated in one or more external cohort (Figures 1b, 2b) and two proteins, oligodendrocyte myelin glycoprotein (OMG) and neuronal pentraxin receptor (NPTXR), remained associated with late‐life WMH volume when measured nearly two decades earlier during midlife (Figures 1c, 2c). Eight of the 13 WMH‐associated proteins were associated with lacunar infarcts, 6 with subcortical CMHs, and 4 with lobar CMHs (Figures 1d, 2d). Although none of the genes coding for WMH‐associated proteins have been nominated by WMH GWAS, 7 of these genes have been previously linked to cardiometabolic traits known to influence cSVD, such as blood pressure and cholesterol (Figures 1e, 2e). Finally, 11 candidate proteins were associated with incident dementia, underscoring their clinical relevance (Figures 1f, 2f).ConclusionsThis large‐scale proteomic analysis within longitudinal community‐based samples identified several plasma proteins, including OMG and NPTXR, as top candidate biomarkers for elevated WMH volume and its clinical manifestations.

Introduction Less than 20% of US adults meet physical activity (PA) recommendations, yet few physicians provide consistent PA counseling. There is limited research on the state of education of PA counseling in medical school curricula. The purpose of this study was to analyze medical students’ perspectives on the current state and perceived quality of PA education in medical school. Methods An online survey was administered to the students of nine United States medical schools in January 2021. Descriptive statistics were used to analyze results. Results Of 5500 invited students, 1182 (21.5%) responded. Only 8% of students received any formal training on PA counseling for patient or self-use throughout their medical education. The majority (64% and 85%, respectively) of respondents felt that both learning more about the benefits of PA and gaining more practical skills in counseling on PA should be requirements to graduate. Students across all medical school years agreed that formal training on patient counseling for PA should be taught more in-depth. Conclusions Medical students believe that PA and exercise physiology should comprise more of medical education curricula. Such training may equip students with the tools they believe they need to adequately treat patients effectively throughout their careers.

Introduction: The current literature regarding both specific interventions and the current level of nutrition education in the United States is scarce. The purpose of this paper is to provide medical student perspectives on both the degree and necessity of nutrition education during medical school. Methods: Medicine in Motion (MM) is a non-profit student-run organization founded in 2018 that aims to address burnout in medicine through physical activity, community service, and philanthropy. MM issued a survey to nine of its chapters in January 2021 to assess a range of topics including burnout, physical activity, and nutrition education. Results: Of 5500 invited students, 1182 (21.5%) responded. An average of 1.2 hours of formal nutrition education per year was reported across all participants. Students who received any degree of nutritional education reported 2.9 hours per year. Most students (57.6%) had not participated in a medical school course that provided formal education in nutrition. Of those that did participate in a nutrition course (42.4%), the course was required for 84.7% of students and the majority (80.1%) received 0-10 hours of nutrition education. Most respondents (88.7%) reported that requiring formal nutrition education should be a graduation requirement and a similar number of students (89.3%) believe medical students should receive formal training on nutrition counseling for patients. The majority (93.3%) of students either somewhat or strongly agreed that understanding the effects of nutrition/eating decisions on the human body is critical to maximizing patient care. Conclusion: Based on prior studies, physicians feel underprepared to provide nutrition counseling to their patients despite the large role poor diet plays in the burden of disease. Most medical students in this cohort believe that understanding nutrition is vital to maximize patient care. Funding and curricular changes should be allocated towards expanding the nutrition curriculum across U.S. medical schools.