Publications

Scholarly Journals--Published

• Introduction The COVID-19 pandemic has underscored the vital connection between lifestyle factors and health outcomes, highlighting the need to understand how lifestyle choices influence both chronic and infectious diseases. Despite known links between lifestyle factors and chronic diseases, the relationship between these factors and infectious diseases like COVID-19 warrants further investigation. Methods This cross-sectional study used an anonymous survey collected from a diverse sample of US residents aged 18 or older. Excluding individuals under 18 or residing outside the USA, the survey captured data on diet, body mass index, smoking status, alcohol consumption, physical activity, sleep duration, COVID-19 infection status, sociodemographics and other potential confounders. Statistical analysis was performed using χ2 tests and logistic regression to explore the associations between lifestyle factors and COVID-19 infection, with a particular focus on gender differences. Results Among 1032 participants, the prevalence of COVID-19 was higher in women (42.8%) compared with men (32.0%). Significant associations were found between inadequate sleep (less than 4 hours per day) and increased risk of COVID-19 in both genders (OR=2.89, 95%CI: 1.13 to 7.35, p=0.02 for men; OR=5.69, 95%CI: 3.14 to 10.29, p<0.00 for women). Additionally, a significant association was observed between a lifestyle index, incorporating multiple lifestyle factors and COVID-19 infection in women (OR=1.79, 95%CI: 1.05 to 3.025, p=0.03). Conclusions The findings indicate a potential link between lifestyle factors and susceptibility to COVID-19, with inadequate sleep identified as a significant risk factor. These results suggest that promoting a healthy lifestyle could be an effective strategy for controlling the pandemic and mitigating the impact of infectious diseases. Further research is recommended to explore the role of restful sleep in preventing COVID-19 for men and women (including multiple lifestyle factors among women) Shaheen R, Beeson WL, Paalani M, Dos Santos, H, Alismail A, & Spencer-Hwang R. (2024). Associations between lifestyle factors and COVID-19 infection rates: a cross-sectional analysis in the USA. BMJ Public Health. (03/2024)
• Amid a global aging trend, particularly notable in the U.S., there is a growing focus on achieving enhanced longevity and well-being.We evaluated the association between lifestyle factors (sleep, diet, and healthy lifestyle index) and COVID-19 infection in an older adult population in San Bernardino and Riverside counties in Southern California, the United States. A sample of 380 older adults ≥75 years old were surveyed cross-sectionally and self-reported lifestyle behaviors and COVID-19 infection. The results revealed that half the participants reported COVID-19 infection. Participants who slept less than 7 hours or more than 8 hours/night had higher odds of COVID-19 infection than those who slept 7–8 hours/night (OR = 1.62, 95% CI: 1.03, 2.55). Healthy lifestyle behaviors were significantly associated with reduced COVID-19 infection (OR = 0.61, 95% CI: 0.40, 0.92). In conclusion, adequate sleep and healthy lifestyle behaviors may be protective against COVID-19 infection among older adults and should be investigated further. Alabadi-Bierman, A., Spencer-Hwang, R., Beeson, W. L., Paalani, M., & Dos Santos, H. (2024). The Association Between Lifestyle Factors and COVID-19 Among Older Adults in Southern California: The Loma Linda Longevity Study. Journal of Applied Gerontology. (03/2024)
• This study examined the potential relationship between sleep, exercise, and depression with coronary heart disease (CHD) using the 2020 Behavioral Risk Factor Surveillance System (BRFSS) (n = 391 750) during the COVID-19 pandemic. CHD was defined as the presence of self-reported CHD or myocardial infarction (MI). Descriptive statistics were used to report variable frequencies and percentages. Logistic regression models were used to assess potential relationships between lifestyle behaviors (individually and for effect modification) and CHD, with additional sensitivity analysis comparing depressed subjects with non-depressed subjects. Sleep and exercise were assessed in the model for potential effect modification. Those with insufficient sleep and those who did not exercise were more likely to report CHD (sleep OR = 1.09; 95% CI: 1.06, 1.12); (exercise OR = 2.00; 95% CI: 1.95, 2.05), though the interaction term was non-significant. Those with self-reported depression were found to be associated with CHD (OR = 1.34; 95% CI: 1.30, 1.38). Among depressed individuals, insufficient sleep and no exercise exhibited a stronger association (sleep OR = 1.19; 95% CI: 1.13,1.25); (exercise OR = 2.13; 95% CI = 2.03, 2.23). Results support an association between sleep, exercise, and self-report of CHD, and this association is potentially magnified among depressed individuals, which may be further exacerbated by the COVID-19 pandemic.   Leal R, Spencer-Hwang R, Beeson WL, Paalani M, Dos Santos H. (2024). Lifestyle Factors and Heart Health: Exploring Effect Modification Using Behavioral Risk Factor Surveillance System Survey Data. American Journal of Lifestyle Medicine. (01/2024)
• Asthma is one of the principal causes of absenteeism from school and the leading cause of emergency department visits for children in the United States. Some dietary habits are associated with asthma prevalence and play a role in the pathogenesis and control of symptoms. The objective of this study was to characterize dietary factors that may affect asthma outcomes among children with asthma in California. The California Health Interview Survey (CHIS) is the largest state health survey in the nation. This cross-sectional study included 7687 surveys, representing an estimated annual 710,534 children (ages 2–11) reported to have asthma between 2001 and 2015. Analysis was survey-weighted. We used multivariable regression, adjusting for covariates, to examine the association between dietary factors and asthma outcomes. Asthmatic children consuming two or more servings of sodas per day had more symptoms of asthma than those who did not consume soda daily (OR = 1.50, 95% CI: 1.04, 2.15). Moreover, those consuming two servings of fruits per day had lower odds of missing school due to asthma. Children with asthma may be affected by certain pro-inflammatory foods that are energy dense. This study provided an additional reason to discourage the consumption of sodas and sugary drinks due to the negative respiratory impact, in addition to their effect on childhood obesity, oral health problems, and future chronic diseases. Dos Santos, H., Chai, E., Gaio, J., Becerra, M.B., Reis, W.P., Paalani, M., Banta, J.E. (2023). Dietary Factors Affecting Asthma Outcomes among Asthmatic Children in California. Appl. Sci., 13, 12538. (11/2023)
• The purpose of this study was to evaluate Wii sports programs as a potential physical activity solution to increasing inactivity among young adults and potentially improving the immune system. An evaluation was done on five Wii Sports games, including tennis, baseball, bowling, golf, and boxing. Measures included caloric expenditure and metabolic equivalents (MET) expended. A total of 16 subjects participated in two interactive video game sessions that took place over a 14-day period, in which their caloric expenditure (based on metabolic equivalents and rate of perceived exertion [RPE]) was compared with accepted reference values associated with playing the actual sports. Results showed that Wii sports were associated with higher MET values than published norms for other actual sports, and all Wii sports showed caloric expenditure that was four to ten times higher than traditional sedentary gaming. In conclusion, the results justify the integration of interactive video-gaming technologies into future fitness programs targeted toward young adults and, consequently, decrease the risk of metabolic syndrome and obesity.  Paalani, M., Bredehoft, M., Montgomery, S., Chipuli, R., Dos Santos, H. (2023). Exergaming: A Good Exercise Option During the Coronavirus Pandemic. Cureus, Aug 20;15(8):e43799.   (08/2023)
• The study aimed to examine whether registered dietitians’ (RDs’) practice areas were associated with their confidence regarding integrative medicine (IM) modalities. An online survey was completed by 5164 members of the Academy of Nutrition and Dietetics. Post hoc analyses revealed that when compared with other practice areas, RDs practicing within IM reported the highest self-rated confidence when recommending high-quality supplements (84.2%, P < .01), disease-specific supplements (73.7%, P < .001), herbal supplements (73.7%, P < .001), and functional foods (84.2%, P < .001). RDs who utilize IM are most confident incorporating IM modalities into their practice, while those employed in other practice areas are significantly less confident.   Malik, N., Paalani, M., Becerra, B. (2023). Nutrition Professionals’ Confidence Recommending Integrative Medicine Modalities. Topics in Clinical Nutrition, 38(2), 104-112.   (06/2023)
• Avocado is a nutrient-rich food that has been shown to benefit the health and diet quality of adults. In this paper, we examined if habitual intake of avocado among adolescents is associated with their diet quality, food and nutrient intake, and measures of obesity and body composition. Participants aged 12–18 years old (n = 534) from selected public and Adventist middle-high schools reported their dietary intake in a web-based food frequency questionnaire (FFQ); anthropometrics were measured during school visits. Diet quality (DQI-I) and avocado intake were calculated from the FFQ; BMI z-scores (BMIz), waist-to-height ratio (WHtR), and fat mass (FM), fat-free mass (FFM), and %body fat (%BF) were determined from the anthropometric data. Compared to non-consumers, avocado consumers had significantly higher covariate-adjusted mean scores on total DQI-I (68.3 vs. 64.6) and energy-adjusted mean scores on variety (18.8 vs. 18.0) and adequacy (36.4 vs. 33.4). Avocado consumption was significantly associated with DQI-I components adequacy (β [SE] = 0.11 [0.03]) and moderation (β [SE] = 0.06 [0.03]) but not with BMIz, WHtR, FM, FFM, and %BF. Mean intakes of fruits, vegetables, and plant protein foods, total and vegetable proteins, dietary fiber, retinol, vitamin C, calcium, magnesium, iron, and potassium were significantly higher for avocado consumers; saturated and trans fats intakes were significantly higher for non-consumers. In our adolescent population, avocado consumption was associated with higher diet quality and intake of plant-based foods and shortfall nutrients, but not with measures of obesity and body composition. Studies are needed to determine the optimal amount of avocado that would confer health benefits during adolescence. Segovia-Siapco, G., Paalani, M., Oda, K., Pribis, P., & Sabaté, J. (2021). Associations between Avocado Consumption and Diet Quality, Dietary Intake, Measures of Obesity and Body Composition in Adolescents: The Teen Food and Development Study. Nutrients, 13(12), 4489. (12/2021)
• The micronutrient adequacy of common fad diets is rarely assessed. We compared a high-fiber diet [HF] with a low-carbohydrate diet [LC] to assess their effects on body weight and micronutrient adequacy. One hundred and seventy-three adult males and females with or without diabetes with a mean body mass index of 36 kg/m2 were randomized to either a HF or LC diet. Differences in anthropometrics, blood lipids, glucose, blood pressure, and micronutrient consumption between groups were assessed after 52 weeks. Differences between groups a priori were assessed using independent t tests and chi-squared tests. Post hoc differences in nutrient consumption between groups while controlling for gender were assessed using factorial analysis of variance. After 52 weeks, LC dieters (n = 24) retained weight loss better than their HF counterparts (n = 30) (p = .06). LC dieters consumed more vitamin K (mcg) [HF = 124.0 ± 15.0; LC = 220.0 ± 39.1; p = .025] and vitamin B12 (mcg) [HF = 3.1 ± 0.3; LC = 4.1 ± 0.4; p = .026]. The HF group consumed more folate (mcg) [HF = 479.9 ± 34.0); LC = 333.8 ± 22.1; p < .001], magnesium (mg) [HF = 353.1 ± 17.4; LC = 281.1 ± 18.0; p < .001], and iron (mg) [HF = 14.6 ± 0.8; LC = 10.7 ± 0.6; p < .001. Both groups consumed less than the respective EAR for vitamins D and E and less than the AI for potassium. While a LC diet may be more effective for long-term weight loss, both diets were deficient in micronutrients.  Malik, Neal, Tonstad, Serena, Paalani, Michael, Dos Santos, Hildemar. (2020) Are common fad diets nutritionally adequate? Long-term adherence to restrictive diets may result in micronutrient deficiencies: A randomised controlled trial.  Food Science & Nutrition. 00: 1-14.    (09/2020)
• The purpose of this study was to identify determinants of smoking cessation in a sample of male Portuguese Californians using data from the Portuguese Study, a dissertation thesis study with a crosssectional design that assessed 141 smokers and 67 ex-smokers of Portuguese origin residing in Southern and Central California recruited from Portuguese community clubs. Socio-demographics, acculturation, health beliefs, stress, and social support for smoking cessation were assessed and measured in this population. Bivariate predictors of becoming an ex-smoker were being married (p=.01), having a high support index for not smoking (p<.01), having a nonsmoking close friend (p<.01), perception that doctors control health (p=.02), disagreement with the belief that health occurs by chance (p=.01), and belief that it is easy to stop smoking (p<.01). In a multivariate analysis - after controlling for demographic variables, acculturation, and stress variables - ex-smoking status remained associated with having a high support index for not smoking (p<.01), having a nonsmoking close friend (p=.05), disagreement with the belief that health occurs by chance (p<.01) and belief that it is easy to stop smoking (p<.01). Conclusion: Social support, the belief that health does not occur by chance and self-efficacy were associated with being an ex-smoker in Portuguese Californian males. Smoking cessation programs in this population should address these determinants. Dos Santos, H., Tonstad, S., Montgomery, S., Paalani, M., Faed, P. (2011). Smoking Cessation Behavior in Male Portuguese Californians. Californian Journal of Health Promotion, 9(2) 68-76. (06/2011)
• Background: Inflammation is a common pathophysiological pathway for a number of chronic diseases, and is strongly influenced by sociodemographic factors and lifestyle. Less is known about factors that may influence the inflammatory response in individuals of distinct ethnic backgrounds. Therefore, this study examined the relationship between ethnicity and blood levels of inflammatory markers in a sample of non-smoking church-goers. Methods: In a cross-sectional investigation, 508 men and women (.35 years old, 62% White, 38% Black) participated in the Biopsychosocial Religion and Health substudy of the Adventist Health Study 2. The contribution of socioeconomic status (education level and difficulty meeting expenses for basic needs) and health covariates (exercise, vegetarian or other type of diet, body mass index, and presence of inflammatory conditions) toward serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-a) was assessed with linear regression models. Levels of interleukin-10 (IL-10), an anti-inflammatory marker, were also assessed. Results: Blacks showed higher levels of CRP and IL-6 than Whites. Controlling for sociodemographic and health variables attenuated the ethnic difference in CRP while IL-6 levels remained higher in Blacks than in Whites (b5.118; 95% confidence interval5.014– .206; P5.025). Ethnic differences in IL-10 and TNF-a were not found. Vegetarian diet was associated with lower CRP levels while exercise frequency was associated with higher IL-10 levels. Conclusion: Higher susceptibility of Blacks to inflammatory diseases may reflect higher IL-6, which could be important in assessing health disparities among Blacks and Whites. Vegetarian diet and exercise may counteract effects of disparities. Paalani, M., Lee, J.W., Haddad, E., Tonstad, S. (2011). Determinants of Inflammatory Markers in a Bi-Ethnic Population. Ethnicity & Disease, 21(2), 142-149. (03/2011)
• To assess the influence of paralysis on the expression of phenotypic protein isoforms related to muscle relaxation, the effects of spinal cord transection (ST) on sarco(endo)plasmic reticulum calcium ATPase (SERCA) pump isoform protein levels in the slow rat soleus were measured. Western blotting using SERCA isoform specific antibodies demonstrated a rapid up-regulation (7 days post ST) of the fast fiber type-specific isoform (SERCA1). In contrast, the slow fiber type-specific isoform, SERCA2, was decreased with a slower time-course. The up-regulation of SERCA1 protein preceded the up-regulation of fast myosin heavy chain (MyHC) (i.e., MyHC-II). Immunohistochemical analyses of single muscle fibers showed that 15 days after ST there was a pronounced increase in the proportion of slow MyHC fibers with SERCA1 confirming that SERCA1 was up-regulated in the slow fibers of the soleus prior to MyHC-II. These data suggest that the expression of the SERCA isoforms (particularly SERCA1) may serve as more sensitive markers of phenotypic adaptation in response to altered levels of contractile activity than the MyHC isoforms. In addition, since the expression of SERCA isoforms was dissociated from MyHC isoforms, regulation of gene expression for these two different protein systems must involve different signaling events and/or synthetic processes. Talmadge, R.J., Paalani, M. (2007). Sarcoplasmic reticulum calcium pump isoforms in paralyzed rat slow muscle.  Biochimica et Biophysica Acta, 1770 (8), 1187-1193. (01/2007)