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Despite research that suggests flavonoids protect against metabolic syndrome (MetS) and evidence that intake of these compounds differs by race, knowledge about whether flavonoid–MetS associations vary among racial groups is limited. This study sought to estimate usual total flavonoid intake in African American and White adults and assess its sex- and sex/race-specific associations with MetS and its risk factors. Analysis of cross-sectional data from 1837 adults participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were analyzed. Usual total flavonoid intake was estimated using the NCI Method, and logistic regression measured its linkages with health outcomes. Among males overall and when stratified by race, odds of MetS and its risk factors low high-density lipoprotein cholesterol (HDL-C) and elevated glucose were lower at the 75th percentile of usual total flavonoid intake than at the 25th percentile (OR for MetS = 0.62; 95% CI = 0.53, 0.71). However, low HDL-C and elevated glucose were positively associated with usual flavonoid intake among females. The comparable associations by race within sex imply that the relationships between flavonoid and health outcomes may be evident across an array of intakes.

Over time, adherence to healthy behaviors may improve physical and mental strength which is essential for successful aging. A plausible mechanism is the reduction of inflammation. Research on the association of risky health behaviors on change in strength with age is limited. This study examined changes in the inflammatory potential of the diet, smoking, illicit drug use with changes in strength in a racially and socioeconomically diverse adult sample from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study. The dietary inflammatory index (DII) was calculated from 35 food components derived from multiple 24-h dietary recalls. Strength was evaluated by handgrip strength (HGS), SF-12 PCS and SF-12 MCS (physical and mental component scores). Repeated measures analyses were used to examine associations. At baseline, mean age was 48.4 ± 0.25 years, 56% of the sample were women, and 58% African American. Significant 4-way interactions were found between age, race, socioeconomic status, and DII for women, on change in HGS (p &lt, 0.05) and in SF-12 PCS (p &lt, 0.05) and for men, in change in SF-12 PCS (p &lt, 0.05). Improvements in SF-12 MCS were associated with all three health behaviors as main effects. This study provided evidence that changes towards improving healthy behaviors, diet with anti-inflammatory potential, not smoking cigarettes and not using illicit drugs, were associated with improved strength. Health professionals, especially registered dietitians and health coaches, should create lifestyle interventions to reduce inflammation targeting change in more than one risky health behavior.

Sandwiches are considered a staple in diets of United States adults. Previous research with Healthy Aging in Neighborhoods of Diversity across the Life Span study participants revealed that 16% consume a sandwich dietary pattern providing with 44% of their daily energy. Yet, little is known about the effect of sandwiches on diet quality over time. The study objectives were to determine the relationship of energy contributed by sandwiches to diet quality in this socioeconomically and racially diverse sample categorized by age (&lt, 50 years and &ge, 50 years at baseline) and to describe patterns of sandwich consumption over ~12 years. The analyses included a series of linear mixed-effects regression models, with age as the time variable centered at 50 years. In each model, the main outcome was Healthy Eating Index-2010 score with up to three scores, while the main predictor was % total energy from sandwiches (0, &gt, 0&ndash, 20%, &gt, 20%) measured concurrently at each visit. Diet quality of older men with income &lt, 125% poverty improved over time for those consuming &gt, 20% and &gt, 20% energy from sandwiches compared to young women with incomes &gt, 125% poverty who were non-reporters of sandwiches (&beta, &plusmn, SE: 10.93 &plusmn, 5.27, p = 0.01, 13.11 &plusmn, 4.96, p = 0.01, respectively). The three most common sandwich types reported, in descending order, were cold cuts, beef, and poultry.

Knowledge of various aspects of dietary diversity (DD)&mdash, an essential healthful dietary component&mdash, across adulthood is limited. This study examined three DD aspects over time in racially diverse adults. Participants were from the National Institute on Aging, Healthy Aging in Neighborhoods of Diversity across the Life Span study. DD measures were calculated at baseline (N = 2177), and first and second examination follow-ups (N = 2140 and N = 2066, respectively) using two 24-h recalls. The count was based on the consumption of &ge, 50% of an equivalent from 21 food groups. Evenness was derived using the Berry-Index adjusted by the food&rsquo, s health value, dissimilarity, by Mahalanobis Distance. Mixed-effects linear regression models were conducted to test changes in DD across adulthood, adjusting for sex, race, poverty status and education as fixed effects, and adjusting for smoking, age and energy as time-dependent variables. Only dissimilarity showed significant interactions of time &times, race (p = 0.0005), and time &times, poverty status (p = 0.0325), indicating a slower rate of increase over time in dissimilarity scores among Whites compared with African&ndash, Americans and those with income &gt, 125% poverty versus &lt, 125% poverty. A significant interaction between time&times, energy (p &lt, 0.0001) was noted for both evenness and dissimilarity scores. To our knowledge, this is the first study to document the differential change in dissimilarity scores by race and income over time.

Complex processes appear to link sleep duration and quality with dietary patterns. Numerous studies show healthful benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, but few have examined its association with sleep duration or quality. The current study tested cross-sectional associations of DASH diet quality score with sleep quality among adults. Analyses of participants were from the 2005&ndash, 2008 wave of the National Health and Nutrition Examination Surveys (n = 3941 adults &ge, 30 years of age, complete data). We performed sex- and age group-stratified multiple OLS regression analyses with DASH total score and components as main predictors and sleep quality as main outcomes, adjusting sequentially for socio-demographic, behavioral and health-related factors. Sex and age differences in associations of DASH with sleep quality, adjusting for covariates, were also examined by incorporating two-way interaction terms between sex/age and the DASH score in each unstratified model. We found that the DASH diet score was inversely related to poor sleep-related daytime dysfunction adjusted by age, sex, demographic and socio-economic factors. Some sex-specific associations were detected between DASH diet component scores and sleep quality. Notably, the potassium DASH component was inversely associated with Factor 1 (&ldquo, sleepiness and sleep disturbance&rdquo, ) among women. The fiber DASH component was associated with better sleep quality and inversely related to Factor 2 (&ldquo, sleep-related daytime dysfunction&rdquo, ) in younger subjects. This study indicates health benefits of the DASH diet for sleep duration and quality. Future longitudinal studies and randomized placebo-controlled trials are required to ascertain protective effects.

Elevated blood homocysteine (Hcy) among middle-aged adults can increase age-related disease risk, possibly through other biochemical and hematological markers. We selected markers for hyperhomocysteinemia among middle-aged adults, studied time-dependent Hcy-marker associations and computed highly predictive indices of hyperhomocysteinemia, with cross-sectional and longitudinal validations. We used data from the National Health and Nutrition Examination Survey (NHANES III, phase 2, nmax = 4000), the NHANES 1999&ndash, 2006 (nmax = 10,151) and pooled NHANES (cross-sectional validation). Longitudinal validation consisted of mixed-effects linear regression models (Hcy predicting markers&rsquo, annual rates of change), applied to the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS, n = 227&ndash, 244 participants, k = 2.4 repeats/participant, Agebase: 30&ndash, 65 years) data. Machine learning detected nine independent markers for Hcy &gt, 14 &micro, mol/L (NHANES III, phase 2): older age, lower folate and B-12 status, higher serum levels of creatinine, uric acid, alkaline phosphatase, and cotinine, mean cell hemoglobin and red cell distribution widths (RDW), results replicated in the 1999&ndash, 2006 NHANES [AUC = 0.60&ndash, 0.80]. Indices combining binary markers increased elevated Hcy odds by 6.9&ndash, 7.5-fold. In HANDLS, first-visit Hcy predicted annual increase in creatinine, RDW and alkaline phosphatase, with third-visit index (2013&ndash, 2018) directly predicting Hcy (2004&ndash, 2009). We provide evidence of the internal and external validity of indices composed of several biomarkers that are strongly associated with elevated Hcy.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is linked to slower weight gain over time. Elevated depressive symptoms may lead to poor quality diets, potentially increasing Body Mass Index (BMI). This study explored these pathways using longitudinal data extracted from 1201&ndash, 1458 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants. DASH mean score was computed using four 24 h recalls [visits(v)1 + v2/2: 2004&ndash, 2013] and depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) scale (v1 + v2/2: 2004&ndash, 2013). BMI was measured at v2: 2009&ndash, 2013 and v3: 2013&ndash, 2017. Multiple linear mixed regression and mediation modeling were conducted, linking CES-D(mean) and DASH(mean) to BMI [v2 and annualized change &Delta, BMI (v3-v2)] and exploring mediation of the CES-D(mean)&ndash, BMI(v3) and DASH(mean)&ndash, BMI(v3) associations through DASH(mean) and CES-D(mean), respectively. Models were further stratified by sex, race and poverty status. Inverse cross-sectional and longitudinal relationships of DASH(mean) with BMI(v2) and &Delta, BMI were detected, mainly in women and &lt, 125% of poverty participants. CES-D(mean) was not associated with BMI(v3), no mediation was detected through DASH(mean) in all socio-demographic strata. Moreover, the inverse DASH(mean)&ndash, BMI(v3) total effect was not mediated through CES-D(mean). Future studies should explore other pathways aside from depressive symptoms by which DASH can have a preventive effect on weight status over time.

Lower cost can lead to poorer-quality diets, potentially worsening metabolic profiles. We explored these pathways among urban adults. Longitudinal data were extracted from 1224&ndash, 1479 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. DASH(mean) (Dietary Approaches to Stop Hypertension) score was computed using four 24 h recalls (v1/v2: 2004&ndash, 2013) linked with a national food price database to estimate monetary value of the diet [MVD(mean)]. Allostatic load (AL) was measured at visits 2 (v2) and 3 (v3) in 2009&ndash, 2018. Mixed-effects regression and structural equation modeling (SEM) were conducted, linking MVD(mean)/DASH(mean) to AL [v2 and annual change(v3&ndash, v2)] and exploring mediating pathways between MVD(mean) and AL(v3) through DASH(mean), stratifying by sex, race and poverty status. MVD(mean) tertiles were linearly associated with contemporaneous DASH(mean), after energy adjustment. In mixed-effects regression models, DASH(mean) was consistently linked to lower AL(v2). DASH(mean) and MVD(mean) were positively associated with higher serum albumin(v2). In SEM, MVD(mean) was linked to AL(v3) through DASH(mean), mainly among Whites and specifically for the cholesterol and Waist-Hip-Ratio AL components. In summary, energy and other covariate-adjusted increase in MVD may have a sizeable impact on DASH which can reduce follow-up AL among urban White middle-aged adults. More studies are needed to replicate findings in comparable samples of urban adults.

We examined the interactive associations of poor diet quality and Alzheimer&rsquo, s Disease (AD) genetic risk with cognitive performance among 304 African American adults (mean age~57 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. In this cross-sectional study, selected participants had complete predictors and covariate data with 13 cognitive test scores as outcomes. Healthy Eating Index-2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH), and mean adequacy ratio (MAR) were measured. A genetic risk score for AD in HANDLS (hAlzScore) was computed from 12 selected single nucleotide polymorphisms (SNPs). Our key hypotheses were tested using linear regression models. The hAlzScore was directly associated with poor performance in verbal memory (&minus, 0.4 &plusmn, 0.2, 0.01) and immediate visual memory (0.4 &plusmn, 0.2, 0.03) measured in seconds, in women only. The hAlzScore interacted synergistically with poorer diet quality to determine lower cognitive performance on a test of verbal fluency. Among numerous SNP &times, diet quality interactions for models of cognitive performance as outcomes, only one passed correction for multiple testing, namely verbal fluency. Our results suggest that improved diet quality can potentially modify performance on cognitive tests of verbal fluency among individuals with higher AD genetic risk.

The study objectives were to measure dietary diversity (DD) of an urban US population and to determine if associations of 10 year atherosclerotic cardiovascular (ASCVD) risk with DD were independent of dietary quality. Participants were drawn from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, wave 4 (n = 2066, 1259 African Americans (AA), 807 Whites (W). Three DD measures were derived from 2 days of 24 h recall data collected with the USDA automated-multiple-pass-method. Count was based on consumption of at least half an equivalent of food from 21 subgroups. Evenness was calculated using Berry Index (BI) and BI-adjusted by food health values. Dissimilarity was calculated by Mahalanobis Distance. Diet quality was assessed by Mean Nutrient Adequacy (MAR) and DASH scores. Associations of DD and quality with ASCVD risk, calculated using 2013 American College of Cardiology and American Heart Association guidelines, were assessed with multivariable regression. Covariates included income, education, food security, and energy/kg weight. Count and MAR were positively associated whereas dissimilarity was negatively associated with ASCVD risk. There was no evidence that evenness contributed to cardiovascular health. The findings suggest more diversity in food attributes and diets rich in micronutrients rather than increased count support cardiovascular health.

Objective: We investigated cross-sectional and longitudinal associations of diet quality with middle-aged caregiver status. Methods: Caregiving in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American (AA)) was measured at waves 3 (2009–2013) and 4 (2013–2017) (mean follow-up time 4.1 years). Diet quality was assessed by the Healthy Eating Index 2010 (HEI-2010) derived from two separate 24 h diet recalls. Multivariable ordinary least square regression was performed for cross-sectional analyses of the association of wave 4 caregiving with wave 4 HEI-2010. Wave 3 caregiving was examined both cross-sectionally and with annual rate of change in HEI using mixed-effects linear regression Models. Multivariable models were adjusted for age, sex, and poverty status. Results: Cross-sectional analyses at wave 4 demonstrate an inverse association of frequent caregiving (“Daily or Weekly” vs. “Never”) for grandchildren with HEI-2010 total score (i.e., lower diet quality) among Whites (β = −2.83 ± 1.19, p = 0.03, Model 2) and AAs (β = −1.84 ± 0.79, p = 0.02,). The “cross-sectional” analysis pertaining to grandchildren caregiving frequency suggested that frequent caregiving (i.e., “Daily or Weekly” vs. “Never” (β = −2.90 ± 1.17, p = 0.04)) only among Whites was inversely related to HEI-2010 total score. Total HEI-2010 score was also related to caring (Model 1), for the elderly over “5 years vs. Never” among Whites (−7.31 ± 3.54, p = 0.04, Model 2). Longitudinally, we found slight potential improvement in diet quality over time (“Daily or Weekly” vs. Never by TIME interaction: +0.88 ± 0.38, p = 0.02) with frequent caregiving among Whites, but not so among AAs. Conclusions: Frequent caring for grandchildren had an inverse relationship with the diet quality of White and AA urban middle-aged caregivers, while caring for elderly was inversely linked to diet quality among Whites only. Longitudinal studies should address the paucity of research on caregivers’ nutritional quality.

Carotenoids may strengthen the association of antioxidant vitamins A, C, and E with favorable cognitive outcomes over time, though a few prospective studies have examined this hypothesis. We evaluated the longitudinal data from 1251 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (Age at visit 1 in 2004&ndash, 2009 (v1): 30&ndash, 65 years). Vitamins A, C, and E dietary intakes and total and individual dietary carotenoids were computed using two 24-h recalls at v1. Cognitive tests, covering global mental status and domains of memory/learning, attention, psychomotor speed, visuo-spatial, language/verbal, and executive function were conducted at v1 and/or v2 (2009&ndash, 2013), mean &plusmn, SD follow-up: 4.66 &plusmn, 0.93 years. Mixed-effects linear regression models detected an interaction between vitamin E and total (and individual) carotenoids for three of 11 cognitive tests at v1, with only one meeting the statistical significance upon multiple testing correction whereby vitamin E was linked with greater verbal memory performance in the uppermost total carotenoid tertile (&gamma, 0a = +0.26 &plusmn, 0.08, p = 0.002), a synergism largely driven by carotenoid lycopene. Vitamins A and C showed no consistent interactions with carotenoids. In conclusion, we provide partial evidence for synergism between vitamin E and carotenoids in relation to better baseline cognitive performance, pending further studies with time-dependent exposures and randomized trials directly examining this synergism.

Flavonoids are polyphenolic phytochemicals with health-promoting properties, yet knowledge about their intake in at-risk populations is limited. This study sought to estimate intakes of total flavonoids and six flavonoid classes in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, determine if differences in intakes exist by race (African American (AA) and White (W)) and income (&lt, or &gt, 125% Federal poverty guidelines), and compare intakes to those of a nationally representative population with similar demographic and socioeconomic characteristics. Data transformation normalized the flavonoid intake distributions prior to conducting statistical tests. With the exception of the flavanone class, flavonoid intakes of AAs were significantly lower than those of W (p &lt, 0.01), regardless of other potential mediating factors including sex, age, and income. Total flavonoid intakes in HANDLS did not differ from intakes in the nationally representative study, but anthocyanidin and flavone intakes were lower, and race specific differences were found for several flavonoid classes. These findings imply that benefits attributable to flavonoid consumption may not be experienced equally by AAs and Whites, nor in vulnerable populations such as that represented by HANDLS relative to the U.S. population, and may play a role in observed health disparities.

The authors wish to make a correction to Table 2 in the published version of their paper [...]

This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults &ge, 30 years of age from the 2001&ndash, 2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1&ndash, 8) (with 78.3% scoring &lt, 4.5), whereas the median allostatic load score was 3 (range: 0&ndash, 9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.

Little is known about the effects of diet quality through adulthood and its association with malnutrition later in life. The first research objective was to evaluate diet quality assessed by Mean Adequacy Ratio (MAR) of United States African American and White adults (n = 2066), examined at baseline and two follow-up waves in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The sample was split into cohorts by age at study baseline: Younger, &lt, 50, and older, &ge, 50 years. The second objective was to assess the association of MAR and risk for malnutrition in adults who were &ge, 60 years at wave 4 (n = 746). The Mini Nutritional Assessment was used to determine risk for malnutrition. At each of the three study waves, 17 micronutrients from two 24 h dietary recalls were used to calculate MAR. Over 13 years MAR changed minimally in the younger cohort as they aged from early to middle adulthood. In contrast, a statistically significant decline in MAR was observed for the older cohort between baseline (2004&ndash, 2009) and wave 4 (2013&ndash, 2017), with a greater degree of worsening at low energy levels. The risk for malnutrition was significantly associated with consuming a diet low in energy, lower protein as a percent of energy at baseline, as well as being food insecure, a current smoker, and having income &lt, 125% poverty. The risk for malnutrition was not associated with a change in protein intake in years prior to age 60, change in MAR scores across waves, MAR at wave 4, age, sex, race, or having hypertension or diabetes. These longitudinal study findings revealed that diet quality was not predictive of risk for malnutrition.