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To investigate the effects of COVID-19 on individuals with tinnitus and their views to guide future tinnitus care. A mixed-methods cross-sectional research design. An online survey was completed by 365 individuals with tinnitus from Australia and other countries. Tinnitus was reported to be more bothersome during the pandemic by 36% of respondents, whereas 59% reported no change and 5% reported less bothersome tinnitus. Nearly half of the respondents had received COVID-19 vaccination(s) and 12% of them reported more bothersome tinnitus while 2% developed tinnitus post-vaccination. Australian respondents spent less time in self-isolation or quarantine and saw fewer change in in-person social contact than respondents from other countries. More than 70% of respondents thought that tinnitus care services were insufficient both before and during the pandemic. Regarding their opinions on how to improve tinnitus care in the future, five themes including alleviation of condition, government policies, reduced barriers, self- and public-awareness, and hearing devices were identified. A majority of respondents did not perceive any change in tinnitus perception and one-third of respondents had worsened tinnitus during the pandemic. To improve tinnitus care, better awareness and more accessible resources and management are crucial. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess whether objectively measured hearing loss and self-perceived hearing handicap in adults are independently associated with food insecurity, and vice versa. Design: Cross-sectional population-based study. Population: 2,500 participants aged 50+ years from the Blue Mountains Hearing Study, with both complete pure-tone audiometry data and information on food security status. Measurements: The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4KHz) >25 dB HL in the better ear, established the presence of hearing loss. Self-perceived hearing handicap was assessed by administering the Hearing Handicap Inventory for Elderly Screening (HHIE-S total scores of ≥8 indicates hearing handicap). A 12-item food security survey was administered, comprising statements related to individual and household food situations. Results: Food insecurity was reported by 12.8% of study participants. After adjusting for all potential confounders, any self-perceived hearing handicap significantly increased the likelihood of participants reporting food insecurity by 94% (p<0.0001). Participants reporting any, mild or severe self-perceived hearing handicap had around 2-fold greater odds of experiencing food insecurity. Objectively measured hearing loss did not significantly influence the food security status of study participants. Conversely, food insecurity was significantly associated with both objectively measured hearing loss and self-perceived hearing handicap: multivariate-adjusted OR 1.37 (95% CI 1.01–1.88) and OR 1.83 (95% CI 1.40–2.39), respectively. Conclusions: Food insecurity was an important social determinant of hearing health among community-dwelling adults. Conversely, participants with a significant self-perceived hearing handicap were more likely to experience food insecurity. These findings add to our understanding of the substantial public health impact of both food insecurity and hearing loss and may highlight areas for future intervention. [ABSTRACT FROM AUTHOR]

Purpose: Dietary flavonoids are bioactive compounds that have been widely investigated for their associations with vascular health outcomes. As the development of tinnitus has been linked to vascular pathways, dietary flavonoids may have role in the prevention of tinnitus symptoms. This study reports the associations between the intakes of major classes of dietary flavonoids and 10-year incidence of tinnitus. Methods: Of the 1753 participants (aged ≥ 50 years) from the Blue Mountains Hearing Study with complete baseline data on tinnitus symptoms and dietary intakes, 536 (31%) cases of tinnitus were identified and excluded from further analysis. Dietary data was collected using a semi-quantitative food frequency questionnaire and intakes of the five major classes of flavonoids were determined using U.S. Department of Agriculture flavonoid databases. Presence of prolonged tinnitus was assessed by a positive response to a single question administered by an audiologist. Results: Of the remaining 1217 participants without tinnitus at baseline, 222 (18%) incident cases of tinnitus were identified over 10 years. After age–sex adjustment, participants in the third versus first quartile of proanthocyanidin intake were significantly less likely to develop incident tinnitus by 36% (HR = 0.64; 95% CI 0.43–0.96, Ptrend = 0.04). Following multivariable adjustment, this protective trend was non-significant (HR = 0.60; 95% CI 0.39–0.92; Ptrend = 0.06). Similarly, a non-significant protective trend was observed when comparing the fourth versus first quartile of intake of all flavonoids (OR = 0.61; 95% CI 0.39–0.96). No other associations were observed. Conclusion: Our findings do not support the hypothesis that dietary flavonoids are protective against the development of tinnitus over 10 years. The weak significant association observed between proanthocyanidin and incident tinnitus may be a chance finding as there was no significant trend following multivariate adjustments and, therefore, requires further studies to investigate these associations. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether dietary intake of flavonoids are associated with longitudinal treatment outcomes of patients with neovascular age-related macular degeneration (nAMD). Methods: 547 participants with nAMD were recruited at baseline, 494 were followed-up after receiving 12 months of anti-vascular endothelial growth factor (anti-VEGF) therapy. Baseline dietary intake of flavonoids was determined using a validated food frequency questionnaire. At follow-up, presence of intra-retinal and sub-retinal fluid (IRF and SRF), retinal pigment epithelium detachment and measurements of central macular thickness (CMT) were recorded from optical coherence tomography scans. Visual acuity (VA) was documented using LogMAR charts. Results: Participants in the first tertile of intake of the flavonol quercetin, and the flavan-3-ols epigallocatechin-3-gallate and epigallocatechin had significantly worse vision than participants in the third tertile—multivariable-adjusted least square (LS) mean VA: 14.68 vs. 19.53 (p = 0.04); 14.06 vs. 18.89 (p = 0.04); 13.86 vs. 18.86 (p = 0.03), respectively. Participants in the first compared to the third tertile of flavan-3-ol, epigallocatechin-3-gallate and epigallocatechin intake all had a twofold higher risk of IRF, multivariable-adjusted p trend of: 0.03, 0.01 and 0.02, respectively. The first vs. the third tertile of tea intake had significantly worse vision (LS mean VA: 13.49 vs. 19.04, p = 0.02), increased risk of IRF (OR 2.13, 95% CI 1.18–3.85) and greater mean CMT (279.59 μm vs. 256.52 μm, p = 0.04). Conclusions: Higher intakes of dietary flavonoids, specifically flavonols and flavan-3-ols, could be associated with better long-term treatment outcomes in nAMD patients receiving anti-VEGF therapy. Confirmation of these associations in interventional studies could result in promising new therapeutic approaches to the treatment of nAMD. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we assessed whether there are independent associations between dietary total flavonoid intake and major flavonoid classes with retinal arteriolar and venular calibre. Methods: Blue Mountains Eye Study participants aged 49+ years who had complete data on diet and retinal vessel measures were analysed (n = 2821). Dietary intake was assessed using a semi-quantitative Food-Frequency Questionnaire (FFQ). Flavonoid content of foods in the FFQ was estimated using the US Department of Agriculture Flavonoid, Isoflavone and Proanthocyanidin databases. Fundus photographs were taken and retinal vascular calibre was measured using validated computer-assisted techniques. The associations of intake of dietary flavonoids with retinal vessel calibre were examined in linear regression models and general linear model. Results: The highest quartile of intake was compared with the lowest quartile using multivariable-adjustment models. Participants with the highest proanthocyanidin intake had narrower retinal venules (223.9 ± 0.62 versus 226.5 ± 0.63, respectively; Ptrend = 0.01); and the highest isoflavone intake was associated with wider retinal arterioles (188.1 ± 0.55 versus 186.3 ± 0.56, respectively; Ptrend = 0.01). The highest apple/pear consumption (a dietary source of catechin) was associated with narrower retinal venules (223.8 ± 0.57 versus 226.1 ± 0.52; Ptrend = 0.01) and wider retinal arterioles (187.9 ± 0.51 versus 186.2 ± 0.51; Ptrend = 0.02). Further, participants who were in the highest versus lowest quartile of chocolate consumption had ~ 2.1 μm narrower retinal venules (multivariable-adjusted P = 0.03). Conclusions: This study shows that higher intakes of specific flavonoid subclasses are associated with a favourable retinal microvascular profile. Greater consumption of flavonoid-rich apples/pears and chocolate was also associated with beneficial variations in retinal vascular calibre. [ABSTRACT FROM AUTHOR]

Purpose: Existing research suggests that changes to retinal vascular caliber reflect nitric oxide (NO)-dependent endothelial dysfunction. Dietary nitrate is an important source of NO; however, studies on the link between dietary nitrate intake and retinal microvasculature are lacking. We aimed to assess the cross-sectional association between intake of dietary nitrate (from vegetable and non-vegetable sources) and retinal arteriolar and venular caliber among older adults. Methods: Participants from the Blue Mountains Eye Study aged 49+ years with complete data at baseline on diet and retinal vessel measures were analyzed (n = 2813). Dietary intake was assessed using a validated semi-quantitative food-frequency questionnaire. Nitrate intake from vegetable and non-vegetable sources was estimated using a validated comprehensive database and other published data where necessary. Fundus photographs were taken and retinal vascular caliber measured using validated computer-assisted techniques and summarized. Results: Participants in the lowest versus highest tertile of vegetable nitrate intake had significantly narrower retinal arterioles: 186.2 ± 0.48 versus 187.6 ± 0.48 µm (multivariable-adjusted p = 0.04). After multivariable adjustment, each 10-unit higher intake of total nitrate and vegetable nitrate was associated with 0.089 ± 0.004 and 0.090 ± 0.004 µm wider retinal arteriolar caliber, respectively, both p = 0.03. Each 10-unit higher vegetable nitrate intake was associated with 0.092 ± 0.005 µm narrower retinal venules (p = 0.05). Conclusion: Intake of dietary nitrate, particularly from vegetable sources, was associated with beneficial variations in both retinal arteriolar and venular caliber among older adults. Further research into associations between dietary nitrate and the retinal microvasculature could allow for greater understanding and possible prevention of clinical cardiovascular events. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to examine the prospective association between dietary glycemic index (GI) and glycemic load (GL) of foods consumed, intakes of carbohydrates and fiber, and the ability to perform activities of daily living (ADL) in older adults. Methods: A total of 844 participants from the Blue Mountains Eye Study aged 60 years or older were examined from 2002–2004 to 2007–2009. Dietary information was collected using a validated, semi-quantitative food-frequency questionnaire. The Older Americans Resources and Services activities of daily living scale were administered to assess the functional status of participants. Multivariable logistic regression analysis was performed. Results: After multivariable adjustment, participants who were in the second and third quartiles of energy-adjusted total fiber intake compared to those in the first quartile of intake (reference group) at baseline had reduced risk of incident impaired instrumental activities of daily living (IADL) 5 years later: OR, 0.39 (95% CI 0.22–0.70) and OR 0.54 (95% CI 0.30–0.95), respectively. Analyses that involved dichotomized total fiber intake showed that participants in the upper three quartiles of total fiber intake (> 19 g/day), compared to those in the lowest quartile of intake (≤ 19 g/day) or reference group, had reduced IADL disability risk 5 years later: OR 0.49 (95% CI 0.31–0.79). Non-significant associations were observed with total carbohydrates, GI, and GL and with risk of impaired total and basic ADL at 5-year follow-up. Conclusions: Habitual fiber consumption might be beneficial in leading to improved health status subserving performance of instrumental daily activities, needed to function in the community. [ABSTRACT FROM AUTHOR]

Abstract Background Dietary nitrate, found predominantly in green leafy vegetables and beetroot, is a precursor of nitric oxide. Under- or overproduction of nitric oxide is implicated in the etiology of several eye diseases. However, the potential influence of dietary nitrate intake on age-related macular degeneration (AMD) risk has not been assessed. Objective To investigate the temporal association between dietary nitrate intake (from both vegetable and nonvegetable sources) and the 15-year incidence of AMD, independent of potential confounders. Design A longitudinal cohort study conducted from 1992-1994 to 2007-2009. Participants/setting The Blue Mountains Eye Study is a population-based study of adults aged 49+ at baseline, from a region west of Sydney, Australia. At baseline, 2,856 participants with complete dietary data and AMD information were examined, and of these, 2,037 participants were re-examined 15 years later and thus included in incidence analysis. Main outcomes measured Incidence of AMD (main outcome) was assessed from retinal photographs. Dietary intake was assessed using a semiquantitative food-frequency questionnaire. Nitrate intake from vegetables and nonvegetable sources was calculated by use of a validated comprehensive database. Results After adjusting for age, sex, smoking, energy intake, fish consumption, and AMD risk alleles (complement factor H and age-related maculopathy susceptibility-2 single nucleotide polymorphisms), participants in the third quartile compared with those in the first quartile (reference group) of total nitrate and total vegetable nitrate intake had reduced risk of incident early AMD: odds ratio (OR) 0.61 (95% CI 0.41 to 0.90) and OR 0.65 (95% CI 0.44 to 0.96), respectively. Significant associations were not observed between the fourth vs first quartile of total nitrate and vegetable nitrate intake with incident early AMD: OR 0.74 (95% CI 0.51 to 1.08) and OR 0.69 (95% CI 0.47 to 1.00), respectively. Nonsignificant associations were also observed with 15-year incidence of late AMD and total nonvegetable nitrate intake. Conclusions These novel findings could have important implications, if the association between total nitrate intake and vegetable nitrate intake and 15-year incidence of early AMD is confirmed in other observational or intervention studies. [ABSTRACT FROM AUTHOR]

Background: The majority of research performed to date has examined the effects of commonly known antioxidants such as vitamins C, E, and A and carotenoids on age-related macular degeneration (AMD) risk and progression. To date, there is limited research on promising phytochemicals with antioxidant and antiinflammatory properties, including flavonoids. Objective: In this exploratory study, we aimed to assess the independent associations between dietary intake of total flavonoids and common flavonoid classes with the prevalence and 15-y incidence of AMD. Design: In this population-based cohort study, 2856 adults aged ≥49 y at baseline and 2037 followed up 15 y later were included in prevalence and incidence analyses, respectively. Dietary intake was assessed by using a semiquantitative food-frequency questionnaire (FFQ). Estimates of the flavonoid content of foods in the FFQ were assessed by using the USDA Flavonoid, Isoflavone, and Proanthocyanidin databases. AMD was assessed from retinal photographs. Results: In cross-sectional analysis, each 1-SD increase in total overall flavonoid intake was associated with a reduced likelihood of any AMD (multivariable-adjusted OR: 0.76; 95% CI: 0.58, 0.99). Each 1-SD increase in dietary intake of total flavonols and total flavanones was associated with reduced odds of the prevalence of any AMD [multivariable-adjusted OR (95% CI): 0.75 (0.58, 0.97) and 0.77 (0.60, 0.99), respectively]. A marginally significant trend (P = 0.05) was observed between increasing the intake of total flavanone and hesperidin (from the first to the fourth quartile) and reduced likelihood of incident late AMD, after multivariable adjustment. Participants who reported ≥1 serving of oranges/d compared with those who never consumed oranges at baseline had a reduced risk of late AMD 15 y later (multivariable-adjusted OR: 0.39; 95% CI: 0.18, 0.85). Conclusions: Our findings suggest an independent and protective association between dietary intake of flavonoids and the likelihood of having AMD. [ABSTRACT FROM AUTHOR]

We aimed to examine the relationship between dietary glycaemic index (GI) and glycaemic load of foods consumed, intakes of carbohydrates, sugars and fibre, and the prevalence of depressive symptoms in older adults. Data collected from 2334 participants aged 55+ years and 1952 participants aged 60+ years were analysed. Dietary information was collected using a semi-quantitative FFQ. Depressive symptoms were based on antidepressant use or either the 36-Item Short-Form Survey, which included the Mental Health Index (MHI), or the Center for Epidemiologic Studies Depression-10 Scale. Participants in the highest v. lowest tertile of dietary GI intake had increased odds of depressive symptoms (assessed by the MHI scale), multivariable-adjusted OR 1·55 (95 % CI 1·12, 2·14). Participants in the highest compared with lowest tertile of fruit consumption had reduced odds of prevalent depressive symptoms, multivariable-adjusted OR 0·66 (95 % CI 0·46, 0·95). Total fibre, vegetable fibre and breads/cereal fibre intakes were all inversely associated with the prevalence of depressive symptoms, with global P values of 0·03, 0·01 and 0·03, respectively. Participants in the second v. first tertile of vegetable consumption had 41 % reduced odds of prevalent depressive symptoms, multivariable-adjusted OR 0·59 (95 % CI 0·40, 0·88). We show that dietary GI and fibre intakes as well as consumption of fruits and vegetables are associated with the prevalence of depressive symptoms. [ABSTRACT FROM AUTHOR]

Objectives: There are few reported data on the relationship between dairy food consumption and health-related quality of life (QOL). In this cohort study, we aimed to assess the association between dairy food intake and QOL scores during adolescence.Methods: Of the 1216 participants who were followed up over 5 years (i.e., from age 12 to 17), 858 participants had complete data on dietary intakes and information on QOL scores at the 5-year survey. Dairy consumption was assessed from validated semiquantitative food frequency questionnaires. Health-related QOL was assessed by the Pediatric Quality of Life Inventory (PedsQL).Results: Among adolescent boys, after multivariable adjustment, those in the highest tertile of yogurt consumption compared to those in the lowest tertile of consumption had 4.7, 5.9, and 9.1 units higher for total score (p-trend = 0.03), and psychosocial health summary (p-trend = 0.02), and school functioning scores (p-trend = 0.01). Boys who remained in the highest tertile compared to the lowest tertile of yogurt consumption during adolescence from ages 12 to 17 had 7.4 and 12.4 units higher psychosocial health summary (p-trend = 0.04) and school functioning scores (p-trend = 0.02), respectively. Nonsignificant associations were observed among girls and with total dairy intake and milk and cheese consumption.Conclusions: Yogurt consumption in boys could influence health-related QOL scores. Given that ours is an observational study we cannot establish a causal nature and direction of the relationship between yogurt intake and quality of life, our findings require further confirmation and clarification by other studies. [ABSTRACT FROM AUTHOR]

Background: concurrent vision and hearing loss are common in older adults; however, epidemiological data on their relationship with the incidence of falls are lacking. Objective: we assessed the association between dual sensory impairment (DSI) and incidence of falls. We examined the influence of self-perceived hearing handicap and hearing aid use and risk of falls. Design: a population-based, cohort study of participants followed over 5 years. Setting: Blue Mountains, west of Sydney, Australia. Subjects: one thousand four hundred and seventy-eight participants aged 55 and older at baseline were included in longitudinal analyses. Methods: visual impairment was defined as presenting or best-corrected visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dB HL (500-4,000 Hz, better ear). The shortened version of the hearing handicap inventory for the elderly was administered. Incident falls were assessed over the 12 months before each visit. Cognitive impairment was determined using the Mini-Mental State Examination. Results: five-year incidence of falls was 10.4%. Participants with severe self-perceived hearing handicap versus no hearing handicap had increased risk of incident falls, multivariable-adjusted OR 1.93 (95% confidence intervals, CI, 1.02-3.64). Hearing aid users versus non-users had 75% increased likelihood of incident falls. Participants with co-existing best-corrected visual impairment and mild hearing loss (>25 to <40 dB HL) had higher odds of incident falls, OR 2.19 (95% CI 1.03-4.67). After excluding persons with cognitive impairment, this association did not persist. Conclusion: these epidemiological data show that DSI in older adults could significantly increase their risk of falling. [ABSTRACT FROM AUTHOR]

Background: We aimed to establish the frequency and characteristics (e.g. socioeconomic, pre-injury, and crash-related parameters) of injured bicyclists and other injured road users.Methods: 748 participants aged ≥17 years who had sustained a minor or non-catastrophic injury in a land-transport crash, were interviewed after presenting to a metro hospital emergency department in New South Wales, Australia. A telephone-administered questionnaire obtained information on socio-economic, pre-injury health, and crash-related characteristics. These factors were then compared between injured bicyclists and other road users (car driver/passengers, motorcyclists/pillion and pedestrians/skateboarders). Cycling injury severity was characterized by three metrics (sustaining multiple injuries; hospital admission for ≥12 h; and sustaining a head/neck and/or facial injury).Results: In this cohort of people with injuries, 238 (32 %) were bicyclists. Frequency of cycling injuries were significantly different between age-groups among men (p = 0.0002), and were more common in men aged 45-59. Bicyclists were more likely to be aged 45-59, married, have university/tertiary qualifications and have a professional occupation compared to other road users (all p <0.0001). Bicyclists compared to participants involved in other types of land transport crashes were more likely to self-report excellent general health (p = 0.01), and were less likely to report a great/overwhelming perceived danger of death or 15.0 % versus 23-41 %; p <0.0001). Frequency of upper extremity and lower extremity injuries in bicyclists were 81.9 % and 60.5 %, respectively. Explanatory variables significantly associated with injury severity metrics were age, education level, paid work status and perceived danger of death/disability in the crash.Conclusions: Minor cycling injuries were a relatively common cause of mild-moderate injury presentations to metro emergency departments. A wide spectrum of socio-demographic-, pre-injury-, and crash-related characteristics were related to cycling injuries. [ABSTRACT FROM AUTHOR]

Purpose: Decreased smell could cause appetite suppression and malnutrition. However, there is a paucity of longitudinal data between olfaction and nutritional status in older adults. We aimed to prospectively examine the relationship between olfactory impairment and overall diet quality (reflecting adherence to dietary guidelines) in a population-based cohort of older adults. Methods: We used 5-year follow-up data from 557 adults (aged 60+ years at baseline) whose olfaction was measured using the San Diego Odor Identification Test (SDOIT). Dietary data were collected using a validated semiquantitative food frequency questionnaire. A total diet score (TDS) was calculated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Final scores ranged from 0 to 20; higher scores indicated closer adherence to dietary guidelines. Results: After adjusting for all potential confounders, older adults with moderate/severe olfactory impairment (SDOIT score ≤ 3; lower scores indicate impairment) compared with those with no olfactory impairment had significantly lower adjusted mean (±SE) TDS, 9.09 (0.40) versus 9.94 (0.10), p = 0.04. Women with moderate/severe impaired olfaction (i.e., scored poorly on the odor identification test) compared with those with normal olfaction had significantly lower adjusted mean TDS, 8.87 (0.69) versus 10.31 (0.13), p = 0.04. No associations were observed between olfaction and TDS in men. Conclusions: Olfactory impairment in older women could signal an increased risk of poorer diet quality, defined as adherence to national dietary guidelines. Additional longitudinal studies are needed to confirm or refute the observed link between olfactory loss and overall patterns of food intake in older adults. [ABSTRACT FROM AUTHOR]

It is unclear whether lifestyle modifications, such as dietary changes, should be advocated to prevent olfactory dysfunction. We investigated the association between dietary intakes of fats (saturated, mono-unsaturated and polyunsaturated fats, and cholesterol) and related food groups (nuts, fish, butter, margarine) with olfactory impairment. There were 1331 and 667 participants (older than 60 years) at baseline and 5-year follow-up, respectively, with complete olfaction and dietary data. Dietary data were collected using a validated semi-quantitative FFQ. Olfaction was measured using the San Diego Odor Identification Test. In a cross-sectional analysis of baseline data, those in the highest v. lowest quartile of n-6 PUFA intake had reduced odds of having any olfactory impairment, multivariable-adjusted OR 0·66 (95 % CI 0·44, 0·97), P for trend = 0·06. Participants in the highest v. lowest quartile of margarine consumption had a 65 % reduced odds of having moderate/severe olfactory impairment (P for trend = 0·02). Participants in the highest quartile compared to the lowest quartile (reference) of nut consumption had a 46 % (P for trend = 0·01) and 58 % (P for trend = 0·001) reduced odds of having any or mild olfactory impairment, respectively. Older adults in the highest v. lowest quartile of fish consumption had 35 % (P for trend = 0·03) and 50 % (P for trend = 0·01) reduced likelihood of having any or mild olfactory impairment, respectively. In longitudinal analyses, a marginally significant association was observed between nut consumption and incidence of any olfactory impairment, highest v. lowest quartile of nut consumption: OR 0·61 (95 % CI 0·37, 1·00). Older adults with the highest consumption of nuts and fish had reduced odds of olfactory impairment, independent of potential confounding variables. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to establish whether time spent in sport-related physical activities and sedentary behaviors (e.g., TV viewing, videogame usage, and homework) was prospectively associated with change in blood pressure (BP) for 5 yr. Methods: Eight hundred and twenty-one students age 6 yr at baseline (397 girls and 424 boys) were examined from 2003-2004 to 2009-2011. Children completed detailed activity questionnaires. BP was measured using a standardized protocol. Results: After adjusting for age, ethnicity, parental education, parental history of hypertension, baseline height, BP, body mass index (BMI), baseline time spent in corresponding activity behavior, and change in BMI, each hour per day spent in total screen time was associated with a 0.69 and 0.59 mm Hg increase in diastolic BP (P = 0.01) and mean arterial BP (P = 0.01), respectively. In boys, each hour per day spent in TV viewing was associated with a concurrent 1.42-mm Hg increase in diastolic BP (P = 0.04) during the 5 yr. Children engaging in low sport-related physical activities at baseline but who engaged in high levels of physical activity (≥60 min• d -1) at follow-up (n = 154) compared with those engaging in low sport-related physical activities at both examinations (n = 305) demonstrated significantly lower mean arterial BP, 7.26 versus 9.61 mm Hg (P = 0.04). Conclusions: Time spent in physical activity and screen time could influence BP measures during childhood. [ABSTRACT FROM AUTHOR]

We aimed to prospectively examine the association between the combined effects of obesogenic behaviors on quality of life (QOL) in adolescents. Of 2353 Sydney schoolchildren surveyed (median age 12.7 years), 1,213 were re-examined 5 years later at age 17-18. Children completed activity and food-frequency questionnaires. An unhealthy behavior score was calculated, allocating 1 point for the following: <60 minutes of total physical activity/ day; 2 hours of screen time/ day; consumed salty snack foods and/or confectionery ≥5 times per week; ≥1 serves of soft drinks and/or cordial/ day; and not consuming both ≥2 serves of fruit and ≥3 serves of vegetables/ day. Health-related QOL was assessed by the Pediatric Quality of Life Inventory (PedsQL). The prevalence of 0, 1, 2, 3, 4, and 5 lifestyle risk factors was 4.2%, 17.1%, 30.7%, 30.5%, 13.9% and 3.6%, respectively. After multivariable-adjustment, children engaging in 5 versus 0 unhealthy behaviors had 9.2-units lower PedsQL physical summary score (p trend =0.001), five years later. Boys reporting 4 or 5 lifestyle risk factors compared to their peers reporting none or one at baseline, had lower total and physical summary scores at follow-up, ptrend =0.02 and 0.01, respectively. Girls engaging in 4 or 5 versus 0 or 1 unhealthy behaviors, had 4.6-units lower physical summary score (ptrend =0.04), five years later. The number of obesogenic lifestyle risk factors was independently associated with subsequent poorer QOL, particularly physical health, during adolescence. These findings underscore the importance of targeting lifestyle behaviors to promote general well-being and physical functioning in adolescents. [ABSTRACT FROM AUTHOR]

Objectives: Published literature shows that individual nutrients could influence the risk of developing vision and hearing loss. There is, however, a lack of population-based data on the relationship between overall patterns of food intake and the presence of concurrent vision and hearing impairment. We aimed to assess the associations between diet quality with the prevalence and 5-year incidence of dual sensory impairment (DSI). Design: Cross-sectional and 5-year longitudinal analyses. Setting: Blue Mountains, Sydney, Australia. Participants: 2443 participants aged ≥50 from baseline were examined and followed over 5 years. Measurements: Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet score (TDS). Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500-4000 Hz, better ear). Results: After adjusting for age, sex, education, noise exposure, current smoking, and type 2 diabetes, participants in the lowest compared to the highest quintile of TDS had a 2-fold increased likelihood of having prevalent DSI, odds ratio, OR, 2.62 (95% confidence intervals, CI, 1.08-6.36), P-trend=0.04. Significant associations were not observed between TDS and the prevalence of having a single sensory impairment (vision or hearing loss). Baseline TDS was not significantly associated with the 5-year incidence of DSI. Adherence to dietary guidelines was associated with a reduced likelihood of having DSI in cross-sectional, but not in longitudinal analyses. Conclusions: Further studies with adequate power are warranted to assess the prospective relationship between diet quality and DSI. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nutritional parameters could influence self-perceived health and functional status of older adults. Objective: We prospectively determined the association between diet quality and quality of life and activities of daily living. Design: This was an observational cohort study in which total diet scores, reflecting adherence to dietary guidelines, were determined. Dietary intakes were assessed using a food frequency questionnaire at baseline. Total diet scores were allocated for intake of selected food groups and nutrients for each participant as described in the Australian Guide to Healthy Eating. Higher scores indicated closer adherence to dietary guidelines. Participants/setting: In Sydney, Australia, 1,305 and 895 participants (aged ≥55 years) with complete data were examined over 5 and 10 years, respectively. Main outcome variables: The 36-Item Short-Form Survey assesses quality of life and has eight subscales representing dimensions of health and well-being; higher scores reflect better quality of life. Functional status was determined once at the 10-year follow-up by the Older Americans Resources and Services activities of daily living scale. This scale has 14 items: seven items assess basic activities of daily living (eg, eating and walking) and seven items assess instrumental activities of daily living (eg, shopping or housework). Statistical analyses performed: Normalized 36-Item Short-Form Survey component scores were used in analysis of covariance to calculate multivariable adjusted mean scores. Logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs to demonstrate the association between total diet score with the 5-year incidence of impaired activities of daily living. Results: Participants in the highest vs lowest quartile of baseline total diet scores had adjusted mean scores 5.6, 4.0, 5.3, and 2.6 units higher in these 36-Item Short-Form Survey domains 5 years later: physical function (P trend=0.003), general health (P trend=0.02), vitality (P trend=0.001), and physical composite score (P trend=0.003), respectively. Participants in the highest vs lowest quartile of baseline total diet scores had 50% reduced risk of impaired instrumental activites of daily living at follow-up (multivariable-adjusted P trend=0.03). Conclusions: Higher diet quality was prospectively associated with better quality of life and functional ability. [Copyright &y& Elsevier]

Non-alcoholic fatty liver disease (NAFLD) is closely associated with insulin resistance and obesity. Hence, carbohydrate quality could be of relevance to the risk of NAFLD, but prospective data are lacking. The aim of the present study was to investigate longitudinal associations between carbohydrate quality (including dietary glycaemic index (GI) and intakes of sugar, starch and fibre) and markers of liver function in an older Australian population. The analysis was based on 866 participants ( ≥ 49 years) of the Blue Mountains Eye Study with fasting blood specimens and dietary intake data at baseline and 5-year follow-up. Multi-level mixed regression analysis was used to relate dietary GI and sugar, starch and fibre intake to the liver enzymes alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT), as well as fasting TAG and HDL-cholesterol (HDL-C). After adjustment for potential confounding factors, a lower fibre intake was cross-sectionally related to higher GGT (P= 0·02) and fasting TAG (P= 0·002) levels, with fruit fibre being the most relevant fibre source (P= 0·095 for GGT; P= 0·003 for TAG). A higher dietary GI was associated with lower HDL-C (P= 0·046). Changes in carbohydrate quality during 5 years were not related to changes in ALT, GGT, TAG or HDL-C (P≥ 0·08). In conclusion, the absence of longitudinal associations between carbohydrate quality and liver enzymes and serum lipids in this older population does not support a major role of carbohydrate nutrition in liver function among the elderly. [ABSTRACT FROM PUBLISHER]

It is unknown whether diet quality is associated with microvascular structure. The present study aimed to investigate the relationship between diet quality, reflecting adherence to dietary guidelines, with retinal microvascular calibre in older adults. The dietary data of 2720 Blue Mountains Eye Study participants, aged 50+ years, were collected using a semi-quantitative FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Fundus photographs were taken and retinal vascular calibre measured using computer-assisted techniques and summarised. After adjusting for age, sex, BMI, mean arterial blood pressure, smoking, serum glucose, leucocyte count and history of diagnosed stroke or CHD, persons with higher TDS had healthier retinal vessels cross-sectionally, with wider retinal arteriolar calibre (by approximately 3 μm, comparing the highest with the lowest quartile of TDS, Ptrend= 0·0001) and narrower retinal venular calibre (by approximately 2·5 μm; Ptrend= 0·02). In younger subjects aged ≤ 65 years, increasing TDS (lowest to the highest quartile) was associated with healthier retinal vessels: approximately 4·4 μm wider retinal arteriolar (Ptrend< 0·0001) and approximately 2·3 μm narrower venular calibre (Ptrend= 0·03). After multivariable adjustment, however, baseline TDS were not associated with retinal arteriolar (Ptrend= 0·89) or venular calibre (Ptrend= 0·25), 5 years later. Also, baseline TDS were not associated with the 5-year change in retinal arteriolar (β = 0·14; P= 0·29) or venular calibre (β = − 0·26; P= 0·07). Greater compliance with published dietary guidelines (higher diet quality) was cross-sectionally associated with wider retinal arterioles and narrower venules, indicating better retinal microvascular health. [ABSTRACT FROM PUBLISHER]

Background: Epidemiologic evidence of a relation between serum total homocysteine (tHcy), vitamin B-12, and folate and age-related macular degeneration (AMD) is inconsistent and unresolved. Objective: In this cohort study, we aimed to investigate associations between intakes and serum concentrations of folate and vitamin B-12 or serum tHcy and 10-y AMD incidence. Design: Serum folate, vitamin B-12, and tHcy were determined from blood samples drawn in 1997-1999 from cohort members aged ≥55 y. AMD was assessed in 1760 survivors from retinal photographs taken in 2002-2004 and 2007-2009. Total intakes of folate and vitamin B-12 were assessed by using a food-frequency questionnaire. Results: After adjustment for age, sex, current smoking, white blood cell count, and fish consumption, each 1-SD increase in serum tHcy was associated with increased risk of incident early and any AMD [ORs (95% CIs): 1.33 (1.09, 1.63) and 1.33 (1.11, 1.60), respectively]. Participants with a serum vitamin B-I 2 deficiency (< 185 pmol/L) had higher risk of incident early and late AMD [ORs (95% CIs): 1.58 (1.06, 2.36) and 2.56 (1.38, 4.73), respectively]. Folate deficiency (< 11 nmol/L) was associated with 75% and 89% increased risk of incident early and any AMD, respectively, 10 y later. Participants who reported supplementary vitamin B-12 intake had 47% reduced risk of incident any AMD (OR: 0.53; 95% CI: 0.33, 0.85). Conclusion: Elevated serum tHcy and folate and vitamin B-12 deficiencies predicted increased risk of incident AMD, which suggests a potential role for vitamin B-12 and folate in reducing AMD risk. [ABSTRACT FROM AUTHOR]

Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during 1992–4, from 2897 people using a 145-item Willett-derived FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine diet quality scores. The Australian National Death Index provided 15-year mortality data using multiple data linkage steps. Hazard risk (HR) ratios and 95 % CI for mortality were assessed for diet quality. Subjects in quintile 5 (highest) of the Total Diet Score had a 21 % reduced risk of all-cause mortality (HR 0·79, 95 % CI 0·63, 0·98, Ptrend= 0·04) compared with those in quintile 1 (lowest) after multivariate adjustment. The present study provides longitudinal support for a reduced risk of all-cause mortality in an older population who have greater compliance with published dietary guidelines. [ABSTRACT FROM PUBLISHER]

ObjectivesWe aimed to establish associations of duration of breast-feeding with mean BMI and waist circumference, as well as the likelihood of being overweight/obese, during early childhood.DesignCross-sectional, population-based study. Height, weight and waist circumference were measured and BMI calculated. Interviewer-administered questionnaire determined whether the child was ever breast-fed and the duration of breast-feeding.SettingSydney, Australia.SubjectsInfants and pre-school children (n 2092) aged 1–6 years were examined in the Sydney Paediatric Eye Disease Study during 2007–2009.ResultsOf the children aged 1–6 years, 1270 had been breast-fed compared with 822 who were never breast-fed. After multivariable adjustment, 1–6-year-old children who were ever breast-fed compared with those who were not had significantly lower BMI, 16·7 (se 0·1) kg/m2v. 17·1 (se 0·2) kg/m2 (P = 0·01). Decreasing BMI was associated with increasing duration of breast-feeding (Ptrend = 0·002). After multivariable adjustment, each month increase in breast-feeding was associated with an average BMI decrease of 0·04 kg/m2 (P = 0·002) and 0·03 kg/m2 (P = 0·03) among children aged 1–2 years and 3–4 years, respectively. In 1–2-year-old children, each month increase in breast-feeding duration was associated with a 0·06 cm decrease in waist circumference (P = 0·04). Significant associations were not observed among 5–6-year-old children. Children who were ever breast-fed v. those never breast-fed were less likely to be overweight/obese (multivariable-adjusted OR = 0·54; 95 % CI 0·36, 0·83).ConclusionsWe demonstrated a modest influence of breast-feeding on children's BMI during early childhood, particularly among those aged less than 5 years. [ABSTRACT FROM AUTHOR]

Background: Higher intake of carbohydrates and high-glycemic index (high-GI) diets could lead to small vessel dysfunction. Objectives: We aimed to assess the associations between intakes of high-GI and high-glycemic load (high-GL) diets, carbohydrate, and the main carbohydrate-containing food groups and retinal microvascular changes in preadolescents. Design: Students aged 12 y (n = 2353) from a random cluster sample of 21 schools underwent detailed eye examinations. Retinal vessel caliber and fractal dimension were measured from digital retinal images. A validated semiquantitative food-frequency questionnaire was administered. Results: After multivariable adjustment, children who consumed soft drinks once or more per day had significantly narrower mean retinal arterioles (-1.9 µm) than did those who never or rarely consumed soft drinks (P-trend = 0.03). When the highest to lowest tertiles of carbohydrate consumption were compared, girls had significantly narrower retinal arterioles (~1.4 µm; P-trend = 0.03), and boys had wider venules (-2.3 µm; P-trend = 0.02). In girls only, a higher-GI diet was associated with narrower retinal arterioles (0.98-//m narrowing of retinal arteriolar caliber per SD increase in GI, P = 0.01). Carbohydrate intake and a high-GL diet were associated with greater retinal fractal dimension in girls (highest compared with lowest tertiles: P-trend = 0.003 and 0.01, respectively). Conclusions: Greater consumption of carbohydrates and soft drinks was associated with retinal arteriolar narrowing and venular widening. Because these microvascular signs have been shown to be markers of future cardiovascular disease risk, the presence of this risk factor in children could support the need for healthy dietary patterns that include lower consumption of high-GI foods and soft drinks. [ABSTRACT FROM AUTHOR]

Background: age-related hearing loss is a common chronic condition; hence, it is important to understand its influence on the functional status of older adults. We assessed the association between hearing impairment with activity limitations as assessed by the activities of daily living (ADL) scale.Methods: a total of 1,952 Blue Mountains Hearing Study participants aged ≥60 years had their hearing levels measured using pure-tone audiometry. A survey instrument with questions on functional status as determined by the Older Americans Resources and Services ADL scale was administered.Results: one hundred and sixty-four (10.4%) participants reported ADL difficulty. A higher proportion of hearing impaired than non-impaired adults reported difficulties in performing three out of the seven basic ADL and six out of the seven instrumental ADL tasks. After multivariable adjustment, increased severity of hearing loss was associated with impaired ADL (Ptrend = 0.001). Subjects with moderate to severe hearing loss compared with those without, had a 2.9-fold increased likelihood of reporting difficulty in ADL, multivariate-adjusted odds ratio (OR): 2.87 [95% confidence interval (CI): 1.59–5.19]. Participants aged <75 years with hearing loss compared with those without, had 2-fold higher odds of impaired ADL. Having worn or wearing a hearing aid was also associated with a 2-fold increased likelihood of impaired ADL.Conclusion: functional status as measured by a common ADL scale is diminished in older hearing impaired adults. Our findings suggest that severely diminished hearing could make the difference between independence and the need for formal support services or placement. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to determine the accuracy of a diet quality measurement tool, the Total Diet Score (TDS) using two validation methods; firstly the TDS calculated from a food frequency questionnaire (FFQ) was compared to the TDS calculated from weighed food records (WFRs); secondly the TDS was compared to a number of dietary biomarkers.Methods and Study Design: Data were collected from a population based cohort study located in the Blue Mountains region of Sydney, Australia. To compare dietary assessment tools, a sub sample of 75 subjects (aged 63 to 83 years) completed the FFQ and three, four-day WFRs at baseline. Fasting blood samples were collected from 2897 subjects at the first follow up in 1997-1999. TDS scores were calculated from both WFRs and FFQs. Methods to compare FFQ TDS scores to WFR TDS scores included paired t-tests, Pearson correlations, Bland-Altman plots, joint classification quartiles and weighted kappa scores. Linear regression analyses were used to assess the relationship between TDS and biomarkers.Results: No significant mean difference was found between FFQ TDS and WFRs TDS (p=0.63) with a significant positive correlation seen between the two methods (r=0.75, p<0001). The Bland-Altman method found no linear trend between the differences and means of TDS scores between the FFQ and WFR (p=0.38). A significant trend for higher serum vitamin B-12, serum folate, homocysteine and lower total cholesterol was found with increasing TDS.Conclusions: These findings suggest that the TDS is a useful tool for assessing diet quality in an older population. [ABSTRACT FROM AUTHOR]