Longitudinal Associations between Monetary Value of the Diet, DASH Diet Score and the Allostatic Load among Middle-Aged Urban Adults

Plasma homocysteine and longitudinal change in cognitive function among urban adults

BACKGROUND

Cross-sectional and longitudinal studies have inconsistently linked cognitive performance and change over time to an elevated level of homocysteine (Hcy), with few conducted among urban adults.

METHODS

Longitudinal data [Visit 1 (2004-2009) and Visit 2 (2009-2013)] were analyzed from up to 1430 selected Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants. Baseline and follow-up blood Hcy was measured, while 11 cognitive function test scores were assessed at either of these two visits. Overall, sex- and race-stratified associations were evaluated using mixed-effects linear regression models, adjusting for key potential confounders. Interaction effects between Hcy and serum levels of folate and vitamin B-12 were also tested.

RESULTS

We found that greater LnHcyv1 was significantly associated with poorer baseline attention based on higher Loge (TRAILS A, in seconds) [β (SE): 0.101 (0.031), P = 0.001]. Heterogeneity was also found by sex and by race. Most notably, among men only, LnHcyv1 was associated with faster decline on the BVRT (# of errors), a measure of visuo-spatial memory (β (SE): 0.297(0.115), P = 0.010, reduced model); while among African American adults only, an elevated and increasing LnHcy over time was associated with faster rate of decline on Loge (TRAILS B, in seconds) [β (SE): +0.012 (0.005), p = 0.008], a measure of executive function. Interactions between Hcy, folate and vitamin B-12 blood exposures were also detected.

CONCLUSIONS

In summary, sex- and race-specific adverse association between elevated Hcy and cognitive performance over time were detected among middle-aged urban adults, in domains of attention, visuo-spatial memory and executive functioning.

Associations of three healthy dietary patterns with homeostatic dysregulation: results from the China Multi-Ethnic Cohort study

BACKGROUND

Homeostatic dysregulation (HD), the measure of aging-related physiological dysregulation, serves as an essential intervenable indicator of aging.

OBJECTIVE

To explore the associations of three healthy dietary patterns with HD, investigate the most recommended dietary patterns, and identify the significant beneficial and harmful food groups METHODS: This prospective cohort study included 8,288 participants aged 30-79 years from the China Multi-Ethnic Cohort (CMEC), with a female majority (61.6%). Dietary information was obtained through the baseline food frequency questionnaire (FFQ). Three dietary patterns were constructed: Dietary Approaches to Stop Hypertension (DASH), alternative Mediterranean diets (aMED), and Healthy Diet Score (HDS). HD was constructed based on clinical biomarkers and anthropometric measurements. Follow-up analyses adjusted for baseline data were employed to assess the longitudinal associations of three dietary patterns at baseline with HD at follow-up. Additionally, quantile G-computation was utilized to evaluate the relative contribution of each food group to the association with HD.

RESULTS

Over a follow-up period of 2.0 years, all healthy dietary patterns exhibited negative associations with HD, with βQ5/Q1 = -0.112, 95%CI (-0.172, -0.051) for HDS, with βQ5/Q1 = -0.073, 95%CI (-0.134, -0.012) for aMED, with βQ5/Q1 = -0.047, 95%CI (-0.107,0.014) for DASH. The results of the component analyses revealed that soybean products were the most significant beneficial food group (relative contribution of 24.0%), while alcohol was identified as the major harmful food group (relative contribution of 76.9%).

CONCLUSION

Healthy dietary patterns, especially HDS, are negatively associated with HD. Additionally, soybean products and alcohol are the most significant beneficial and detrimental food groups respectively. Developing appropriate nutritional strategies may help reduce the burden of disease and promote healthy aging.

Trajectories in allostatic load as predictors of sleep quality among urban adults: Healthy aging in neighborhoods of diversity across the life span study

OBJECTIVE

/Background: The allostatic framework is a theoretical perspective that identifies allostatic load (AL) as a meaningful measure of dysregulation and desynchrony across biological processes due to cumulative stress exposure, thereby increasing disease risk. Research exploring the relationships of AL with sleep quality have yielded inconsistent findings. We examined AL at three visits (2004-2009 [Visit 1], 2009-2013 [Visit 2] and 2013-2017 [Visit 3]) in relation to sleep quality [Visit 3] among urban adults by sex, race and age group.

PATIENTS/METHODS

We analyzed data on 1489 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants [59.6% female, baseline age: 48.2 years, 58.5% African Americans] with available data on cardiovascular, metabolic and inflammatory AL markers and Pittsburgh Sleep Quality Index (PSQI) scores. Least squares regression models were constructed to evaluate AL score at Visit 1 (AL_v1) and z-transformed probability of higher trajectory in AL score between Visit 1 and Visit 3 (AL_traj) as predictors of PSQI score at Visit 3, controlling for demographic, lifestyle and health characteristics at Visit 1. AL_traj was generated using group-based trajectory modeling.

RESULTS

In fully adjusted models, AL_v1 and PSQI score were positively related among men only (β = 0.43, P = 0.001), whereas higher AL_traj was associated with PSQI score among women (β = 0.51, P = 0.001), White (β = 0.45, P = 0.011) and African American (β = 0.33, P = 0.014) populations. There were no statistically significant interactions according to age group (<50 vs. ≥ 50).

CONCLUSIONS

Disparities exist whereby AL trajectory predicted sleep quality among women irrespective of race and baseline AL predicted sleep quality among men. Future studies should examine bi-directional AL-sleep relationships.

Longitudinal association of allostatic load with depressive symptoms among urban adults: Healthy Aging in Neighborhoods of Diversity across the Life Span study

BACKGROUND

Evidence suggests that lifetime exposure to stressful life events and chronic stressors may be linked to geriatric depression. Allostatic load (AL) is considered a mediator of the stress-health relationship and has been linked to psychosocial factors reflecting health disparities. The purpose of this study was to examine the longitudinal associations of AL with depressive symptoms scores among urban adults, before and after stratifying by sex and race.

METHODS

Secondary analyses were performed using Visit 1 (2004-2009), Visit 2 (2009-2013) and Visit 3 (2013-2017) data collected on 2298 Healthy Aging in Neighborhoods of Diversity across the Life Span study participants (baseline age: 30-64 y). AL at Visit 1 (ALv1) and z-transformed probability of higher AL trajectory (ALtraj) between Visits 1 and 3 were calculated using cardiovascular, metabolic and inflammatory risk indicators. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to calculate total and domain-specific depressive symptoms scores. Mixed-effects linear models controlled for socio-demographic, lifestyle and health characteristics.

RESULTS

In fully adjusted models, a positive cross-sectional relationship was observed between ALv1 and "somatic complaints" depressive symptoms (β = 0.21, P = 0.006) score at Visit 1, whereas ALtraj was associated with increasing depressive symptoms score (β = 0.086, P = 0.003) between Visits 1 and 3. An inverse relationship was observed between ALtraj and "positive affect" depressive symptoms score at Visit 1 among women (β = -0.31, P < 0.0001) and White adults (β = -0.32, P = 0.004). Among women, ALtraj was also positively related to change in "somatic complaints" depressive symptoms score between Visits 1 and 3 (β = 0.043, P = 0.020).

CONCLUSIONS

Among urban adults, AL may be associated with "somatic complaints" depressive symptoms at baseline. Higher AL trajectories may predict increasing depressive symptoms (overall) and increasing "somatic complaints" depressive symptoms (among women). A higher AL trajectory may be associated with lower "positive affect" depressive symptoms at baseline among women and White adults only.

Allostatic Load and Cognitive Function Among Urban Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study

BACKGROUND

Cross-sectional studies have linked cognition to allostatic load (AL) which reflects multisystem dysregulation from life course exposure to stressors.

OBJECTIVE

To examine baseline and changes in AL and their relationships with 11 cognitive function test scores, while exploring health disparities according to sex and race.

METHODS

Longitudinal [Visit 1 (2004-2009) and Visit 2 (2009-2013)] data were analyzed from 2,223 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. We calculated AL total score using cardiovascular, metabolic, and inflammatory risk indicators, and applied group-based trajectory modeling to define AL change.

RESULTS

Overall and stratum-specific relationships were evaluated using mixed-effects linear regression models that controlled for socio-demographic, lifestyle, and health characteristics. Baseline AL was significantly associated with higher log-transformed Part A Trail Making Test score [Loge (TRAILS A)] (β= 0.020, p = 0.004) and increasing AL was associated with higher Benton Visual Retention Test score [BVRT] (β= 0.35, p = 0.002) at baseline, in models that controlled for age, sex, race, poverty status, education, literacy, smoking, drug use, the 2010 healthy eating index and body mass index. Baseline AL and AL change were not related to change in cognitive function between visits. There were no statistically significant interaction effects by sex or race in fully-adjusted models.

CONCLUSION

At baseline, AL was associated with worse attention or executive functioning. Increasing AL was associated with worse non-verbal memory or visuo-constructional abilities at baseline. AL was not related to change in cognitive function over time, and relationships did not vary by sex or race.

The association between Mediterranean diet adherence and allostatic load in older adults

Allostatic load (AL) is a multisystemic index of biological wear and tear which is associated with poor health outcomes. In recent years, researchers have examined the association between dietary pattern intake and AL; however, no studies to date have examined the relationship between AL and consumption of a Mediterranean diet. Blood and urine samples were collected from 201 community-dwelling older adults who completed a Food Frequency Questionnaire (FFQ). A Mediterranean Diet Score (MDS) was calculated based on previous recommendations and a sex-based AL index was calculated using a count-based approach for 16 biomarkers associated with neuroendocrine, immune, cardiovascular, or metabolic function. It was hypothesized that a higher MDS would be associated with lower AL, and that this association would be particularly robust for the immune and metabolic subcomponents of the AL index. In support of the primary study hypotheses, generalized linear models revealed a significant inverse relationship between MDS and AL (ß = -0.03, P = 0.037). However, subcomponents of the AL model were not significantly associated with MDS. Exploratory sub-group analyses by sex suggested that the association between AL and MDS was more robust in male than in female participants. The current findings are interpreted with caution given the study design and sample characteristics. Nonetheless, these findings contribute to the literature supporting the Mediterranean diet as an important lifestyle behavior that may minimize AL, and therefore support healthy aging.

Energy intake and season interact to influence physiological stress load among midlife women

Allostatic load (AL) is an index that measures physiologic stress associated with chronic disease risk. One factor that may influence overall physiologic stress load and AL is energy consumption, but whether this association differs across different seasons is unknown. We tested whether energy consumption interacted with the season to influence AL in 52 mid-life (40-60 years) women from the Life in All Seasons Study. Women completed an online 24-h recall every 10 days and had components of allostatic load measured seasonally. Women were from the greater Grand Forks, ND catchment area and were followed for one year between July 2012 and July 2014. We found a significant (p = 0.01) interaction between season and energy consumption on AL. Further inspection showed that, during the summer and winter seasons, the average allostatic load rose with relatively higher energy consumption. We also observed a linear and positive association between AL and energy intake in summer (β = 0.0013 ± 0.0004; p = 0.001; r² = 0.14) and winter (β = 0.0011 ± 0.0004; p = 0.007; r² = 0.10), but not in fall or spring. These results suggest that factors associated with distinct times of the year promote or prevent the effects of higher energy consumption on physiological stress load. Since allostatic load is linked to elevated disease risk, our results provide additional information that may help to explain seasonal differences in disease risk of some women.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Higher-diet quality is associated with higher diet costs when eating at home and away from home: National Health and Nutrition Examination Survey, 2005-2016

OBJECTIVES

To evaluate the association between diet quality and cost for foods purchased for consumption at home and away from home.

DESIGN

Cross-sectional analysis. Multivariable linear regression models evaluated the association between diet quality and cost for all food, food at home (FAH) and food away from home (FAFH).

SETTING

Daily food intake data from the National Health and Nutrition Examination Survey (2005-2016). Food prices were derived using data from multiple, publicly available databases. Diet quality was assessed using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010.

PARTICIPANTS

30 564 individuals ≥20 years with complete and reliable dietary data.

RESULTS

Mean per capita daily diet cost was $14·19 (95 % CI (13·91, 14·48)), including $6·92 (95 % CI (6·73, 7·10)) for FAH and $7·28 (95 % CI (7·05, 7·50)) for FAFH. Diet quality was higher for FAH compared to FAFH (P < 0·001). Higher diet quality was associated with higher food costs overall, FAH and FAFH (P < 0·001 for all comparisons).

CONCLUSIONS

These findings demonstrate that higher diet quality is associated with higher costs for all food, FAH and FAFH. This research provides policymakers, public health professionals and clinicians with information needed to support healthy eating habits. These findings are particularly relevant to contemporary health and economic concerns that have worsened because of the COVID-19 pandemic.