Search

Novel dietary assessment methods are needed to study chronic disease risk in agrarian cultures where food availability is highly seasonal. In 16,320 rural Nepalese women, we tested a novel food frequency questionnaire, administered once, to assess past 7-day intake and usual frequency of intake throughout the year for year-round foods and when in season for seasonal foods. Spearman rank correlations between usual and past 7-day intakes were 0.12–0.85 and weighted kappa statistics, representing chance-corrected agreement, were 0.10–0.80, with better agreement for frequently consumed foods. The questionnaire performed well, but may require refinement for settings of extremely low dietary diversity.

Objectives: Intake and status of carotenoids have been associated with chronic disease. The objectives of this study were to examine the association between carotenoid intakes as measured by two regional food-frequency questionnaires (FFQs) and their corresponding measures in serum, and to report on dietary food sources of carotenoids in Jackson Heart Study (JHS) participants.Design: Cross-sectional analysis of data for 402 African American men and women participating in the Diet and Physical Activity Sub-Study (DPASS) of the JHS.Results: Mean serum carotenoid concentrations and intakes in this population were comparable to those reported for the general US population. After adjustment for covariates, correlations between serum and dietary measures of each carotenoid, for the average of the recalls (deattenuated), the short FFQ and the long FFQ, respectively, were: 035 and 0-carotene; 026 and 0-carotene; 017 and 0-carotene; 034 and 0-cryptoxanthin; 015 and 037, 014 for lycopene. Major dietary sources of -carotene and lutein plus zeaxanthin, mustard, turnip and collard greens; of beta-cryptoxanthin, orange juice; and of lycopene, tomato juice.Conclusions: On average, carotenoid intakes and serum concentrations are not lower in this southern African American population than the general US population. The two regional FFQs developed for a southern US population and used as dietary assessment tools in the JHS appear to provide reasonably valid information for most of these carotenoids. [ABSTRACT FROM AUTHOR]

Background: Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition., Methods: A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the "Life's Essential 8" (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including "low LE8" (0-49), indicating low CVH, "moderate LE8 (50-79)", indicating moderate CVH, and "high LE8 (80-100)", indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years., Results: Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46-0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73-0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53-0.72, p < 0.001)., Conclusion: While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy., (© 2024 The American Geriatrics Society.)

More than half of women of reproductive age in India are anemic. This study investigates the role of interpersonal communication in increasing the consumption of iron-folic acid supplements. Interventions that increase interpersonal communication may influence and empower individuals and the larger community in promoting behavior change. This investigation uses data from a cluster randomized intervention to understand the pathways by which interpersonal communication mediates the consumption of iron-folic acid supplements. Longitudinal data from control and intervention arms in rural Odisha, India, were collected at baseline ( N  = 3,691) and 20 months later at end-line ( N  = 3,394). Structural equation models highlighted the positive role of interpersonal communication in mediating iron-folic acid supplement use. This study illustrates that even during social distancing due to COVID-19, strategic interpersonal communication can improve iron-folic acid supplement use. Our results elucidate two key interpersonal communication pathways at play, namely the ritualistic and instrumental pathways in improving health behavior change in the community.

Background: Anemia is associated with fatigue, low physical activity, and poor quality of life. The purpose of this study was to determine the effects of a field trial on 6-month change in anemia and physical activity among nonpregnant women living in rural India., Methods: The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized controlled trial of a social norms-based intervention to reduce anemia among women (15-49 years). Participants ( n  = 292) performed a modified Queen's College Step Test (QCST) and wore an ActivPAL accelerometer for 3 days. Hemoglobin concentrations (g/dL) were determined using a HemoCue 301 photometer. Linear regression tested the effects of the intervention on 6-month change in hemoglobin and physical activity, while adjusting for age, body mass index, education, parity, and predicted VO 2max ., Results: We observed no differences in hemoglobin (11.8 ± 1.2 vs.11.6 ± 1.4 g/dL) or overall physical activity (36.6 ± 2.1 vs. 35.3 ± 5.8 metabolic equivalent of task-hours/day) at 6 months between the treatment and control groups, respectively. In contrast, steps/day was significantly higher in the treatment, compared with the control group (β = 1353.83; 95% confidence interval: 372.46, 2335.31), independent of other covariables., Conclusions: The potential to modify walking and other health-seeking behaviors using a social norms approach is worthy of further investigation among women living in rural India.Clinical Trial Registry - India: CTRI/2018/10/016186., (© Loretta DiPietro et al., 2023; Published by Mary Ann Liebert, Inc.)

Background and Aims: South Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups., Methods: We assessed the distribution of CVH metrics (inadequate: score 0-8, average: 9-10, optimal: 11-14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA)., Results: We included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (p interaction  = 0.85 and p interaction  = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14-0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19-0.53), p < 0.01]., Conclusions: Optimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Hearing loss, a public health issue in older populations, is closely related to functional decline., Objective: To investigate the longitudinal associations between 4 dietary indices and hearing status., Methods: Data from the Baltimore Longitudinal Study of Aging were used and included 882 participants ≥45 y of age. Dietary intake was assessed using a validated food frequency questionnaire, and 4 dietary scores (Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet [MIND], Mediterranean style diet score [MDS], Alternative Healthy Eating Index [AHEI], and Healthy Eating Index [HEI]) were calculated as averages over time. Hearing status was examined using pure-tone audiometry, and pure-tone average (PTA) of hearing thresholds were calculated at speech-level (PTA (500, 1000, 2000, 4000 Hz) ), low (PTA (500, 1000 Hz) ), and high (PTA (4000, 8000 Hz) ) frequencies, with lower thresholds indicating better hearing. Multivariable linear mixed-effect models were used to examine associations between dietary indices and hearing threshold change over time adjusted for confounders., Results: At baseline, the mean age of participants was 67 y and 55% were female. Over a median of 8 y of follow-up, MDS ≥7 was associated with 3.5 (95% CI: -6.5, -0.4) and 5.0 (95% CI: -9.1, -1.0) dB lower PTA (500, 1000, 2000, 4000 Hz) and PTA (4000, 8000 Hz) , respectively, compared with MDS ≤3; the highest tertile of the AHEI was associated with 2.3 (95% CI: -4.6, -0.1) and 5.0 (95% CI: -8.0, -2.0) dB lower PTA (500, 1000, 2000, 4000 Hz) and PTA (4000, 8000 Hz) ; and each standard deviation increment in HEI was associated with 1.6 dB (95% CI: -2.7, -0.6), 1.1 dB (95% CI: -2.1, -0.1), and 2.1 dB (95% CI: -3.5, -0.6) lower PTA (500, 1000, 2000, 4000 Hz) , PTA (500, 1000 Hz) , and PTA (4000, 8000 Hz) , respectively., Conclusions: Adherence to healthy dietary patterns was associated with better hearing status, with stronger associations at high frequencies. Am J Clin Nutr 20xx;x:xx., (Copyright © 2024 American Society for Nutrition. All rights reserved.)

Background: Mounting evidence indicates that although some plant-based diets are healthful, others are not. Changes in the gut microbiome and microbiome-dependent metabolites, such as trimethylamine N-oxide (TMAO), may explain differential health effects of plant-based diets. However, human data are sparse on whether qualitatively distinct types of plant-based diets differentially affect gut microbiome diversity, composition, particularly at the species level, and/or metabolites., Objectives: We aimed to examine cross-sectional associations of different plant-based indices with adult gut microbiome diversity, composition, and the metabolite TMAO., Methods: We studied 705 adults in the Baltimore Longitudinal Study of Aging with data for diet, fecal microbiome (shotgun metagenomic sequencing), and key covariates. We derived healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI) using data from food frequency questionnaires. We examined plant-based diet indices with microbiome α-diversity (richness and evenness measures), β-diversity (Bray-Curtis and UniFrac measures), composition (species level), and plasma TMAO. We used regression models to determine associations before and after adjustment for age, sex, education, physical activity, smoking status, body mass index, and total energy intake., Results: The analytic sample (mean age, 71.0 years, SD = 12.8 years) comprised 55.6% female and 67.5% non-Hispanic White participants. hPDI was positively and uPDI negatively associated with microbiome α-diversity, driven by microbial evenness (Pielou P < 0.05). hPDI was also positively associated with relative abundance of 3 polysaccharide-degrading bacterial species (Faecalibacterium prausnitzii, Eubacterium eligens, and Bacteroides thetaiotaomicron) and inversely associated with 6 species (Blautia hydrogenotrophica, Doreasp CAG 317, Eisenbergiella massiliensis, Sellimonas intestinalis, Blautia wexlerae, and Alistipes shahii). Furthermore, hPDI was inversely associated with TMAO. Associations did not differ by age, sex, or race., Conclusions: Greater adherence to a healthful plant-based diet is associated with microbiome features that have been linked to positive health; adherence to an unhealthful plant-based diet has opposing or null associations with these features., (Copyright © 2024 American Society for Nutrition. All rights reserved.)

Objective: The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome., Design: This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score., Setting: Hinds, Madison and Rankin counties, Mississippi, USA., Participants: African American adults, ages 21-94 years, 60·9 % female., Results: Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 ( P -trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P -trend = 0·03)., Conclusion: These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

Background: Dietary guidance is set on the basis of age and life stage and defines older adults as ≥60 y. Yet, little is known about if and/or how diet quality differs beyond the age of 60., Objective: The objective of this study was to compare the dietary intakes of 60-69 (n = 2079), 70-79 (n = 1181), and 80+ y old (n = 644) noninstitutionalized men and women in the United States using the Healthy Eating Index 2015 (HEI) and the What We Eat in America food categories., Methods: Data were obtained from National Health and Nutrition Examination Survey 2015-2016 and 2017-March 2020. HEI and component scores were calculated using the population ratio method. Population estimates for dietary intake were calculated as the average reported over 2 separate nonconsecutive 24-h dietary recalls., Results: In men and women, the reported energy intake was lower among the 80+ y olds (kcal/d men-80+: 1884 ± 30, 70-79: 2022 ± 33, 60-69: 2142 ± 39; women-80+: 1523 ± 36; 70-79: 1525 ± 33, 60-69: 1650 ± 25; P-trend < 0.001). Total HEI scores did not differ significantly across the 3 age categories, but the 80+ y olds had significantly lower scores for the green vegetables and beans component than the 60-69 y olds [men-mean (95% confidence interval): 2.0 (1.5, 2.5) compared with 3.4 (2.6, 4.1); women-2.3 (1.8, 2.8) compared with 4.4 (3.7, 5.0)]. In women, the percentage of daily calories from protein was significantly lower in the 80+ y olds than in the 60-69 and 70-79 y olds (12.9% ± 0.6%, compared with 17.0% ± 0.9% and 15.6% ± 0.6%, respectively). Protein intake did not differ significantly among the 3 age groups in men. The 80+ y old men and women reported consuming a significantly higher percentage of calories from snacks and sweets compared with the 60-69 y olds (men-80+: 18.1% ± 0.8%, 60-69: 15.4% ± 0.7%; women-80+: 19.6% ± 0.8%, 60-69: 15.5% ± 0.7%)., Conclusion: The diet of 80+ y olds differed from that of 60-69 y olds in some key components, including energy, snacks and sweets, protein, and green vegetables. Future research is needed to determine if there are health-related consequences to these differences., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

There is evidence that the association of protein intake and frailty may depend on the source of dietary protein. The mechanism underlying this association is not clear. In this study, we explore circulating metabolites as mediators of the relationship between dietary protein and of frailty in participants of the Baltimore Longitudinal Study of Aging (BLSA). Cross-sectional analyses in 735 BLSA participants of associations between plant and animal protein intake and frailty. Usual protein intake from plant and animal sources were estimated with a Food Frequency Questionnaire (FFQ) and frailty was assessed with a 44-item Frailty Index (FI). Compared with the lowest quartile, higher quartiles of plant, but not animal, protein were associated with lower FI. Twenty-five plasma metabolites were associated with plant protein intake; of these, fifteen, including phosphatidylcholines, cholesterol esters, sphingomyelins, and indole metabolites, mediated the association between plant protein intake and FI. The protective association between plant protein consumption and FI is mediated by lower abundance of lipid metabolites and higher abundance of tryptophan-related metabolites.

High blood pressure is an important predictor of atherosclerotic cardiovascular disease (ASCVD), particularly among South Asians, who are at higher risk for ASCVD when compared to other population groups. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is established as the best proven nonpharmacological approach to preventing hypertension in adults. Using data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we calculated a DASH dietary score to examine the association between adherence to the DASH diet and its components, and prevalent and incident hypertension and systolic and diastolic blood pressure, after five years of follow-up. We found that the relative risk ratio (RRR) of incident hypertension was 67% lower among participants in the highest DASH diet score category (aRRR: 0.33; 95% CI: 0.13, 0.82; p trend = 0.02) compared with those in the lowest DASH diet score category in fully adjusted models. These findings are consistent with previous clinical trials and large prospective cohort studies, adding to evidence that supports the diet-disease relationship established between DASH diet and hypertension. This study is the first to examine DASH diet adherence and hypertension among South Asian adults in the U.S.

South Asian Americans experience high cardiovascular disease risk. We evaluated the distribution and correlates of cardiovascular health (CVH) summarized by the Life's Essential 8 (LE8) score among South Asian adults. In participants of the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study, the association of demographic, social, and cultural factors with LE8 score was evaluated with t tests and analysis of variance. The association of LE8 score with coronary artery calcium (CAC) was evaluated with adjusted logistic regression. There were 556 women (mean age 55.9 years [SD 8.7], mean LE8 score 67.2 (SD 12.6) and 608 men (mean age 57.5 years [SD 9.9], mean LE8 score 61.9 (SD 13.1). Among women and men, the LE8 CVH score was higher in participants with higher annual family income, higher educational attainment, and fewer depressive symptoms. Overall, there was 26% lower odds of any CAC for each 10-point higher LE8 score (odds ratios [OR] 0.74, 95% confidence intervals [CI] 0.66 to 0.83), with similar magnitude of association in women and men. Participants with a high LE8 CVH score had 82% lower odds of CAC (OR 0.18, 95% CI 0.09 to 0.33), and participants with an intermediate LE8 CVH score had 38% lower odds of CAC (OR 0.62, 95% CI 0.41 to 0.94) than did participants with a low LE8 CVH score, with similar findings stratified by gender. In conclusion, in this cohort of South Asian Americans, most adults had suboptimal CVH assessed by the LE8 score. Higher LE8 score correlated with lower odds of any CAC., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Measures of cardiovascular health (CVH) assessed by a combination of behavioral and biological factors has shown protective associations with all-cause mortality. The mechanisms underlying these associations have not been fully elucidated. In this study, we characterized the plasma proteomics profile of CVH and tested whether specific proteins mediated the associations between CVH and all-cause mortality in participants of the InCHIANTI study. Of the 1301 proteins tested, 92 proteins were associated with CVH (22 positively, 70 negatively). Proteins most strongly associated with CVH included leptin (LEP), fatty acid binding protein 3 (FABP3), Angiopoietin-2 (ANGPT2), and growth-differential factor 15 (GDF15). Of the 92 CVH-associated proteins, 33 proteins significantly mediated the associations between CVH and all-cause mortality, with percent mediation ranging from 5 to 30%. The most significant mediating proteins were GDF15 and insulin-like growth factor 2 (IGFBP2). Proteins associated with better CVH were enriched for proteins that reflect the suppression of the complement coagulation and GH/IGF pathways.

Introduction: South Asians are an underrepresented population subgroup in the U.S., yet they have higher rates of chronic diseases. There is currently no tool that assesses the nutrition intake of South Asians in the U.S., despite their unique dietary profile that may be associated with disease outcomes. The objective of this preliminary study was to create a food list, inclusive of herbs and spices, that will be used in the development of the web-based South Asian Food Intake System for dietary assessment of South Asian adults living in the U.S., Methods: Authors used a Qualtrics survey to collect sociodemographic information ( n =66), and 24-hour diet recall and Home Food Inventory interviews were conducted through Zoom ( n =31). Grocery store tours and cookbook and existing food frequency questionnaire review were conducted., Results: A food list of 484 individual food items was generated. These items were sorted into 12 main food categories and condensed into 302 line items. Most respondents (68%) reported consuming South Asian meals regularly and utilizing herbs/spices during food preparation (83%)., Conclusions: This pilot study describes the data collection to develop a food list for the South Asian Food Intake System, which can be utilized by educators, clinicians, and researchers to more accurately collect information about dietary intake among South Asian Americans., (© 2023 The Author(s).)

Background : The quality of carbohydrate consumed may influence the risk of frailty. In this study, we tested the hypothesis that indices of carbohydrate intake are associated with trajectories of frailty in participants of the Baltimore Longitudinal Study of Aging (BLSA). Methods : Cross sectional and longitudinal analyses were conducted in 1024 BLSA participants to examine the association between usual intake of carbohydrate and frailty index. Seven measures of carbohydrate consumption were estimated using data derived from Food Frequency Questionnaires (FFQs) and examined in association with a 43-item Frailty Index (FI). Results: In cross-sectional analyses, there was a significant, positive association between higher tertiles of total carbohydrate, glycemic load, and non-whole grains and FI. Conversely, higher tertiles of fiber-to-carbohydrate ratio was associated with lower FI. These differences persisted over the follow-up period of up to 13.8 years. Women in the highest tertile of the fiber-to-carbohydrate ratio showed a less steep increase in FI over time. Conclusions : Carbohydrate intake was positively associated with increased frailty risk in the BLSA participants, whereas a higher fiber-to-carbohydrate ratio was related to reduced risk for frailty.

Background: Vitamin D status has been found to be inversely associated with metabolic syndrome (MetS) in some studies. Vitamin D status varies by race and ethnicity, and the association of MetS with vitamin D status in US adults and by race and Hispanic origin has not been evaluated extensively., Objectives: We aimed to examine the associations between vitamin D status and MetS overall, and across race and Hispanic origin groups, in a nationally representative sample of US adults who participated in the NHANES from 2007 to 2014., Methods: The total sample included 8639 adults, ≥20 y of age. Serum vitamin D was measured using a standardized LC-tandem MS method and was categorized using data-driven tertiles. MetS was defined using measured waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were fitted [accounting for sociodemographic and lifestyle factors, dietary supplement use, and BMI (in kg/m 2 )] to examine the associations of serum vitamin D with MetS among adults overall, and by race and Hispanic origin., Results: Serum vitamin D in the lowest tertile (≤56 nmol/L) was significantly associated with increased odds of MetS compared with the highest tertile (>77.9 nmol/L) (fully adjusted model OR: 1.85; 95% CI: 1.51, 2.27). Inverse associations were noted for all race-Hispanic origin groups: non-Hispanic white (NHW) (OR: 2.24; 95% CI: 1.67, 3.01), non-Hispanic black (OR: 1.56; 95% CI: 1.06, 2.29), and Hispanic (OR: 1.48; 95% CI: 1.03, 2.14) adults., Conclusions: Lower vitamin D status was significantly associated with MetS among US adults after adjusting for sociodemographic and lifestyle factors, dietary supplement use, and BMI. This finding was noted across all race and Hispanic origin groups, although the strength of the association varied, being strongest for NHW adults., (Copyright © 2022 American Society for Nutrition.)

South Asians are among the fastest growing ethnic group in the USA yet remain understudied in epidemiologic studies. Due to their unique disease profile, identifying risk moderators and mitigators, such as dietary patterns and food intake, will help to determine the diet-disease relationship that is specific to this largely immigrant population group in the USA. The aim of this commentary is to highlight the dietary traditions and acculturated practices experienced by South Asians in the USA with a call for a diet assessment instrument that adequately captures their dietary diversity. Specifically, we call for (i) the inclusion of traditional food items, such as herbs and spices, that individualize diet assessment for participants; and (ii) leveraging technology that will enhance the experience of diet assessment for both researchers and participants, tailoring the collection of habitual dietary intake in this diverse population group., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Diet quality has been associated with slower rates of aging; however, the mechanisms underlying the role of a healthy diet in aging are not fully understood. To address this question, we aimed to identify plasma metabolomic biomarkers of dietary patterns and explored whether these metabolites mediate the relationship between diet and healthy aging, as assessed by the frailty index (FI) in 806 participants of the Baltimore Longitudinal Study of Aging. Adherence to different dietary patterns was evaluated using the Mediterranean diet score (MDS), Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) score, and Alternate Healthy Eating Index-2010 (AHEI). Associations between diet, FI, and metabolites were assessed using linear regression models. Higher adherence to these dietary patterns was associated with lower FI. We found 236, 218, and 278 metabolites associated with the MDS, MIND, and AHEI, respectively, with 127 common metabolites, which included lipids, tri/di-glycerides, lyso/phosphatidylcholine, amino acids, bile acids, ceramides, cholesterol esters, fatty acids and acylcarnitines, indoles, and sphingomyelins. Metabolomic signatures of diet explained 28%, 37%, and 38% of the variance of the MDS, MIND, and AHEI, respectively. Signatures of MIND and AHEI mediated 55% and 61% of the association between each dietary pattern with FI, while the mediating effect of MDS signature was not statistically significant. The high number of metabolites associated with the different dietary patterns supports the notion of common mechanisms that underly the relationship between diet and frailty. The identification of multiple metabolite classes suggests that the effect of diet is complex and not mediated by any specific biomarkers. Furthermore, these metabolites may serve as biomarkers for poor diet quality to identify individuals for targeted dietary interventions.

Background: The inverse association between ideal cardiovascular health (CVH) as measured by the American Heart Association's Life Simple 7 (LS7) and cardiovascular disease (CVD) incidence is well documented. However, research exploring the association between CVH and specific risk factors for cardiometabolic disease is sparse in diverse cohorts., Methods: This study included 7717 participants from the Mediators of Atherosclerosis in South Asians Living in America and the Multi-Ethnic Study of Atherosclerosis cohorts. We assigned each LS7 component a 0, 1, and 2 and summed these scores to derive an overall CVH score. Visceral, subcutaneous, and intermuscular fat area, pericardial fat volume, and hepatic fat attenuation were measured using noncontrast computed tomography. Multivariable linear regression was used to examine associations between CVH categories and each log-transformed ectopic fat depot, as well as the homeostatic assessment for insulin resistance (HOMA-IR)., Results: In adjusted analysis, compared to those with ideal CVH, participants with poor CVH demonstrated 63.4% (95% CI, 54.3-73.0) higher visceral fat area, 84.0% (95% CI, 76.5-92.1) higher pericardial fat volume, 61.6% (95% CI, 50.7-73.2) higher subcutaneous fat area, and 40.6% (95% CI, 30.2-52.0) higher intermuscular fat area, and 15.1% (95% CI, 13.1-17.2) higher hepatic fat (all Ps < 0.001). Also, poor CVH was associated with 148.2% (95% CI, 131.1-166.7) higher HOMA-IR. We also found significant heterogeneity in the strengths of association by race/ethnicity for each ectopic fat depot., Conclusion: Poor and intermediate CVH, as defined by LS7 metrics, were associated with significantly higher measures of ectopic fat and insulin resistance among individuals from 5 racial/ethnic groups., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The aim of this study is to examine diet diversity, predictors associated with it, and its associations with anemia among non-pregnant women of reproductive age in rural India. Baseline data from the Reductions in Anemia through Normative Innovations (RANI) project were used and included 980 non-pregnant women aged 15-49 years from Odisha, India. The Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W) was used to assess diet diversity. Anemia was determined by hemoglobin level and categorized as normal (hemoglobin ≥ 12 g/dL), mild (11 ≤ hemoglobin <12 g/dL) and moderate/severe (hemoglobin < 11 g/dL). Multivariable logistic regression was used to examine factors associated with diet diversity, and multinomial logistic regression for associations between diet diversity and anemia. Forty-four percent of women were classified as having a diverse diet (MDD-W ≥5). Women with higher education level, belonging to a scheduled caste (vs. tribe), and higher body mass index had higher odds of a diversified diet ( p < .05 for all). A more diverse diet was associated with 30% of lower odds of mild anemia (odds ratio = 0.7, 95% confidence interval: 0.5-0.98, p = .035), however, no statistically significant associations were found for moderate/severe anemia. Diet diversity was inversely associated with prevalence of mild anemia among non-pregnant women of reproductive age in rural India.

Background: Diet quality may be protective of physical function and muscle strength during aging., Objectives: We aimed to investigate associations of the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet with physical function and grip strength., Methods: Data were obtained from men and women in the Baltimore Longitudinal Study of Aging (mean ± SD age: 68 ± 14 y at first diet visit; n = 1358). Diet was assessed by FFQ. MIND diet score was calculated from 15 food groups, with a higher score indicating better diet quality; tertile categories of averaged MIND score across visits were used. Physical function was assessed using the Short Physical Performance Battery (SPPB), with a score < 10 indicative of impaired function, and the Health, Aging and Body Composition Physical Performance Battery (HABCPPB). The highest value of grip strength over 3 trials was used. Multivariable logistic and linear mixed-effects models were examined with repeated measurements of physical function and grip strength, respectively., Results: MIND score was inversely associated with physical function impairment (per 1-point increment: OR: 0.81; 95% CI: 0.71, 0.93; P < 0.01), and with each SPPB component, over a median 6 y of follow-up. Participants in the highest compared with the lowest tertile of MIND diet score had 57% lower odds of functional impairment (OR: 0.43; 95% CI: 0.25, 0.73; P < 0.01), and slower decline by the HABCPPB. Men and women in the highest compared with the lowest tertiles of MIND score had 1.86-kg (95% CI: 0.33, 3.40 kg; P < 0.05) and 1.24-kg (95% CI: 0.04, 2.45 kg; P < 0.05) greater grip strength, respectively., Conclusions: Adherence to the MIND dietary pattern was associated with lower odds of physical function impairment and decline, and with better muscle strength, indicating that the MIND dietary pattern may be protective of physical functional health in older adults., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Prior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population., Methods and Findings: We conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21-95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants' adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06, 95% CI 0.78-1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80-1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71-1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78-1.18), 0.94 (0.76-1.16), and 1.06 (0.86-1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74-1.61), 1.11 (0.76-1.61), and 0.79 (0.52-1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66-1.52), 0.91 (0.61-1.36), and 1.26 (0.84-1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods., Conclusions: In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality., Competing Interests: The authors have declared that no competing interests exist.

Objective: More than half of Indian women of reproductive age are anemic. Regular iron folic acid uptake can prevent and treat anemia. This study investigated the effect of interpersonal communication on improving IFA use among women of reproductive age., Methods: The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized trial that collected longitudinal data from control (n = 1896) and intervention (n = 1898) communities in Odisha, India at Time 1 and six months later at Time 2. Structural equation models assessed the effect of the intervention on iron folic acid use via multiple interpersonal communication pathways., Results: Compared to the control arm, iron folic acid use significantly increased in the intervention arm. Both, general health interpersonal communication and anemia-specific interpersonal communication were augmented in the intervention communities. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication., Conclusion: The RANI Project increased interpersonal communication among participants, resulting in increased iron folic acid use for anemia reduction., Practice Implications: Strategic use of targeted interpersonal communication to promote behavior change appears to be a viable strategy to increase iron folic acid use to reduce anemia., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Snacking away from home is thought to contribute to excess intake of energy, added sugars, saturated fat, and sodium compared to snacking at home. Using data from the National Health and Nutrition Examination Survey 2009-2016, we examined associations between location of snack consumption (at home or away from home) and added sugars, saturated fat, and sodium intake from food and beverage snacks in U.S. adolescents aged 12-19. We also compared top snack contributors to intakes of these nutrients by location of consumption. Nutrient intake (added sugars, saturated fat, and sodium) from food and beverage snacks was estimated by the average intake from two 24-hour dietary recalls, and location of consumption for each snack was reported by participants as at home or away from home. Adjusted mixed effects models were performed to examine associations between nutrient intakes and the location of consumption. Adolescents (n = 3,869) had lower intakes of added sugars (-5.20 g/day), saturated fat (-2.06 g/day) and sodium (-170.15 mg/day) from food snacks consumed away from home compared to at home (p < 0.0001). Similarly, adolescents had lower intake of added sugars (-2.74 g/day), saturated fat (-0.32 g/day) and sodium (-16.04 mg/day) from beverage snacks consumed away from home compared to at home (p < 0.0001). The top contributors to the target nutrients were similar irrespective of location. Taken together, our results demonstrate that adolescents consumed more target nutrients from snacks at home than away from home. Larger snack portion sizes and higher frequency of snacking at home may explain these findings and requires further study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors. Published by Elsevier Inc.)

Adequate dietary intake is critical to prevent adverse pregnancy outcomes. India has a high burden of maternal and child morbidity and mortality, but there is a lack of adequate tools to assess dietary intake. We validate an FFQ, New Interactive Nutrition Assistant - Diet in India Study of Health (NINA-DISH), among pregnant women living with and without HIV in Pune, India. Women were selected from a cohort study investigating immune responses to HIV and latent tuberculosis during pregnancy. The FFQ was administered during the third trimester and validated against multiple 24-h dietary recalls (24-HDR) collected in second and third trimesters. Data for analysis were available from fifty-eight women out of seventy enrolled into this sub-study, after excluding those with incomplete data or implausible energy intake. The median (Q1, Q3) age of study participants was 23 (20, 25) years. Median (Q1, Q3) daily energy intakes were 10 552 (8000, 11 958) and 10 673 (8510, 13 962) kJ by 24-HDR and FFQ, respectively, with FFQ overestimating nutrient intake. Pearson correlations between log-transformed estimates from FFQ and 24-HDR for energy, protein, carbohydrate, fat, Fe and Zn were 0·47, 0·48, 0·45, 0·33, 0·4 and 0·54, respectively. Energy-adjusted and de-attenuated correlations ranged from 0·41 (saturated fat) to 0·73 (Na). The highest misclassification into extreme tertiles was observed for fat (22 %), saturated fat (21 %) and Na (21 %). Bias existed at higher intake levels as observed by Bland-Altman plots. In conclusion, NINA-DISH is a valid and feasible tool for estimating dietary intakes among urban pregnant women in Western India.

South Asians, who are at a disproportionately greater risk of atherosclerotic CVD (ASCVD), represent a rapidly growing population in the USA. The relationship between dairy products, a major component of South Asian diets, and body composition - an established risk factor for ASCVD, is unclear. The aim of the present study was to examine associations between dairy intake and multiple measures of body composition (BMI, waist and hip circumference, waist:hip ratio, abdominal lean mass, subcutaneous, visceral, and intermuscular fat areas) among South Asian adults in the USA. A baseline analysis was conducted using existing data from the Mediators of Atherosclerosis in South Asians Living in America cohort. In women, the highest (>1·9 servings/d) v. lowest (<1 serving/d) tertile of dairy intake was associated with 53 % lower odds of a waist circumference >80 cm (95 % CI 0·25, 0·89, Pfor trend<0·05). No associations were observed between dairy intake and measures of body composition. However, >3 servings of low-fat yogurt/week was associated with a 9·9 cm2 lower visceral fat area (95 % CI -19·07, -0·72, P<0·05) and 2·3 cm2 lower intermuscular fat area (95 % CI -3·76, -0·79, P<0·05) as compared with those with three servings/week. Milk and cheese were not associated with body composition measures. These analyses suggest that higher consumption of low-fat yogurt is associated with lower visceral and intermuscular fat in the whole sample, and women with higher dairy intake have lower waist circumference. Our study supports dietary incorporation of dairy products, and recognises the utility of multidimensional measures of central adiposity.

Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.

Objective: To investigate associations between a vegetarian diet and depression among South Asians in the United States. Design: Data from 892 South Asians (age range 40-83 y , 47% women) enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study were included. A vegetarian diet was defined as no intake of meat, poultry or fish in the previous year as reported on a validated food frequency questionnaire. Depressive symptomology was assessed using the Center for Epidemiologic Studies-Depression Scale (CES-D) and depression was classified as CES-D score ≥16. Multivariable logistic regression was used and covariates included age, sex, study site, education, smoking, body mass index, acculturation, intentional exercise, alcohol and energy intake, and antidepressant medication use. Results: Our study demonstrated 43% lower odds of depression among vegetarians ( p  = 0.023). Conclusions: Vegetarian diet was found to be inversely associated with the prevalence of depression. Longitudinal examinations confirming these findings are needed.

Background and Aims: Data on the relation of egg consumption with risk of type 2 diabetes (T2D) and coronary heart disease (CHD) are limited and inconsistent. Few studies have controlled for overall dietary patterns in egg-T2D or egg-CHD analyses, and it is unclear whether any observed elevated risks of T2D and CHD with frequent egg consumption is real or due to confounding by dietary habits. We tested the hypothesis that frequent egg consumption is associated with a higher risk of T2D and CHD risk after adjustment for overall dietary patterns among adults., Design: We used prospective cohort design to complete time-to-event analyses., Methods: We pooled de novo, harmonized, individual-level analyses from nine US cohorts (n = 103,811). Cox regression was used to estimate hazard ratios separately in each cohort adjusting for age, ethnicity, body mass index (BMI), exercise, smoking, alcohol intake, and dietary patterns. We pooled cohort-specific results using an inverse-variance weighted method to estimate summary relative risks., Results: Median age ranged from 25 to 72 years. Median egg consumption was 1 egg per week in most of the cohorts. While egg consumption up to one per week was not associated with T2D risk, consumption of ≥2 eggs per week was associated with elevated risk [27% elevated risk of T2D comparing 7+ eggs/week with none (95% CI: 16%-37%)]. There was little evidence for heterogeneity across cohorts and we observed similar conclusions when stratified by BMI. Overall, egg consumption was not associated with the risk of CHD. However, in a sensitivity analysis, there was a 30% higher risk of CHD (95% CI: 3%-56%) restricted to older adults consuming 5-6 eggs/week., Conclusions: Our data showed an elevated risk of T2D with egg consumption of ≥2 eggs per week but not with <2 eggs/week. While there was no overall association of egg consumption with CHD risk, the elevated CHD observed with consumption of 5-6 eggs/week in older cohorts merits further investigation., Competing Interests: Disclosures Dr. Djousse received investigator-initiated grant from American Egg Board for current analyses; sponsor had no influence on design, conduct, and interpretation of the results. Other co-authors have no disclosures., (Published by Elsevier Ltd.)

Background: The negative impact of anemia on work capacity has been studied extensively in male and female workers; however, the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered. The purpose of this study was to examine cross-sectionally the multivariable correlates of work capacity in non-pregnant women (n = 330) living in rural India., Methods: The Reduction in Anemia through Normative Innovations (RANI) Project is a norms-based, clustered randomized controlled trial to reduce anemia among women (15-49 years) living in Odisha, India between 2018 and 2021. For the larger trial, 89 clusters of villages were randomized into treatment and control groups on a 1:1 basis. Women (2055/group) living in 15 selected clusters (40-41 villages) were then randomly selected for data collection. The sampling design also randomly-generated a subset (n = 375) of non-pregnant participants who performed a modified Queen's College Step Test (QCST) and who wore an activity monitor for 3 days. Predicted work capacity (VO 2max ) was determined using the QCST. Levels (h/day) of daily reclining, sitting, standing, walking (steps/day), and energy expenditure (MET∙h/day) were determined using an ActivPAL accelerometer. Hemoglobin concentrations (g/dL) were determined using a HemoCue photometer. Predetermined hierarchical (non-multilevel) regression models tested the independent associations between the primary study variables of interest (physical activity, hemoglobin concentrations) and predicted VO 2max , while adjusting for age, body mass index (BMI: kg/m 2 ), education, parity, and dietary diversity score., Results: Approximately 61% of the participants had anemia (Hb < 12 g/dL). Age 2 (β = - 0.01; 95% CI: - 0.01, 0.00), BMI (β = - 0.19; 95% CI:-0.28, - 0.09), educational attainment (β = - 1.35; 95% CI: - 2.34, - 0.36), and MET∙h/day (β = 0.19; 95% CI: 0.00, 0.38) were significant and independent determinants of work capacity. Hemoglobin concentration was marginally associated with work capacity in the presence of the other covariables (β = 0.22; 95% CI:-0.02, 0.47)., Conclusions: Our data indicate that factors other than anemia are important correlates of work capacity and should be considered when promoting the health and economic capacity of rural Indian women., Trial Registration: Clinical Trial Registry- India (CTRI) http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26285&EncHid=&userName=CTRI/2018/10/016186 on 29 October 2018.

Identifying modifying protective factors to promote healthy aging is of utmost public health importance. The frailty index (FI) reflects the accumulation of health deficits and is one widely used method to assess health trajectories in aging. Adherence to a Mediterranean-type diet (MTD) has been associated with favorable health trajectories. Therefore, this study explored whether adherence to a MTD is negatively associated with FI in the InCHIANTI study. Participants ( n = 485) included individuals over 65 years of age at baseline with complete data over a follow-up period of 10 years. MTD was computed on a scale of 0-9 and categorized based on these scores into three groups of low (≤3), medium (4-5), and high (≥6) adherence. Being in a high or medium adherence group was associated with 0.03 and 0.013 unit lower FI scores over the follow-up period, compared to the low adherence group. In participants with a low FI at baseline, being in a high or medium MTD-adherence group had 0.004 and 0.005 unit/year slower progression of FI compared to the low adherence group. These study results support adherence to a MTD as a protective strategy to maintain a lower FI.

Background: Increasingly, lifestyle factors in midlife are reported to impact health and functional status in old age. This work examines associations between dietary trajectories in middle age and subsequent impairments in physical function., Method: Data are from 851 participants (61% men, mean age at first dietary assessment = 47 years, range 30-59 years) from the Baltimore Longitudinal Study of Aging. We used latent class analysis to derive dietary trajectories based on adherence to the Alternative Healthy Eating Index-2010 (AHEI), and further classified them based on tertiles, as poor (score <39.3), intermediate (39.3-48.9), or good (>48.9). Physical function was assessed with the Short Physical Performance Battery (SPPB). Random effects tobit regression models were used to examine associations between dietary trajectories and later physical function., Results: Two latent classes of AHEI scores were generated and labeled "greatly improved" or "moderately improved." In the greatly improved class, participants showed a trend in overall AHEI score from poor/intermediate to good diet categories across dietary assessments with age, over time. In the moderately improved class, the overall AHEI score shifted from poor to intermediate diet categories over time, and the prevalence of the good diet category remained low. Mean AHEI score between ages 30 and 59 years was higher in the greatly, than moderately, improved class. The moderately improved class had 1.6 points lower SPPB score (indicating poorer physical function) at older age than the greatly improved class (p = .022)., Conclusions: Findings suggest that improving diet quality in middle age may contribute to better physical function in older age., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The aim of this study was to investigate associations between cumulative biological risk and subclinical atherosclerosis in South Asian immigrants., Methods: Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, including 858 participants at baseline (mean age = 56 [standard deviation = 9] years, 46% women). A cumulative biological risk score was derived using nine biomarkers across cardiovascular, immune, and metabolic systems with a possible score range of 0-9. Common and internal carotid artery intima media thickness (CIMT) and coronary artery calcium (CAC) were used as indicators of subclinical atherosclerosis., Results: Higher cumulative biological risk score was significantly associated with higher common and internal CIMT and higher odds of CAC at baseline. The odds of new CAC after 5 years of follow-up were 31% higher per 1-point increase in cumulative biological risk score, and the higher cumulative biological risk score was also associated with CAC progression., Conclusions: Among South Asian immigrants, cumulative biological risk was directly associated with subclinical atherosclerosis and its progression.

In pregnant women, studies are lacking on the relationship of vegetable and animal flesh (poultry, red meat and seafood) intake with inflammation, especially in low- and middle-income countries. We conducted a cohort study of pregnant women receiving antenatal care at BJ Medical College in Pune, India. The dietary intake of pregnant women was queried in the third trimester using a validated food frequency questionnaire. Twelve inflammatory markers were measured in plasma samples using immunoassays. Only 12% of the study population were vegetarians, although animal flesh intake levels were lower compared to Western populations. In multivariable models, higher intakes of total vegetables were associated with lower levels of the T-helper (Th) 17 cytokine interleukin (IL)-17a ( p = 0.03) and the monocyte/macrophage activation marker soluble CD163 (sCD163) ( p = 0.02). Additionally, higher intakes of poultry were negatively associated with intestinal fatty-acid binding protein (I-FABP) levels ( p = 0.01), a marker of intestinal barrier dysfunction and Th2 cytokine IL-13 ( p = 0.03), and higher seafood was associated with lower IL-13 ( p = 0.005). Our data from pregnant women in India suggest that a higher quality diet emphasizing vegetables and with some animal flesh is associated with lower inflammation. Future studies should confirm these findings and test if modulating vegetables and animal flesh intake could impact specific aspects of immunity and perinatal health.

Background: Social and cultural norms, operating through social networks, may influence an individual's dietary choices. We examined correlations between social network characteristics and dietary patterns among South Asians in the United States (U.S.)., Methods: Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Social Network study were analyzed among 756 participants (mean age = 59 y standard deviation [SD] = 9 y; 44% women). A culturally adapted, validated food frequency questionnaire was used for dietary assessment. A posteriori dietary patterns using principal component analysis were named 1) animal protein, 2) fried snacks, sweets and high-fat dairy, and 3) fruits, vegetables, nuts and legumes. Social network characteristics were assessed using a standard egocentric approach, where participants (egos) self-reported data on perceived dietary habits of their network members. Partial correlations between social network characteristics and egos' dietary patterns were examined., Results: The mean social network size of egos was 4.2 (SD = 1.1), with high proportion of network members being family (72%), South Asian ethnicity (89%), and half having daily contact. Animal protein pattern scores were negatively correlated with fruits and cooked vegetables consumption of network. Fried snacks, sweets and high-fat dairy pattern scores were positively correlated with sugar-sweetened beverages, South Asian sweets, fried/fast foods and ghee (clarified butter) consumption of network. Fruits, vegetables, nuts and legumes pattern scores were positively correlated with vegetables, fruits, and brown rice/quinoa consumption of network., Conclusions: Network member characteristics and their perceived dietary behaviors were correlated with dietary patterns of egos. Dietary intervention studies among South Asians should consider social network characteristics as candidate components for dietary intervention., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Observational studies have shown that alcohol consumption above the recommended limit is associated with increased cardiovascular disease (CVD), although its association in South Asians is unclear. Less is known regarding the association between alcohol consumption and cardiovascular health (CVH), assessed by the American Heart Association's Life's Simple 7 (LS7) health metrics among those with South Asian ancestry., Methods: This analysis included 701 participants without CVD from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort (2015 to 2018). Based on a personal history questionnaire, participants were divided into never, former, and current drinkers. The current drinking category was further classified into 1 to 3 drinks/wk, 4 to 7 drinks/wk, and >7 drinks/wk. The consumption of 5 or more drinks on 1 occasion in the past month was defined as binge drinking. Each LS7 component was given a point score of 0, 1, or 2. The total score was categorized into 0 to 6, 7 to 10, and 11 to 14 to represent poor, intermediate, and ideal CVH, respectively. We use multinomial logistic regression to examine the association between alcohol consumption and CVH., Results: In the MASALA cohort (mean age = 59 years, 43% female), participants consuming >7 drinks/wk had the lowest mean CVH score. Compared with never drinkers, male participants consuming >7 drinks/wk were less likely to have intermediate CVH (0.44 [0.08, 0.91]) and ideal CVH (0.23 [0.03, 0.96]). Binge drinking was associated with significantly lower odds of ideal CVH compared with never drinkers., Conclusion: We found evidence of an inverse association of moderate to heavy alcohol consumption and ideal CVH in South Asian men. These findings further underscore the important relationship between alcohol consumption and CVH in this unique population of South Asians., (Copyright © 2020 by the Research Society on Alcoholism.)

Background: Low-calorie sweetened beverages (LCSBs) are commonly used as a lower-calorie alternative to sugar-sweetened beverages (SSBs) by individuals with type 2 diabetes. However, little is known about how intake of LCSBs is related to dietary intake and cardiometabolic health, particularly among youth., Objective: To test the hypothesis that having higher baseline LCSB intake and increasing LCSB intake over 2 years of follow-up are associated with poorer dietary intake and higher cardiometabolic risk factors among youth enrolled in the Treatment Option for Type 2 Diabetes in Adolescents and Youth (TODAY) study., Design: Secondary, exploratory, analysis of baseline and longitudinal data from the TODAY study, which was a randomized, multisite trial conducted from 2004 to 2012, to compare effects of 3 interventions (metformin alone, metformin + rosiglitazone, and metformin + intensive lifestyle intervention) on glycemic control in youth with type 2 diabetes., Participants/setting: The study included 476 children and adolescents (10-17 years, mean body mass index 34.9 ± 7.8 kg/m 2 ), who were participants in the multicenter (n = 15) TODAY study., Main Outcome Measures: Diet was assessed using a food frequency questionnaire. Differences in energy intake, macronutrients, food group intakes, and cardiometabolic biomarkers were evaluated in 3 groups of LCSB consumers at baseline (low [1-4 servings/wk], medium [5-11 servings/wk], and high [≥12 servings/wk]), each compared with nonconsumers, and between 4 groups of change in LCSB intake (nonconsumption at start of study and nonconsumption after 2 years, increase in consumption after 2 years, decrease in consumption after 2 years, and high consumption at start of study and high consumption after 2 years)., Statistical Analyses Performed: Multivariable linear regression was performed at baseline and longitudinally over 2 years of follow-up., Results: Energy (kilocalories), fiber, carbohydrate, total fat, saturated fat, and protein intake (grams) were higher among high LCSB consumers compared with nonconsumers at baseline. No associations were observed between LCSB consumption and cardiometabolic risk factors at baseline. Change in LCSB intake between baseline and follow-up was not associated with change in energy intake or cardiometabolic risk factors. Participants who decreased LCSB consumption reported greater increases in sugar intake (18.4 ± 4.8 g) compared with those who increased LCSB consumption (5.7 ± 4.9 g) or remained high LCSB consumers (5.9 ± 7.4 g), but this trend was not statistically significant after a correction for multiple testing., Conclusions: LCSB consumption was associated with higher energy intake in youth with type 2 diabetes, with the highest energy intakes reported in high LCSB consumers. Those who reduced LCSB consumption tended to report greater increases in sugar intake during follow-up, but further studies are needed to better understand this trend., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Estimates of the components of nutrient intake variation are needed for modelling distributions of usual intake or predicting the usual intake of individuals. Season is a potential source of variation in nutrient intakes in addition to within- and between-person variation, particularly in low- or middle-income countries. We aimed to describe seasonal variation in nutrient intakes and estimate within-person, between-person and other major components of intake variance among Zambian children. Children from rural villages and peri-urban towns in Mkushi District, Zambia aged 4-8 years were enrolled in the non-intervened arm of a randomised controlled trial of pro-vitamin A carotenoid biofortified maize (n 200). Up to seven 24-h dietary recalls per child were obtained at monthly intervals over a 6-month period covering the late post-harvest (August-October), early lean (November-January) and late lean (February-April) seasons (2012-2013). Nutrient intakes varied significantly by season. For energy and most nutrients, intakes were highest in the early lean season and lower in the late post-harvest and late lean seasons. Season and recall on a market day had the strongest effects on nutrient intakes among covariates examined. Unadjusted within- to between-person variance ratios ranged from 4·5 to 31·3. In components of variance models, season accounted for 3-20 % of nutrient intake variance. Particularly in rural settings in low- and middle-income countries, where availability of locally grown, nutrient-rich foods may vary seasonally, studies should include replicates across seasons to more precisely estimate long-term usual intakes.

Background: Diet quality is an important risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). Little is known about the diet quality of South Asians in the United States, a group with higher rates of T2D and CVD compared with other racial/ethnic groups., Objective: This study determined whether diet quality differs between South Asian adults in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and whites, Chinese Americans, African Americans, and Hispanics in the Multi-Ethnic Study of Atherosclerosis (MESA)., Methods: Cross-sectional data from 3926 participants free of CVD from MESA visit 5 (2010-2011) and 889 South Asian participants from MASALA visit 1 (2010-2013) were pooled. Diet quality was assessed using the Alternative Healthy Eating Index (AHEI-2010) derived using FFQs. Multivariable linear regression models adjusted for age, sex, and total energy intake were used to compare mean differences in diet quality between the racial/ethnic groups., Results: MESA participants were, on average, 14 y older than MASALA participants. The adjusted mean (95% CI) scores for the AHEI-2010 were 70.2 (69.5, 70.9) among South Asians, 66.2 (66.3, 68.2) among Chinese Americans, 61.1 (60.7, 61.6) among whites, 59.0 (58.4, 59.7) among Hispanics, and 57.5 (56.9, 58.1) among African Americans. The mean AHEI scores among South Asians were 3.1 (1.8, 4.3), 9.2 (8.3, 10.1), 11.2 (10.2, 12.3), and 12.8 (11.8, 13.7) points higher compared with Chinese Americans, whites, Hispanics, and African Americans, respectively., Conclusions: South Asian adults in the United States have a higher diet quality compared with other racial/ethnic groups. This paradoxical finding is not consistent with the observed higher rates of T2D and CVD compared with other groups. This is further evidence of the importance of studying the South Asian population to better understand the causes of chronic disease not explained by diet quality., (Copyright © The Author(s) 2020.)

Objective: To examine the associations between overall diet quality and hearing function among middle-older aged adults in the USA., Design: Cross-sectional analysis. Diet quality was examined using the Mediterranean Diet Score (MDS), using data from a single 24 h dietary recall. Hearing function was objectively measured by audiometry assessments and hearing loss, including high- and low-frequency hearing loss, was defined as pure-tone averages at specific ranges of hearing frequencies >25 dB. Weighted logistic regression analyses were performed to examine the associations of MDS (scored 0-9, categorized at the median as ≤3 or >3) with hearing loss and high- and low-frequency hearing loss., Setting: National Health and Nutrition Examination Surveys 2000-2006 and 2009-2012., Participants: Adults aged ≥50 years (n 1639) with valid dietary and audiometry assessments., Results: After adjusting for potential confounders, a non-significant trend for a protective association of higher MDS was observed for hearing loss (OR = 0·78; 95 % CI 0·49, 1·23). A significant inverse association was observed for high-frequency hearing loss (OR = 0·64; 95 % CI 0·43, 0·95). No association was found for low-frequency hearing loss among women; however, higher MDS was significantly associated with higher odds of low-frequency hearing loss among men (OR = 2·63; 95 % CI 1·39, 4·95)., Conclusions: Among middle-older aged adults, adherence to a Mediterranean-style diet was inversely associated with hearing loss, including those at high hearing frequencies, among older adults. However, a detrimental association was observed at low hearing frequencies among men. Future investigations with a longitudinal design are needed to clarify the associations between diet quality and hearing loss.

Objective: The aim of this study was to investigate whether an index of overall cardiovascular health (CVH) is associated with disability in older individuals. Method: Data on 925 participants of the InCHIANTI study (Invecchiare in Chianti, aging in the Chianti area, ≥65 years, 55% women) with median follow-up of 9 years were used. CVH score was assessed by smoking status, physical activity, body mass index, diet quality, blood pressure, plasma cholesterol, and fasting blood glucose. Disability was examined using instrumental activities of daily living (IADL disabilities >0 vs. 0) and activities of daily living (ADL disabilities >0 vs. 0). Generalized estimating equations and Cox models assessed relationships between baseline CVH with disability and worsening over 9 years. Results: A 1-point increase in the CVH score was associated with 23% and 17% of lower odds of ADL ( p < .001) and IADL ( p < .001) disability and was protective of worsening of disability over 9 years. Cox models demonstrated that a 1-point increase in CVH score was associated with lower hazards of both ADL (hazard ratio [HR] = 0.86, p = .005) and IADL (HR = 0.91, p = .007) disability. Discussion: Among older individuals, better CVH was associated with lower risk of disability and worsening over 9 years.

Background/objective: To evaluate the relationship between self-reported hearing loss and nonfatal fall-related injury in a nationally representative sample of community-dwelling adults living in the United States., Design: Cross-sectional analysis of national survey data., Setting: National Health Interview Survey (2016)., Participants: A total of 30 994 community-dwelling adults in the United States, aged 18 years and older., Measurements: We evaluated the association between self-reported hearing loss and nonfatal injury resulting from a fall in the previous 3 months. We used multivariate logistic regression to calculate adjusted odds ratios (ORs) and evaluated effect measure modification by age., Results: The odds of nonfatal fall-related injury were 1.60 times higher among respondents with hearing loss compared to respondents without hearing loss (95% confidence interval [CI] = 1.20-2.12; P = .0012). Results were unchanged when adjusting for demographics (OR = 1.59; 95% CI = 1.18-2.15; P = .002). After adjustment for cardiovascular risk factors, cardiovascular disease, visual impairment, and limitation caused by nervous system/sensory organ conditions and depression, anxiety, or another emotional problem, the OR fell to 1.27 (95% CI = 0.92-1.74; P = .14). In the fully adjusted model, including adjustment for vestibular vertigo, there was little support to link hearing loss and fall-related injury (OR = 1.16; 95% CI = 0.84-1.60; P = .36). Effect modification by age was not observed., Conclusions: Self-reported hearing loss may be a clinically useful indicator of increased fall risk, but treatment for hearing loss is unlikely to mitigate this risk, given that there is no independent association between self-reported hearing loss and nonfatal falls after accounting for vestibular function and other potential confounders., (© 2019 The American Geriatrics Society.)

Following a Mediterranean diet high in plant-based foods and fish, low in meat and dairy foods, and with moderate alcohol intake has been shown to promote healthy aging. Therefore, we examined the association between a Mediterranean diet and trajectories of cognitive performance in the InCHIANTI study. Subjects ( N = 832) were examined every 2⁻3 years up to 18 years with an average follow-up period of 10.1 years. Cognitive performance was assessed using the Mini Mental State Examination (MMSE) at every visit. Dietary habits were assessed using a validated food frequency questionnaire and adherence to Mediterranean diet was computed on a scale of 0-9 and categorized into three groups of low (≤3), medium (4⁻5), and high (≥6). Those in the highest adherence group (OR = 0.48, 95% CI: 0.29⁻0.79) and medium adherence group (OR = 0.64, 95% CI: 0.41⁻0.99) were less likely to experience cognitive decline. The annual average decline in MMSE scores was 0.4 units, for those in the high and medium adherence group this decline was attenuated by 0.34 units ( p < 0.001) and 0.16 units ( p = 0.03), respectively. Our findings suggest that adherence to a Mediterranean diet can have long-lasting protective effects on cognitive decline and may be an effective strategy for the prevent or delay dementia.

Background: Consumption of low-calorie sweeteners (LCS) has increased in the US and is associated with cardiometabolic risk. No data exist on LCS consumption in South Asians., Aim: The aim of this study was to assess the prevalence of LCS use across socio-demographic characteristics, chronic disease status, and cardiometabolic risk factors., Methods: Cross-sectional analyses were conducted using data from the Mediators of Atherosclerosis in South Asians Living in America study ( N = 892; 47% women; mean age = 55 (standard deviation = 9.4) y). Chi-squared and ANOVA tests were used to compare LCS consumption across socio-demographic characteristics and cardiometabolic risk factors., Results: Twenty-two percent of participants reported LCS use, with higher consumption among men and those with longer residency in the US. LCS use was associated with adiposity and higher odds of hypertension, high cholesterol, and diabetes., Conclusions: LCS use is prevalent among South Asians, emphasizing the need for long-term, prospective studies to investigate its role in incident cardiometabolic risk in an already metabolically vulnerable population.

Background: Following a vegetarian diet is considered to be beneficial for overall health and is associated with a lower risk of chronic disease., Objective: This study examined whether South Asians in the United States who consume a vegetarian diet have a lower prevalence of cardiometabolic risk factors., Methods: Data from the Mediators of Atherosclerosis in South Asians Living in America study, which included 892 South Asians (47% women), with an age range of 40-83 y and a mean ± SD age of 55 ± 9.4 y, were used. Participants were classified as vegetarian if they reported no consumption of meat, poultry, or fish in the previous year on a validated and culturally appropriate food-frequency questionnaire. Adjusted linear and logistic regression models were used to examine associations of a vegetarian diet with cardiometabolic risk factors., Results: Thirty-eight percent of the cohort participants were classified as vegetarian. Vegetarians reported more frequent weekly eating occasions of whole grains (median frequency/wk: 10 compared with 9, P = 0.012) and beans and legumes (median frequency/wk: 8.5 compared with 5.1, P < 0.001), and less frequent weekly eating occasions of sweets and desserts (median frequency/wk: 1.9 compared with 2.3, P < 0.001). Consuming a vegetarian diet was associated with lower body mass index (P = 0.023), fasting glucose (P = 0.015), insulin resistance (P = 0.003), total cholesterol (P = 0.027), and LDL cholesterol (P = 0.004) and lower odds of fatty liver (OR: 0.43; 95% CI: 0.23, 0.78, P = 0.006). The odds of having any coronary artery calcium were lower for vegetarian men (OR: 0.53; 95% CI: 0.32, 0.87, P = 0.013); however, no significant associations were observed among women., Conclusions: Among US South Asians, a vegetarian diet was associated with fewer cardiometabolic risk factors overall and with less subclinical atherosclerosis among men.

Objective: Sedentary behaviors related to television (TV) viewing are associated with adiposity; however, few investigations have focused on South Asians, an ethnicity particularly vulnerable to metabolic perturbations. This study examined the relationships between TV viewing and adiposity in a cohort of middle-aged and older South Asians., Method: Data were obtained from Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (N = 906; mean age [standard deviation] = 55 [9.4] years, 46% women). TV viewing hours per week was assessed through questionnaire and classified into tertiles for analysis. Multivariate linear regression models were used to examine the associations between TV viewing and measures of adiposity and body composition including body mass index (BMI), waist circumference, pericardial fat volume, and visceral, subcutaneous, and inter-muscular fat area after adjusting for covariates including intentional exercise., Results: Participants who were women, older, with lower education levels, and living longer in the United States watched TV for longer periods of times. Duration of TV viewing was positively associated with BMI (p < 0.001), waist circumference (p < 0.001), visceral fat area (p = 0.001), and pericardial fat volume (p = 0.003) independent of intentional exercise., Conclusions: While studies in South Asians with a longitudinal design need to confirm our findings, our cross-sectional results indicate that reduction in TV viewing may be beneficial in reducing adiposity and maintaining a healthy body composition.

Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women's work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, called the Reduction in Anemia through Normative Innovations (RANI) Project, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. Before collecting the data, and after analyzing the results, we will hold convenings in India to engage key stakeholders in collaborative design. Following the intervention design, we will test components of the intervention, gather user feedback and fine-tune as necessary. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach., Competing Interests: No competing interests were disclosed.