Food Insecurity and Hearing Loss Are Interrelated: A Cross-Sectional Population-Based Study.

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

Hypertension is associated with narrower retinal arteriolar calibre in persons with and without coronary artery disease.

The aims of this study were to investigate independent associations between hypertension and retinal vessel calibre in a high cardiovascular risk cohort and to determine whether these associations also exist in patients without coronary artery disease (CAD). The Australian Heart Eye Study is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. Hypertension was defined as systolic >140 mm Hg, diastolic >90 mm Hg or treated (use of antihypertensive medications). Retinal arteriolar and venular calibres were measured from retinal photographs. CAD was quantified using severity (Gensini) and extent scores. Subanalyses were performed for people with and without CAD and for men and women. A total of 1114 participants had complete data on hypertension, coronary vessel evaluation and retinal vessel measurements and were included in cross-sectional analyses. Among persons with CAD, those with hypertension (compared with without) had narrower retinal arteriolar calibre (mean arteriolar calibre difference 2.1 µm, P=0.02), adjusting for age, sex, ethnicity, body mass index, smoking status and fellow vessel calibre. This association was also present among persons without CAD (mean difference 5.0 µm, P=0.04). Stratification by sex indicated that women with hypertension had marginally narrower retinal arterioles compared with normotensive women (multivariable-adjusted P=0.04). No significant association between hypertension and retinal arteriolar calibre was observed in men (P=0.13). No significant differences in retinal venular calibre were observed (P>0.05). In conclusion, in both subjects with and without CAD, hypertension was independently associated with narrower retinal arterioles.

Dairy food consumption, blood pressure and retinal microcirculation in adolescents.

BACKGROUND AND AIMS: The relationship between dairy food consumption and dietary calcium intake, and vascular risk factors during adolescence remains unclear. We aimed to prospectively assess whether dairy food consumption (milk, cheese, yoghurt) is associated with blood pressure (BP) and retinal microvascular signs among adolescents. METHODS AND RESULTS: As many as 2353 and 1216 participants aged 12 and 17, respectively, were examined. Longitudinal analyses involved 888 subjects with complete baseline and follow-up data. Dairy consumption was assessed from validated semi-quantitative food frequency questionnaires. BP information was collected and retinal vessel caliber was quantified from digital photographs using computer software. In girls, after multivariable adjustment, each serve/day increase in total dairy intake was concurrently associated with 1.04 (p = 0.03) and 1.10 mm Hg (p = 0.02) decreases in mean diastolic and arterial BP, respectively. Also in girls, each serve/day increase in cheese intake over 5 years was concurrently related to 7.18 (p = 0.001), 5.28 (p = 0.002) and 5.79 mm Hg (p = 0.001) decrease in mean systolic, diastolic and arterial BP, respectively. Among girls, each 100 mg/day increase in dietary calcium intake was associated with a concurrent 0.5 (p = 0.01) and 0.3 mm Hg (p = 0.02) decrease in mean systolic and arterial BP, respectively. Cross-sectionally, adolescents in the highest versus lowest tertile of yoghurt intake had ∼ 1.3 µm wider retinal arterioles (p = 0.05) and ∼ 2.0 µm narrower venules (p = 0.04). CONCLUSIONS: Consumption of dairy products, particularly cheese, could have a beneficial effect on BP, particularly among girls.

Association between diet quality with concurrent vision and hearing impairment in older adults.

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

Lower dairy products and calcium intake is associated with adverse retinal vascular changes in older adults.

BACKGROUND AND AIMS: Higher consumption of dairy products and calcium is likely to play a role in maintaining optimal vascular health. In this study, we aimed to explore the associations between consumption of total-, regular- and low-fat dairy foods, and total calcium intake with retinal vascular caliber. METHODS AND RESULTS: 2813 Blue Mountains Eye Study participants aged 50+ years had dietary data collected using a semi-quantitative food frequency questionnaire, and serves of dairy consumption were calculated. Fundus photographs were taken and retinal vascular caliber measured using computer-assisted techniques and summarized. After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, serum glucose, white cell count, history of diagnosed hypertension, stroke and coronary heart disease, plus retinal arteriolar caliber, participants in the lowest quintile of total dairy consumption compared to those in the remaining highest 4 quintiles had significantly wider retinal venular caliber, 227.2 versus 224.7 µm, respectively (multivariable-adjusted p = 0.002). Also, subjects in the lowest quintile of low-fat dairy product consumption versus those in the remaining quintiles of low-fat dairy intake had wider retinal venules (∼ 1.7 µm, p = 0.03) and narrower retinal arterioles (∼ 1.4 µm, p = 0.04). Participants in the lowest quintile versus highest quintile of total dietary calcium intake had ∼ 2.3 µm wider retinal venules (multivariable-adjusted p-trend = 0.02). CONCLUSIONS: A significant association was observed between lower intake of dairy products or calcium and adverse retinal vascular signs. We cannot discount the possibility of confounding from unmeasured risk factors; hence, further studies are warranted to confirm these findings.

Differences in association between birth parameters and blood pressure in children from preschool to high school.

We aimed to investigate the association between birth parameters with blood pressure (BP) among preschool- and school-aged children. Two separate childhood datasets were used: (1) 1295 children aged 3-6 years were examined during 2007-2009; and (2) 1741 and 2353 children aged 6 and 12 years, respectively, were examined during 2004-2006. Birth parameter data were obtained from parental records. BP was measured using standard protocols. Among 6-year-old children, each 1 kg decrease in birth weight was associated with a 1.33- and 1.20-mm Hg higher systolic and diastolic BP, respectively, after multivariable adjustment. In 6-year-old children, a decrease of 1 week in gestational age was independently associated with a 0.33- and 0.37-mm Hg higher systolic and diastolic BP, respectively. Six-year-old children in the low birth weight category (≤ 2499 g) versus those in the normal/high birth weight category (≥ 2500 g) had significantly higher systolic BP (P<0.0001). Girls in the low birth weight category versus those in the normal/high weight category had higher systolic BP (P=0.02). Significant associations were not observed among preschool-aged children and preadolescents. Birth weight and gestational age were strongly associated with BP among 6-year-old children, particularly girls, but not among preschoolers or preadolescents.

A better diet quality is associated with a reduced likelihood of CKD in older adults.

BACKGROUND AND AIMS: Studies of diet in relation to chronic kidney disease (CKD) have focused on individual nutrients. The relationship between overall patterns of food intake and renal function has not been well explored. We aimed to investigate the associations between diet quality with the prevalence, incidence and progression of CKD in a cohort of older adults. METHODS AND RESULTS: 1952 participants aged ≥50 years at baseline were examined between 1992-1994 and 2002-2004. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Baseline biochemistry including serum creatinine was measured. CKD was defined as MDRD estimated glomerular filtration rate (eGFR) <60 mL min⁻¹·1.73 m⁻². Participants in the highest quartile of mean TDS compared to those in the first quartile (reference), had a 41% reduced likelihood of having eGFR <60 mL min⁻¹·1.73 m⁻², [multivariable-adjusted odds ratio, OR, 0.59 (95% confidence intervals, CI, 0.41-0.85), P-trend = 0.005]. Each unit increase in TDS was associated with a 15% decrease in the odds of having prevalent CKD, multivariable-adjusted OR 0.85 (95% CI 0.74-0.97). A non-significant, inverse association between TDS and CKD incidence was observed (P-trend = 0.10). CONCLUSION: Older adults with better diet quality had a reduced likelihood of having eGFR <60 mL min⁻¹·1.73 m⁻². Adherence to dietary guidelines were not prospectively associated with CKD incidence or progression. Further studies with adequate power are warranted to assess the longitudinal association between diet quality and CKD.

Higher regular fat dairy consumption is associated with lower incidence of metabolic syndrome but not type 2 diabetes.

BACKGROUND AND AIMS: Limited evidence suggests habitual dairy consumption to be protective against metabolic syndrome (MetSyn) and type 2 diabetes among older adults. We assessed the association of baseline consumption of dairy products with the incidence of MetSyn and type 2 diabetes among a cohort of Australian adults aged 49 years and over. METHODS AND RESULTS: A validated 145-item semi-quantitative food frequency questionnaire was used to assess food and nutrient intake at baseline. Ten-year incidence of MetSyn and type 2 diabetes were obtained from 1807 and 1824 subjects respectively. Odds ratios (OR) were calculated by discrete time logistic regression modelling. Compared with subjects in the lowest intake quartile of regular fat dairy products, those in the highest quartile had a 59% lower risk of MetSyn (multivariate adjusted OR: 0.41; 95% CI: 0.23-0.71; p(trend) = 0.004), after adjustment for risk factors. Among obese subjects, an association between a high intake of regular fat dairy foods and reduced risk of type 2 diabetes was also found (age and sex adjusted OR 0.37; 95% CI: 0.16-0.88; p(trend) = 0.030), but the association did not persist after adjustment for additional confounders. There was no association between total dairy consumption and risk of MetSyn or type 2 diabetes. CONCLUSIONS: We found an inverse association between regular fat dairy consumption and risk of MetSyn among Australian older adults. Further studies are warranted to examine the association between weight status, dairy consumption and risk of type 2 diabetes.

Retinal nerve fiber layer and optic disc measurements by spectral domain OCT: normative values and associations in young adults.

PURPOSE: To determine normative values and associations of retinal nerve fiber layer (RNFL) and optic disc parameters in normal eyes measured by spectral domain optical coherence tomography (OCT). METHODS: In a population-based setting, 1521 young adults were examined as part of the Sydney Adolescent Vascular and Eye Study (SAVES). Their mean age was 17.3±0.6 years. RNFL and optic disc parameter measurements were made using Cirrus HD-OCT 4000. RESULTS: The average RNFL was found to be 99.4±9.6 µm. RNFL thickness was least for the temporal quadrant (69.9±11.2 µm), followed by the nasal (74.3±12.8 µm), superior (124.7±15.7 µm) and inferior (128.8±17.1 µm) quadrants. The mean disc area in this population was 1.98±0.38 mm(2) with a mean rim area of 1.50±0.30 mm(2) and a mean cup/disc ratio of 0.44±0.18. Multivariate-adjusted RNFL thickness was marginally greater in East Asian than in white participants (100.1 µm vs 99.5 µm; P=0.0005). The RNFL was thinner with greater axial length (P<0.0001), less positive spherical equivalent refractions (P<0.0001), smaller disc area and rim area (P<0.0001). CONCLUSION: This study documents normative values for the RNFL and optic disc measured using Cirrus HD-OCT in young adults. The values and associations reported in this study can inform clinicians on the normal variation in RNFL and optic disc parameters.

Dietary antioxidant intake is associated with the prevalence but not incidence of age-related hearing loss.

OBJECTIVES: Diet is one of the few modifiable risk factors for age-related hearing loss. We aimed to examine the link between dietary and supplement intakes of antioxidants, and both the prevalence and 5-year incidence of measured hearing loss. DESIGN: Cross-sectional and 5-year longitudinal analyses. SETTING: Blue Mountains, Sydney, Australia. PARTICIPANTS: 2,956 Blue Mountains Hearing Study participants aged 50+ at baseline, examined during 1997-9 to 2002-4. MEASUREMENTS: Age-related hearing loss was measured and defined as the pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz >25 dB HL. Dietary data were collected in a semi-quantitative food frequency questionnaire, and intakes of α-carotene; ß-carotene; ß-cryptoxanthin; lutein and zeaxanthin; lycopene; vitamins A, C and E; iron and zinc were calculated. RESULTS: After adjusting for age, sex, smoking, education, occupational noise exposure, family history of hearing loss, history of diagnosed diabetes and stroke, each standard deviation (SD) increase in dietary vitamin E intake was associated with a 14% reduced likelihood of prevalent hearing loss, odds ratio, OR, 0.86 (95% confidence interval, CI, 0.78-0.98). Those in the highest quintile of dietary vitamin A intake had a 47% reduced risk of having moderate or greater hearing loss (>40 dB HL) compared to those in the lowest quintile of intake, multivariable-adjusted OR 0.53 (CI 0.30-0.92), P for trend = 0.04. However, dietary antioxidant intake was not associated with the 5-year incidence of hearing loss. CONCLUSIONS: Dietary vitamin A and vitamin E intake were significantly associated with the prevalence of hearing loss. However, dietary antioxidant intake did not increase the risk of incident hearing loss. Further large, prospective studies are warranted to assess these relationships in older adults.

Food and nutrient consumption trends in older Australians: a 10-year cohort study.

BACKGROUND/OBJECTIVES: Few longitudinal population-based cohort studies of older people have described dietary intakes over time. The objective of this study was to assess changes in the food and nutrient intake in a cohort of older Australians, using longitudinal data collected over 10 years. SUBJECTS/METHODS: Population-based cohort of people aged 49 years and over at baseline (82% of those eligible) living in two postcode areas, west of Sydney. In 1992-1994, 3654 people were examined; 2334 were reexamined after 5 years and 1952 after 10 years (75% survivors at both examinations). A 145-item food frequency questionnaire was used to assess food and nutrient intake on each occasion, and 1166 participants provided usable dietary data at all three examinations. RESULTS: Energy and sugar intake significantly increased among women over the 10-year period (P-value for trend <0.0001). Long-chain omega-3 fatty acid and fish intake significantly increased in both men and women (P-value for trend <0.0001). Folate intake significantly increased in both men and women (women: 325 dietary folate equivalents (DFE) vs 403 DFE; men: 346 DFE vs 425 DFE, P<0.0001). Wholemeal/grain bread consumption decreased in both men and women (P-value for trend <0.0001). CONCLUSIONS: Many of the observed changes in diet over the 10-year period were consistent with current population dietary recommendations. Some changes, however, appear to have been due to poorer dietary choices. This information could be used to inform nutrition policy and programs targeted to older persons. These data highlight the need to identify barriers to better food choices.

The effects of smoking and alcohol consumption on age-related hearing loss: the Blue Mountains Hearing Study.

OBJECTIVES: We aimed to investigate the temporal association between smoking or alcohol consumption and hearing loss, and to confirm previously published cross-sectional associations. DESIGN: The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was measured in 2956 participants (aged 50+ yrs) and was defined as the pure-tone average of frequencies 0.5, 1.0, 2.0, and 4.0 kHz >25 dB HL in the better ear (bilateral hearing loss). Alcohol consumption and smoking status were measured using an interviewer-administered questionnaire. Logistic regression was used to obtain odds ratios (OR) with 95% confidence intervals (95% CI) that compared the chances of having hearing loss in participants who did or did not smoke or consume alcohol, after adjusting for other factors previously reported to be associated with hearing loss. RESULTS: The prevalence of hearing loss at baseline was 33.0% (N = 929) and the 5-year incidence of hearing loss was 17.9% (N = 156). Cross-sectional analysis demonstrated a significant protective association between the moderate consumption of alcohol (>1 but < or =2 drinks/day) and hearing function in older adults (compared with nondrinkers), OR 0.75 (95% CI, 0.57 to 0.98). Current smokers not exposed to occupational noise had a significantly higher likelihood of hearing loss after adjusting for multiple variables, OR 1.63 (95% CI, 1.01 to 2.64). A formal likelihood ratio test demonstrated that the interaction between smoking and noise exposure was not significant (p = 0.23). When the joint effects of alcohol consumption and smoking on hearing were explored, there was a trend for alcohol to have a protective relationship with hearing loss in smokers, but this was not statistically significant. However, the 5-year incidence of hearing loss was not predicted by either smoking or alcohol consumption. CONCLUSIONS: This study confirms previously reported associations between alcohol consumption or smoking and prevalent hearing loss, but these were not demonstrated in temporal data. Other risk factors could confer greater vulnerability or cause the initial damage to hearing. Future large population-based studies, exploring the influence of other risk factors on the development of age-related hearing loss are warranted.