Health Literacy, Numeracy, and Dietary Approaches to Stop Hypertension Accordance Among Hypertensive Adults.

BACKGROUND: Health literacy (HL) and health numeracy (HN), the ability to interpret and act on quantitative health information, are important for hypertension self-management such as limiting sodium intake. We examined associations of HL, HN, and Dietary Approaches to Stop Hypertension (DASH) diet accordance. PARTICIPANTS: Among 1,073 hypertensive adults enrolled in a Baltimore, Maryland-based cohort study, we performed a cross-sectional analysis. Rapid Estimate of Adult Literacy in Medicine (REALM) measured HL and Test of Functional Health Literacy in Adults (TOFHLA) numeracy score measured HN. METHOD: DASH accordance was based on nine key nutrients. Linear regression models estimated associations of HL and HN with DASH total and sodium score, inclusive of dietary supplement data. RESULTS: In our sample, 39% of participants were male, 66% were Black, 40.2% lived in poverty, and 29.5% reported food insecurity. Fully, 32.5% had limited HL and 14.5% had limited HN. Mean DASH score overall was 2 (range = 0-7.5); only 6.9% were DASH accordant (score ≥4.5). In age and sex adjusted models, higher REALM was associated with a higher DASH score in the overall sample; the relationship of HN with DASH was statistically significant among White but not Black participants. Educational attainment appeared to explain both findings. There were no significant associations between HL or HN and DASH sodium scores. CONCLUSION: Differences in educational attainment explained the relation of higher HL and greater accordance to the DASH diet in a population of hypertensive adults. Understanding these factors is vital to reducing disparities in hypertension and its sequelae.

Caregiver Status and Diet Quality in Community-Dwelling Adults.

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

Longitudinal associations between dietary quality and Alzheimer's disease genetic risk on cognitive performance among African American adults.

Poor diet quality (DQ) is associated with poor cognition and increased neurodegeneration, including Alzheimer's disease (AD). We are interested in the role of DQ on cognitive functioning (by sex and increasing genetic risk for AD), in a sample of African American (AA) middle-aged adults. We analysed a sub-group of participants (about 55 % women; mean follow-up time of about 4·7 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a genetic risk score for AD (hAlzScore). The Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension and the mean adequacy ratio computed at baseline (2004-2009) and follow-up visits (2009-2013) were used to assess initial DQ and change over time. Linear mixed-effects regression models were utilised, adjusting for select covariates, selection bias and multiple testing. DQ change (ΔDQ) was associated with California Verbal Learning Test-List A - overall (0·15 (se 0·06), P = 0·008) and in women (0·21 (se 0·08), P = 0·006), at highest AD risk, indicating protective effects over time. Greater AD risk was longitudinally associated with poorer Clock Command Test scores in men. Poor DQ was positively and cross-sectionally associated with Trails B scores, but in women only. Better-quality diet was associated with a slower decline in verbal memory among AA women, with greater AD risk. Insufficient clinical evidence and/or mixed findings dictate that more studies are needed to investigate brain morphology and volume changes in relation to DQ in an at-risk population for AD, over time.

The Interplay of Diet Quality and Alzheimer's Disease Genetic Risk Score in Relation to Cognitive Performance Among Urban African Americans.

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

Impact of tart cherry juice on systolic blood pressure and low-density lipoprotein cholesterol in older adults: a randomized controlled trial.

Hypertension and dyslipidemia are major risk factors for cardiovascular disease (CVD). Common treatments for high blood pressure (BP) and dyslipidemia include medications, but there is question as to whether natural sources may be adequate to reduce CVD risk factors. We examined the effects of tart cherry juice on lipid profiles, BP, glucose, insulin, and homeostatic model assessment-insulin resistance (HOMA-IR) in older adults. In this randomized-controlled clinical trial, 17 men and 20 women between the ages of 65-80 years were randomly assigned to consume 480 ml of tart cherry juice or control drink daily for 12 weeks. Control beverages were matched for energy and sugar content. Outcome variables were assessed at baseline and after 12 weeks of tart cherry juice or control drink. Systolic BP and low-density lipoprotein cholesterol (LDL) exhibited treatment × time interaction effects. At the end of the study, participants in the tart cherry group had lower levels of LDL cholesterol (difference of -20.6 with P = 0.001) and total cholesterol (difference of -19.11 with P = 0.01), and higher levels of glucose (difference of 7.94 with P = 0.001), triglycerides (difference of 6.66 with P = 0.01) and BMI (difference of 1.06 with P = 0.02) than in the control group. Neither tart cherry juice nor control significantly altered body weight, high-density lipoprotein cholesterol, diastolic BP, insulin and HOMA-IR. Our findings show that tart cherry juice can lower the levels of systolic BP and LDL cholesterol. However, larger and longer follow-up studies are needed to further assess cardio-protective effects of tart cherry juice.

Health Literacy and Education Predict Nutrient Quality of Diet of Socioeconomically Diverse, Urban Adults.

BACKGROUND: Research has shown that health literacy may be a stronger predictor of health than age, employment status, education level, race, and income. Evidence supports a strong link between low health literacy and poor dietary management of chronic diseases. OBJECTIVE: The aim was to evaluate the relationship of micronutrient quality of diet, health numeracy and health literacy in White and African American adults randomly selected from 13 Baltimore neighborhoods. DESIGN: Cross-sectional analysis of Wave 3 (2009-2013) of the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study initiated in 2004. MAIN OUTCOME MEASURES: Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Health numeracy was measured using the numeracy subscale of the Test of Functional Health Literacy in Adults (TOFHLA). Nutrient-based diet quality was measured using Mean Adequacy Ratio (MAR-S) scores calculated from 17 micronutrients from diet plus dietary supplement intake. STATISTICAL ANALYSES: The relationship of MAR-S scores to the health literacy measures were explored with multiple ordinary least square regression models, adjusting for a number of potential confounders. RESULTS: REALM but not numeracy was associated with MAR-S; significant covariates included age, current cigarette smoking status, and energy intake. The interactions of race and educational attainment, and REALM and educational attainment were significant, with the relationship between REALM and MAR-S becoming stronger as education level increased. CONCLUSION: There is a synergistic relationship between health literacy and educational attainment in predicting nutrient-based diet quality. Education was a stronger predictor for Whites compared to African Americans emphasizing the need for health professionals to focus on both education and literacy when creating and providing diet and health-related interventions and resources.

Beverage Consumption Patterns of a Low-Income Population.

High-energy-dense foods provide an inexpensive source of calories. Healthy Aging in Neighborhoods of Diversity across the Life Span study participants (n = 1987), low- to low-middle-income, urban African American and white adults, consumed between 17% and 20% of their daily energy intake from beverages. Of all beverages consumed, calorically sweetened beverages ranked second among African Americans and third among whites. Calorically-sweetened beverage consumption was not influenced by weight status. Increasing awareness of risks for adverse health outcomes associated with selected beverages may improve dietary choices.

Vitamin B(12) deficiency is linked with long-term use of proton pump inhibitors in institutionalized older adults: could a cyanocobalamin nasal spray be beneficial?

The purpose of this study was to determine whether institutionalized older individuals taking proton pump inhibitors (PPI) for more than 12 months were more likely to have vitamin B(12) deficiency than individuals not taking PPI, and whether cyanocobalamin nasal spray would improve their vitamin B(12) status. Participants were long-term care residents aged 60-89 years. PPI users (n = 17) were treated with cyanocobalamin nasal spray for 8 weeks; non-PPI users (n = 19) were not treated but were followed for the same time duration. Serum samples from all subjects were analyzed for vitamin B(12) and serum methylmalonic acid (sMMA) at baseline and the end of the 8-week treatment. There was a significant difference in mean vitamin B(12), sMMA, and frequency of deficiency between control and intervention groups at baseline. After treatment, there was an increase (p = 0.012) in serum vitamin B(12) concentration, and a decrease (p = 0.004) in frequency of deficiency in PPI users. Thus, we found that institutionalized older individuals on PPI for more than 12 months may be more likely to be vitamin B(12) deficient than non-PPI users. Additionally, treatment of PPI users with cyanocobalamin nasal spray for 8 weeks could improve vitamin B(12) status.