No abstract

Purpose of the study: Investigating health disparities requires studies designed to recruit and retain racially and socioeconomically diverse cohorts. It is critical to address the barriers that disproportionately affect participation in clinical research by minorities and the socioeconomically disadvantaged. This study sought to identify and rectify these barriers to recruit and retain a biracial (African American and non-Hispanic White) and socioeconomically diverse cohort for a longitudinal study. Design and Method: The Healthy Aging in Neighborhoods of Diversity across the Life Span study is a 20-year longitudinal examination of how race and socioeconomic status influence the development of age-related health disparities. One goal was to create a multifactorial recruitment and retention strategy. The recruitment paradigm targeted known barriers and identified those unique to the study's urban environment. The retention paradigm mirrored the recruitment plan but was based on specifically developed approaches. Results: This cohort recruitment required attention to developing community partnerships, designing the research study to meet the study hypotheses and to provide benefit to participants, providing a safe community-based site for the research and creating didactics to develop staff cultural proficiency. These efforts facilitated study implementation and enhanced recruitment resulting in accrual of a biracial and socioeconomically diverse cohort of 3,722 participants. Implications: Recruiting and retaining minority or poor research participants is challenging but possible. The essential facets include clear communication of the research hypothesis, focus on providing a direct benefit for participants, and selection of a hypothesis that is directly relevant to the community studied

This disease-based registry cohort represents a population exposed to multiple therapies, long disease duration, and multiple comorbidities and can be used to examine comparative safety and efficacy of various therapies.

Future mental health interventions targeted at reducing SES disparities in dietary quality and central adiposity may have different effects across sex-ethnicity groups.

Background Dietary antioxidants can inhibit reactions accompanying neurodegeneration, and thus prevent cognitive impairment. We describe associations of dietary antioxidants with cognitive function in a large biracial population, while testing moderation by sex, race and age and mediation by depressive symptoms. Methods This was a cross-sectional analysis of 1,274 adults (541 men and 733 women) aged 30–64y at baseline (Mean±SD: 47.5±9.3) in the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study (HANDLS), Baltimore city, MD. Cognitive performance in the domains of memory, language/verbal, attention, spatial, psychomotor speed, executive function, and global mental status were assessed. The 20-item Center for Epidemiologic Studies Depression Scale (CES-D) scale was used to measure depressive symptoms. Dietary intake was assessed with two 24-hr recalls, estimating daily consumption of total carotenoids, vitamins A, C and E, per 1,000 kcal. Results Among key findings, one standard deviation (SD~2.02 mg/1,000kcal) higher vitamin E was associated with a higher score on verbal memory, immediate recall, (β=+0.64±0.19, p=0.001) and better language/verbal fluency performance (β=+0.53±0.16, p=0.001), particularly among the younger age group. Women with higher vitamin E intake (β=+0.68±0.21, p=0.001) had better performance on a psychomotor speed test. The vitamin E-verbal memory association was partially mediated by depressive symptoms (proportion mediated=13–16%). Conclusions In sum, future cohort studies and dietary interventions should focus on associations of dietary vitamin E with cognitive decline, specifically for domains of verbal memory, verbal fluency and psychomotor speed.

The primary objective of this cross-sectional study was to characterize dietary patterns of African Americans and Whites, 30 to 64 years, examined in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Other objectives of the study were to evaluate micronutrient adequacy of each pattern and to determine the association of diet with sarcopenia. Cluster analysis was used to determine patterns and mean adequacy ratio (MAR) to determine adequacy of 15 micmnutrients. Ten clusters were identified: sandwich, sweet drink, pizza, poultry, frozen meal, dessert, alcoholic drink, bread, starchy vegetables, and pasta/rice dish. MAR ranged from 69 for the sweet drink cluster to 82 for the pasta/rice dish cluster. Sarcopenia was present in 6.4% of the sample, ranging from 1.5% in the poultry cluster to 14.1% in the alcoholic drink cluster. This study is the first to report an association between diet and sarcopenia in people younger than 65 years. The identification of presarcopenia has important implications for dietary interventions that might delay age-associated loss of lean mass.

Background C-Reactive Protein (CRP), an inflammatory biomarker, is influenced by many factors including socioeconomic position, genetics and diet. The inverse association between diet and CRP is biologically feasible because micronutrients with antioxidative properties may enable the body to manage the balance between production and accumulation of reactive species that cause oxidative stress. Objective To determine the quality of the diet consumed by urban, low-income African American and White adults aged 30 to 64 years, and association of diet quality with CRP. Design Data from a cross-sectional study were used to evaluate diet quality assessed by mean adequacy ratio (MAR). Two 24-hour recalls were collected by trained interviewers using the USDA automated multiple pass method. Participants The sample consisted of Healthy Aging in Neighborhoods of Diversity across the Life Span baseline study participants, 2004–2009, who completed both recalls (n=2017). Main outcome measures MAR equaled the average of the ratio of intakes to RDA for 15 vitamins and minerals. CRP levels were assessed by the nephelometric method utilizing latex particles coated with CRP monoclonal antibodies. Statistical analysis performed Linear ordinary least square regression and generalized linear models were performed to determine the association of MAR (independent variable) with CRP (dependent variable) while adjusting for potential confounders. Results MAR scores ranged from 74.3 to 82.2. Intakes of magnesium and Vitamins A, C, and E were the most inadequate compared to Estimated Average Requirements. CRP levels were significantly associated with MAR, DXA-measured body fat, and hypertension. A 10% increase in MAR was associated to a 4% decrease in CRP. Conclusions The MAR was independently and significantly inversely associated with CRP, suggesting diet is associated with the regulation of inflammation. Interventions to assist people make better food choices may not only improve diet quality but also their health, possibly reducing risk for cardiovascular disease.

ObjectivesThis analysis examined the association between psoriasis severity, assessed by body surface area (BSA) and the Investigator’s Global Assessment (IGA; previously used only in clinical trials), and patient-reported outcomes (PROs) in a real-world setting.DesignCross-sectional analysis within the Corrona Psoriasis Registry, an independent, prospective registry.Setting70 dermatology practices in the USA.Participants1529 adult patients with psoriasis being treated with biological or non-biological systemic psoriasis treatment by 31 May 2016.Primary and secondary outcome measuresPsoriasis severity was assessed by percentage of affected BSA (mild (0%–5%), moderate (>5%–10%), severe (>10%–15%), very severe (>15%)) and IGA scores (clear/almost clear (0–1), mild (2), moderate (3), severe (4)). PROs (pain, itch, fatigue; Dermatology Life Quality Index [DLQI]; EuroQoL Visual Analogue Scale [EQ-VAS]; Work Productivity and Activity Impairment [WPAI]) were compared across BSA and IGA levels using analysis of variance and X2 tests. The association between psoriasis severity and PROs was examined using multivariable regression models.ResultsThe mean age was 50.6 years and 47% of patients were female. Consistently with more severe psoriasis, symptoms worsened, DLQI scores increased (p<0.05 for each level of BSA and IGA), EQ-VAS decreased (p<0.05 for each level of BSA and IGA) and WPAI scores increased. By BSA score, moderate to very severe psoriasis was associated with poorer outcomes for the ‘impairment while working’ and ‘daily activities impaired’ WPAI domains (all p<0.05 vs mild psoriasis). Very severe psoriasis was associated with increased ‘work hours missed’ and ‘work hours affected’ (both p<0.05 vs mild psoriasis) Findings were similar by IGA. Results were confirmed by multivariable regression analyses.ConclusionsIn a real-world setting, more severe psoriasis, assessed by BSA and IGA, was consistently associated with worse PROs.