No abstract

Depression and/or cognitive impairment was identified in one-third of older adults with multimorbidity, and these combinations were associated with substantially greater prospective disability than combinations comprised exclusively of somatic conditions. This argues for identifying and managing mental health conditions that co-occur with somatic conditions.

In the inpatient setting, prevalence, predictors and outcomes (mortality risk (MR), length of stay (LOS) and total charges (TC)) of Alzheimer’s Disease (AD) are largely unknown. We used data on older adults (60y+) from the Nationwide Inpatient Sample (NIS) 2002–2012. AD prevalence was ~3.12% in 2012 (total weighted discharges with AD±standard error: 474,410±6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR=1.67, 95%CI:1.63–1.71, p<0.001), fluid/electrolyte disorders (OR=1.25, 95%CI:1.22–1.27, p<0.001), weight loss (OR=1.26, 95%CI:1.22–1.30, p<0.001) and psychosis (OR=2.59, 95%CI:2.47–2.71, p<0.001), with mean total co-morbidities increasing over-time. AD was linked to higher MR, longer LOS but lower TC. TC rose in AD, while MR and LOS dropped markedly over-time. In AD, co-morbidities predicting simultaneously higher MR, TC and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders and weight loss. In sum, co-morbidities and TC increased over-time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD.

The purpose of this study was to investigate Michigan school food service directors' interest in, and opportunities and barriers to, implementing a farm-to-school program. Farm-to-school may be a timely and innovative approach to improving the school food environment and helping food service directors meet their nutrition goals for school meals. Health and agriculture advocates have recognized the importance of farm-to-school in addressing health issues and creating opportunities for farmers and rural communities. Research subjects were 664 food service directors representing school districts across Michigan. Respondents (n = 383) reported a high degree of interest in sourcing food from local producers (73% reported being very interested or interested). Interest was significantly augmented (83%) when respondents were asked to assume that these foods were available through current vendors. Interest was independent of free/reduced lunch participation rate or school district location (rural, suburban, urban location). Food service directors expressed diverse motivations for their interest in farm-to-school, including supporting the local economy and community; accessing fresher, higher-quality food; and potentially increasing students' fruit and vegetable consumption. The most frequently reported barriers and concerns included cost, federal and state procurement regulations, reliable supply, seasonality of fruits and vegetables, and food safety. Michigan school food service directors appear ready to make linkages with local agriculture. However, there is need to address the concerns and barriers through education; inclusion of community partners, such as current vendors; funding; and state and federal policies that support local purchasing.

Uric acid, a waste metabolite among humans, was linked to various cognitive outcomes. We describe sex and age-group specific associations of baseline SUA (SUAbase) and significant change in SUA (ΔSUA: 1 vs. 0=decrease vs. no change; 2 vs. 0=Increase vs. no change) with longitudinal annual rate of cognitive change among a large sample of urban adults. Data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study, 2004–2009 (visit 1) and 2009–2013 (visit 2) were used. Of 3,720 adults selected at baseline (age range:30-64y), complete data were available for N=1,487–1,602 with a mean repeat of 1.5–1.7 visits/participant. Cognitive test domains spanned attention, processing speed, learning/memory, executive function, visuo-spatial/visuo-construction ability, language/verbal and global cognitive function. SUA was measured at both visits. Multiple mixed-effect regression analyses were conducted. In the total population, a higher SUAbase was associated with a faster annual rate of decline on a measure of visual memory/visuo-construction ability (the Benton Visual Retention Test) by γ=0.07 with a standard error of 0.02, P<0.001. Among older men, a significant increase in SUA was associated with slower decline on a test of attention/processing speed, namely Trailmaking test, Part A, measured in seconds to completion (γ=−6.91±1.73, p<0.001). In sum, a higher SUAbase was associated with faster cognitive decline over-time in a visual memory/visuo-construction ability test. ΔSUA had particular beneficial effects of an increasing ΔSUA on the domain of attention/processing speed among older men. More longitudinal studies are needed to examine cognitive domain-specific effects of over-time change in SUA within sex and age groups.

Objective Perceived discrimination has been associated with psychosocial distress and adverse health outcomes. We examined associations of perceived discrimination measures with changes in kidney function in a prospective cohort study, the Healthy Aging in Neighborhoods of Diversity Across the LifeSpan. Methods Our study included 1,620 participants with preserved baseline kidney function (estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73m2) (662 Whites and 958 African-Americans (AA), aged 30–64 years). Self-reported perceived racial discrimination (PRD) and perceived gender discrimination (PGD) and a general measure of experience of discrimination (EOD) [“Medium vs. low”, “High vs. low”] were examined in relation to baseline, follow-up and annual rate of change in eGFR using multiple mixed-effects regression (γbase, γrate) and OLS models (γfollow). Results Perceived gender discrimination “High vs. Low PGD” was associated with a lower baseline eGFR in all models (γbase=−3.51(1.34), p=0.009 for total sample). Among White women, High EOD was associated with lower baseline eGFR, an effect that was strengthened in the full model (γbase=−5.86(2.52), p=0.020). Overall, “High vs. Low” PGD was associated with lower follow-up eGFR (γfollow=−3.03(1.45), p=0.036). Among AA women, both PRD and PGD were linked to lower follow-up kidney function, an effect that was attenuated with covariate adjustment, indicating mediation through health-related, psychosocial and lifestyle factors. In contrast, EOD was not linked to follow-up eGFR in any of the sex by race groups. Conclusions Perceived racial and gender discrimination are associated with poor kidney function assessed by glomerular filtration rate and the strength of associations differ by sex and race groups. Perceived discrimination deserves further investigation in psychsocial risk factors for kidney disease.

In the present study, we examined longitudinal changes in self-reported depressive symptoms (and related domains) in relation to baseline intakes of n-3 fatty acids (absolute and relative to n-6 fatty acids). Sex-specific associations were evaluated in a prospective cohort of adults (n = 2,053) from Baltimore, Maryland, who were 30-64 years of age at baseline and were followed for a mean of 4.65 (standard deviation, 0.93) years (2004-2013). Using mean intakes of n-3 and n-6 fatty acids reported on two 24-hour dietary recalls, we estimated the ratios of n-3 to n-6 fatty acids for both highly unsaturated fatty acids (≥20 carbon atoms) (HUFAs) and polyunsaturated fatty acids (≥18 carbon atoms) (PUFAs). Outcomes included total and domain-specific scores on the 20-item Center for Epidemiologic Studies-Depression scale. Based on mixed-effects regression models, among women, both higher n-3 HUFA:n-6 PUFA and n-3 PUFA:n-6 PUFA ratios were associated with a slower rate of increase in total Center for Epidemiologic Studies-Depression scores over time. Higher n-3 HUFA:n-6 HUFA ratios were associated with slower increases in somatic complaints in men, whereas among women, higher n-3 HUFA:n-6 PUFA and n-3 PUFA:n-6 PUFA ratios were both linked to putative longitudinal improvement in positive affect over time. Among US adults, n-3:n-6 dietary fatty acid ratio was associated with longitudinal changes in depressive symptoms, with a higher ratio linked to a slower increase in depressive symptoms over time, particularly among women.

Recent evidence indicates that thyroid hormones may be closely linked to cognition among adults. We investigated associations between thyroid hormones and longitudinal cognitive change, within and outside of reference ranges, stratifying by sex and race. This longitudinal study used data from the Healthy Aging in Neighborhoods of Diversity Across the Lifespan (HANDLS) study, set in Baltimore City, MD, 2004-2013, on adults aged 30-64y at baseline visit, with a length of follow-up between visits 1 and 2 ranging from <1 year – 8 years; Mean±SD: 4.64±0.93. The final analytic sample sizes ranged from 1,486-1,602 participants with 1.6-1.7 visits/participant (total visits: 2,496-2,757), depending on the cognitive test. Eleven cognitive test scores spanning domains of learning/memory, language/verbal, attention, visuo-spatial/visuo-construction, psychomotor speed, executive function, and mental status were used. Mixed-effects regression models were conducted, interacting time of follow-up with several thyroid exposures. Whites performed better than African-Americans, with only four cognitive test scores of eleven declining significantly over-time. Importantly, above reference range thyroid stimulating hormone (vs. reference range, TSHarr) was linked to faster rates of decline on the Digits Span Backwards test, reflecting working memory (TSHarr×Time γ±SE:-0.14±0.05, P=0.006) and clock-command, a test of visuo-spational/visuo-construction abilities (TSHarr×Time γ±SE:-0.10±0.04, P=0.004). The latter finding was replicated when comparing normal thyroid function to “subclinical hypothyroidism”. Within reference ranges, a higher TSH was related to faster decline on the clock-command test scores in women. In sum, higher baseline TSH was associated with faster cognitive decline over-time among urban US adults, specifically in domains of working memory and visuo-spatial/visuo-construction abilities.