Marc A. Mason

Role of depressive symptoms in explaining socioeconomic status disparities in dietary quality and central adiposity among US adults: a structural equation modeling approach

BACKGROUND The link between socioeconomic status (SES), depression, dietary quality, and central adiposity remains unclear. OBJECTIVE Pathways linking SES to dietary quality and central adiposity through depressive symptoms were examined across sex-ethnicity groups. DESIGN Extensive data on US adults aged 30-64 y from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used in multiple linear logistic regression models and structural equation models to test pathway associations. Measures included Center for Epidemiologic Studies-Depression (CES-D) scores, 2005 Healthy Eating Index (HEI) values, and dual-energy X-ray absorptiometry. Sample sizes for most analyses ranged between 1789 for anthropometric outcomes and 1227 for trunk fat outcomes. RESULTS The CES-D score was associated with lower HEI scores in all sex-ethnicity groups, except in African American men, and with higher waist-to-hip ratios (WHRs) among African American women. A CES-D score > or =16 was positively associated with waist circumference (WC) and with trunk fat among white women and men, respectively. SES was positively related to central adiposity among African American men (central obesity and WC) and African American women (central obesity and percentage trunk fat) but was inversely related to central adiposity among white women. Among whites only, the total positive effect of SES on HEI was significantly mediated by CES-D score. Among white women, the total inverse effect of SES on WC and WHR was significantly explained by the CES-D score and HEI, whereas the CES-D score was positively associated with WHR among African American women, independently of SES. CONCLUSION Future mental health interventions targeted at reducing SES disparities in dietary quality and central adiposity may have different effects across sex-ethnicity groups.

The Sex-Specific Role of Plasma Folate in Mediating the Association of Dietary Quality with Depressive Symptoms

Folate deficiency has been implicated in the etiology of unipolar depression. In this study, we attempted to cross-link plasma folate, depressive symptoms, and dietary quality (or dietary intake of folate) together in a comprehensive framework, while examining effect modification of those associations by sex. This was a cross-sectional, population-based study of 1681 participants aged 30-64 y (Healthy Aging in Neighborhoods of Diversity across the Lifespan Study). Participants were administered the Center for Epidemiologic Studies Depression scale (CES-D). Measures of plasma folate and dietary intakes (2 24-h recalls) from which the 2005-Healthy Eating Index (HEI) was computed were available. Multivariate logistic regression and structural equation modeling (SM) were conducted. Compared with the lowest tertile, the middle and uppermost tertiles of plasma folate were associated with a 39-40% reduced odds of elevated CES-D (> or =16) among women [adjusted odds ratio (T(3) vs. T(1)) = 0.60 (95% CI = 0.42-0.86); P = 0.006]. Confounding of this association by HEI(total) was noted among both men and women, although dietary folate did not confound this association appreciably. In SM, plasma folate completely mediated the inverse HEI(total)-CES-D association among men only, specifically for HEI(2) (higher intakes of whole fruits), HEI(3) (total vegetables), HEI(5) (total grains), HEI(6) (whole grains), HEI(7) (milk), and HEI(12) (lower discretionary energy). Among women, HEI(total) and 4 components had an inverse direct effect on CES-D score, suggesting a mechanism that is independent of plasma folate. Depressive symptoms in our study may be alleviated by improving overall dietary quality, with plasma folate playing a potential mediating role only among men.

Diet Quality Is Inversely Associated with C-Reactive Protein Levels in Urban, Low-Income African-American and White Adults

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 US Department of Agriculture 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=2,017). MAIN OUTCOME MEASURES MAR equaled the average of the ratio of intakes to Recommended Dietary Allowance for 15 vitamins and minerals. CRP levels were assessed by the nephelometric method utilizing latex particles coated with CRP monoclonal antibodies. STATISTICAL ANALYSIS 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 with Estimated Average Requirements. CRP levels were significantly associated with MAR, dual-energy x-ray absorptiometry-measured body fat, and hypertension. A 10% increase in MAR was associated with 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, thereby possibly reducing risk for cardiovascular disease.

Receiver-operating characteristics of adiposity for metabolic syndrome: the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study.

OBJECTIVE To assess the predictive values of various adiposity indices for metabolic syndrome (MetS) among adults using baseline data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) cohort. DESIGN In a cross-sectional study, BMI, waist circumference (WC), body composition by dual-energy X-ray absorptiometry (DEXA) and metabolic risk factors such as TAG, HDL cholesterol, blood pressure, fasting glucose and insulin, uric acid and C-reactive protein were measured. Receiver-operating characteristic (ROC) curves and logistic regression analyses were conducted. SETTING Baltimore, Maryland. SUBJECTS White and African-American US adults (n 1981), aged 30-64 years. RESULTS In predicting risk of MetS using obesity-independent National Cholesterol Education Program Adult Treatment Panel III criteria, percentage total body fat mass (TtFM) assessed using DEXA measuring overall adiposity had no added value over WC. This was true among both men (area under the ROC curve (AUC) = 0.680 v. 0.733 for TtFM and WC, respectively; P < 0.05) and women (AUC = 0.581 v. 0.686). Percentage rib fat mass (RbFM) was superior to TtFM only in women for MetS (AUC = 0.701 and 0.581 for RbFM and TtFM, respectively; P < 0.05), particularly among African-American women. Elevated percentage leg fat mass (LgFM) was protective against MetS among African-American men. Among white men, BMI was inferior to WC in predicting MetS. Optimal WC cut-off points varied across ethnic-sex groups and differed from those recommended by the National Institutes of Health/North American Association for the Study of Obesity. CONCLUSIONS The study provides evidence that WC is among the most powerful tools to predict MetS, and that optimal cut-off points for various indices including WC may differ by sex and race.

Dietary Antioxidant Intake and Its Association With Cognitive Function in an Ethnically Diverse Sample of US Adults

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 1274 adults (541 men and 733 women) aged 30 to 64 years at baseline (mean [standard deviation] = 47.5 [9.3]) in the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study, 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 was used to measure depressive symptoms. Dietary intake was assessed with two 24-hour recalls, estimating daily consumption of total carotenoids and vitamins A, C, and E per 1000 kcal. Results Among key findings, 1 standard deviation (∼2.02 mg/1000 kcal) higher vitamin E was associated with a higher score on verbal memory, immediate recall (&bgr; = +0.64 [0.19], p = .001), and better language/verbal fluency performance (&bgr; = +0.53 [0.16], p = .001), particularly among the younger age group. Women with higher vitamin E intake (&bgr; = +0.68 [0.21], p = .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.

Serum ferritin levels associated with increased risk for developing CHD in a low-income urban population

OBJECTIVE The present study examined the association of serum ferritin with CHD risk using the Framingham Heart Studys 10-year risk algorithm. DESIGN Ordinal logistic regression modelling was used to interpret risk. Proportional odds modelling assessed four divisions of ranked CHD risk (4, high; 3, increased; 2, slight; 1, minimal), separately by sex. SETTING Baltimore, MD, USA. SUBJECTS African-American and white participants (n 1823) from baseline of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, aged 30-64 years. RESULTS For men, there was a 0·5 % increase in risk for every 10-unit rise in serum ferritin (pmol/l). Other significant predictors included increased BMI, white race, unemployment and C-reactive protein ≥9·5 mg/l. For women, there was a 1·5 % [corrected] increase in risk per 10-unit rise in serum ferritin (pmol/l). Other significant predictors included increased BMI, lower education, unemployment and C-reactive protein ≥9·5 mg/l. CONCLUSIONS Serum ferritin is a significant predictor of 10-year hard CHD risk for HANDLS study participants, a low-income, urban population. Serum ferritin, independent of elevated C-reactive protein, was associated with increased 10-year CHD risk for HANDLS participants. To our knowledge, these data provide the first evidence of the role of serum ferritin as a risk factor for hard CHD in African-American and white postmenopausal women in the USA. Future research on cardiovascular events from this prospective study may confirm the association.

Literacy Contributes to Greater Higher Diet Quality in a Socioeconomically Diverse Urban Prospective Cohort

Literacy influences dietary outcomes, such as food label comprehension and portion size estimation skills. This study evaluated the relationship of literacy and diet quality among Healthy Aging in Neighborhoods of Diversity across the Life Span study participants. Healthy Aging in Neighborhoods of Diversity across the Life Span is a prospective study of socioeconomically diverse urban African Americans and whites. Diet quality was measured by the Healthy Eating Index-2010 on the basis of 2 recalls, and literacy, the Wide Range Achievement Test—3rd edition reading scores. An independent and synergistic association of literacy and education with diet quality was found, emphasizing the need to consider both variables when counseling clients about nutrition.

Serum ferritin levels associated with increased risk for developing CHD in a low-income urban population - Corrigendum.

On page 1 in the Results paragraph of the Abstract instead of: Results For women, there was a 5-1% increase in risk per 10-unit rise in serum ferritin (pmol/l) It should read Results For women, there was a 1–5% increase in risk per 10-unil rise in serum ferritin (pmol/l) On page 5, column 2, in ihe second sentence instead of: For every 10-unit rise in scrum ferritin (pmol/l), 10-year CHD risk increased by 5-1%,… it should read: For every 10-unit rise in scrum ferritin (pmol/l), 10-year CHD risk increased by 1–5%,… On page 6, Table 6, the point estimate for the Female Ferritin (odds per 100-unit increase) instead of 1–51 it should say 1–15 On page 7, in the Conclusions, in column 2, lines 1–5 instead of: However, serum ferritin was a significant predictor of 10-year CHD risk in low-income, urban men and women, showing a 0–5% and 5–1% increase with each 10-unit increase in scrum ferritin (pmol/l),-… it should read: However, serum ferritin was a significant predictor of 10-year CHD risk in low-income, urban men and women, showing a 0–5% and 1–5% increase with each 10-unit increase in scrum ferritin (pmol/l),-…