Midlife Health Research Articles

Early-life socioeconomic status, adolescent cognitive ability, and cognition in late midlife: Evidence from the Wisconsin Longitudinal Study

Although the association between childhood socioeconomic status (SES) and late-life cognition is well-established, the mechanisms underlying this association are less clear. One important potential mediator seldom examined is adolescent cognitive ability. To address this gap, we examined 5,880 respondents from the Wisconsin Longitudinal Study, which follows a random sample of high school students who graduated from Wisconsin high schools in 1957. Structural equation models were used to examine the direct and indirect effects of childhood SES on cognition in late midlife through adolescent cognitive ability, educational attainment, midlife economic condition, and midlife health. Cognitive function was measured as a latent variable composed of scores from 6 cognitive assessments including immediate and delayed recall, digit ordering, letter and category fluency, and a subset of the Wechsler Adult Intelligence Scale similarities test. We found that childhood SES predicts cognition in late midlife, and this association is largely mediated by adolescent cognitive ability and educational attainment and to a lesser extent by midlife economic condition and health. The findings underscore the long-arm of childhood SES in cognitive function in later life and highlight the complex life-course pathways underlying the association between childhood SES and cognition.

Factors Influencing Longitudinal Stair Climb Performance from Midlife to Early Late Life: The Study of Women's Health Across the Nation Chicago and Michigan Sites.

To quantify the longitudinal change in stair climb performance (a measure indicative of both physical function and muscle power), determine whether physical activity is related to slower decline in performance, and to identify factors that modify the longitudinal change in performance among women from midlife to late life. Longitudinal cohort study with up to 15 study visits. Two sites of the Study of Women's Health Across the Nation. Black (n=411) and white (N=419) women followed from median age 47.0 (44.6-49.6) to 62.0 (55.8-65.3) years. N/A. Performance on a stair climb test (ascend/descend 4 steps, 3 cycles) was timed. Physical activity (PA) was assessed using the Kaiser Physical Activity Survey (KPAS; possible range 0-15 points). Sociodemographic and health factors were assessed via self-report. BMI was calculated with measured height and weight. Mixed-effects regression modeled longitudinal change in stair climb performance. Average baseline stair climb time was 18.12 seconds (95% CI: 17.83-18.41), with 0.98% (95% CI: 0.84%-1.11%) annual slowing. In fully adjusted models, higher levels of PA were associated with faster stair climb times (2.09% faster per point higher, 95% CI: -2.87%- -1.30%), and black women had 5.22% (95% CI: 2.43%-8.01%) slower performance compared to white women. Smoking, financial strain, diabetes, osteoarthritis, fair/poor health, and stroke were associated with 3.36% (95% CI: 0.07%-6.65%), 7.56% (95% CI: 4.75%-10.37%), 8.40% (95% CI: 2.89%-13.92%), 8.46% (95% CI: 5.12%-11.79%), 9.16% (95% CI: 4.72%-13.60%), and 16.94% (95% CI: 5.37%-28.51%) slower performance, respectively. In separate models, higher BMI (per 1-unit), osteoarthritis, fair/poor health, and diabetes, were each associated with 0.06% (95% CI:0.04%-0.08%), 0.48% (95% CI:0.12%-0.84%), 0.81% (95% CI:0.35%-1.28%), and 0.84% (95% CI:0.22%-1.46%), additional slowing per year over time. Significant declines in function were evident as women transitioned from midlife to early late life. Declines were amplified by indicators of poor health, emphasizing the importance of health in midlife for promoting healthy aging.

Abstract 072: Medroxyprogesterone Prevents the Decline in Renal Health Due to Estradiol

We previously published that estradiol (E2) treatment initiated immediately after midlife ovariectomy (OVX) for 80 days in female Long Evans rats exerted negative effects on renal health. Medroxyprogesterone (MPA) is a progesterone derivative commonly used in menopausal hormone therapy to oppose the uterotrophic effects of E2. Therefore, our goal was to determine if coadministration with MPA opposed the negative effects of E2 on renal health. Female retired breeders underwent OVX at 11 months of age and received an implant of E2, E2+MPA or vehicle for 40 days. Body weights, blood pressure and urine were measured pre- and post-treatment along with tissue weights. Systolic blood pressure was not altered from baseline in any treatment group (Veh: 144±4 vs.135±5; E2: 143±4 vs.143±6; E2+MPA: 147±4 vs.143±5 mmHg; ns). Kidney hypertrophy was significantly increased following E2+MPA treatment (Veh: 2.73±0.1; E2: 3.03±0.9; E2+MPA: 3.42±0.2 g/kg body wt; P=0.002), while body and heart weights were comparable between groups. Coadministration of MPA prevented the E2-induced increase in proteinuria (Veh: 0.27±0.07; E2: 3.53±1.16; E2+MPA: 1.20±0.58 mg/mg creatinine; P=0.01) and decline in glomerular filtration rate (Veh: 0.51±0.02; E2: 0.24±0.05; E2+MPA: 0.39±0.05 ml/min; P=0.001). Our results show that even short-term E2 exerts a negative effect on renal health in midlife, but coadministration with MPA prevents E2-mediated damage, possibly via compensatory hypertrophy of the kidney. Therefore, midlife hormone therapy containing MPA may protect the kidneys against unopposed E2-mediated damage and provide a beneficial effect for menopausal women.

Arnica Montana and Bellis Perennis for Seroma Reduction Following Mastectomy and Immediate Breast Reconstruction: Prospective, Randomized, Double-blinded, Placebo-controlled Trial

PURPOSE: Seroma is a common surgical complication created by the inflammatory process that follows mastectomy and reconstruction.1,2 It is, therefore, common practice to insert surgical drains, which often remain in place for long periods and delay recovery.3,4 In light of the many advantages of homeopathic treatment, there has been a global trend of integrating this with conventional medicine.5 In this study, we examined the effect of Arnica montana and Bellis perennis on seroma prevention after mastectomy and breast reconstruction. METHODS: This was a prospective, double-blind, randomized analysis of 55 patients (78 breasts) who underwent mastectomy and immediate breast reconstruction between January 2016 and August 2017. Patients were randomly assigned and treated with A. montana and B. perennis or placebo from surgery and up to the time of drain removal. RESULTS:A. montana and B. perennis significantly reduced drain removal time (discharge <30 ml) by 18% (2.4 days; P< 0.05), 11.1 days (6.1 days) in the study groups compared with 13.5 days (6.4 days) in the placebo group. Age, body mass index, mastectomy type, and lymph node dissection were similar among groups. Patient opioid intake was lower (P < 0.057) in the study group. Quality of life, postoperative pain, hemoglobin and cortisol levels, and complications were not associated with any treatment. CONCLUSION:A. montana and B. perennis have been shown to reduce seroma formation and opioid intake following mastectomy and reconstruction. Because this treatment lacks side effects and is inexpensive, it should serve as a valuable treatment adjunct in patients undergoing mastectomy and reconstruction. REFERENCES: 1. Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76:1088–1095. 2. Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J Surg Oncol. 2003;29:711–717. 3. Purushotham AD, McLatchie E, Young D, et al. Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg. 2002;89:286–292. 4. Puttawibul P, Sangthong B, Maipang T, et al. Mastectomy without drain at pectoral area: a randomized controlled trial. J Med Assoc Thai. 2003;86:325–331. 5. Johnson PJ, Jou J, Rhee TG, et al. Complementary health approaches for health and wellness in midlife and older US adults. Maturitas. 2016;89:36–42.

Is the relationship between men's age at first birth and midlife health changing? Evidence from two British cohorts.

Becoming a father, particularly for the first time, is a central transition in men's lives, and whether this transition takes place early or later in life may have important ramifications on the whole later life course. Previous research has shown that men who father their first child early in life have poorer later-life health than men who postpone having children. However, it is not known how selection by cognitive ability and other childhood characteristics confound the association between the timing of fatherhood and later-life health, or how the association is changing over time as parenthood is postponed to an older age. We investigate the association between men's age at the birth of their first child and midlife self-rated health in two British cohorts born in 1958 and 1970. The study employs logit models. Relative to men who had their first child when they were between 25 and 29 years old, men who had their first child before the age of 20 have the poorest health, followed by men who had a child when they were 20–24 years old. This result was observed in both cohorts. Childhood cognitive ability, which previous research has not analyzed, strongly contributed to this association, and to a greater extent than other childhood characteristics. For the 1970 cohort, those who became fathers at age 35 or older had the best health. This advantage was not found for the 1958 cohort. These findings suggest that the relationship between young age at fatherhood and midlife health is strongly confounded by cognitive ability, and that in recent cohorts a new pattern of advantage among older fathers has emerged.

Assessing within- and between-family variations in an expanded measure of childhood adversity.

Previous measures of childhood adversity have enabled the identification of powerful links with later-life wellbeing. The challenge for the next generation of childhood adversity assessment is to better characterize those links through comprehensive, fine-grained measurement strategies. The expanded, retrospective measure of childhood adversity presented here leveraged analytic and theoretical advances to examine multiple domains of childhood adversity at both the microlevel of siblings and the macrolevel of families. Despite the fact that childhood adversity most often occurs in the context of families, there is a dearth of studies that have validated childhood adversity measures on multiple members of the same families. Multilevel psychometric analyses of this childhood adversity measure administered to 1,194 siblings in 500 families indicated that the additional categories of childhood adversity were widely endorsed, and increased understanding of the sources and sequalae of childhood adversity when partitioned into within- and between-family levels. For example, multilevel confirmatory factor analyses (MCFAs) indicated that financial stress, unsafe neighborhood, and parental unemployment were often experienced similarly by siblings in the same families and stemmed primarily from family wide (between-family) sources. On the other hand, being bullied and school stressors were often experienced differently by siblings and derived primarily from individual (within-family) processes. Multilevel structural equation modeling (MSEM) further illuminated differential criterion validity correlations between these categories of childhood adversity with midlife psychological, social, and physical health. Expanded, multidomain, and multilevel measures of childhood adversity appear to hold promise for identifying layered causes and consequences of adverse childhood experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Are there sensitive neighbourhood effect periods during the life course on midlife health and wellbeing?

Since the turn of the century there has been an explosion in the number of epidemiological studies that have analysed neighbourhood effects on health and wellbeing. The vast majority of these studies are cross-sectional in nature and assume that a contemporaneous place of residence captures a meaningful neighbourhood effect. Over the same time frame, social epidemiology has focussed increasingly on life course effects. This paper aims to bring these two areas of study together and tests whether there a certain ages during the life course when neighbourhoods are more important for our health and wellbeing than others. We use two British birth cohort studies (1958 National Child Development Study and British Cohort Study 1970) each comprising approximately 6,000 sample members at midlife linked to historic census measures used to derived Townsend neighbourhood deprivation scores over the life course. We find little evidence to support our hypothesis that adolescence is a key period of neighbourhood effect, rather we find late-early-adulthood neighbourhood deprivation and midlife neighbourhood deprivation are more strongly related to mid-life health and wellbeing. We are not able to conclude whether these effects are causal and encourage further investigation of selection mechanisms into neighbourhoods and mediation throughout the life course using our newly created dataset.

SAT-525 Risk Factors Associated with Bone Mineral Density in Middle-Aged Women in Southern Brazil: A Population-Based Study

Low bone mineral density (BMD) and changes of bone quality are common in postmenopausal women with osteoporosis. Among the factors related to bone loss are the estrogen decrease, aging and alteration of body composition. The aim of this cross-sectional study, nested to the Passo Fundo cohort study1, was to investigate risk factors associated with BMD among midlife women. A total of 301 women were enrolled in which demographic, anthropometric characteristics, use of hormone therapy (HT), physical activity (PA), smoking status and alcohol intake were obtained. Visceral (VAT) and subcutaneous adipose tissue (SAT) areas were measured using CT scanner. Physical activity was obtained by the International Physical Activity Questionnaire (IPAQ) along with dosages of estradiol and vitamin D. BMD was assessed in lumbar spine (LS), femoral neck (FN) and total femur (TF) by DXA and bone mass status were classified according to NOF2. The mean age was 57.5±5.4 years, 83.3% women were postmenopausal, 11.6% presented osteoporosis and 43.7% osteopenia. Women with osteoporosis were older (60.0 ±4.8 vs. 56.4 ± 5.2 years, p=0.001), had lower BMI (24.7 ± 3 vs. 30.0 ± 6.3, p<0.001) and estradiol levels (6.4 ± 4.0 vs. 29.6 ± 65.3, p=0.003) than those with normal bone women. VAT [71.9 (35.9 – 107.5) vs. 146.6 (78.3 – 168.9) vs 218.5 (168.3 – 248.4), p=0.003], SAT [223.5 (80.1 – 238.5) vs 169.3 (110.7 – 287.5) vs 282.5 (252.8 – 392.5) p=0.001] and WC [75.5 (64.4 – 80.7) vs 81 (74 – 89.5) vs 93.6 (86.7 – 98.2) p<0.001] were lower when compared to those with osteopenia or normal bone mass. According to a multiple linear regression model using BMD as the dependent variable, age (p=0.004) had an independent negative contribution and BMI (p=0.009) and VAT (p=0.031) had independent positive contributions to the BMD for all three sites. In addition, METs had an independent positive contribution to TF BMD (p=0.041) and current HT had an independent positive contribution to LS BMD (p=0.012) in a model adjusted for smoking. In conclusion, these results suggest that midlife women with osteoporosis are more frequently older, leaner and postmenopausal than those with normal bone mass. BMD is negatively impacted by age and positively by BMI, visceral adiposity, physical activity and hormonal therapy. (1) Oppermann et al., Women's Midlife Health (2015) (2) Cosman et al., Osteoporos Int DOI 10.1007/s00198-014-2794-2 Sources of Research Support: CNPq, FAPERGS

Gender and Educational Differences in the Association between Lifestyle and Cognitive Decline over 10 Years: The Doetinchem Cohort Study.

Background:Several modifiable risk factors for cognitive decline have been identified, but whether differences by gender and educational level exist is unclear.Objective:The present study aims to clarify this by prospectively investigating the relationship between health and lifestyle factors and cognitive functioning in different subgroups defined by gender and educational level.Methods:2,347 cognitive healthy individuals (mean age = 54.8, SD = 6.8, range: 41–71; 51.8% female; 26.2% low education) from the Doetinchem Cohort Study were examined for cognitive function at baseline, and at 5- and 10-year follow-up. Health- and lifestyle factors were captured by a poly-environmental risk score labelled ‘LIfestyle for BRAin Health’ (LIBRA). This score consists of 12 modifiable risk and protective factors for cognitive decline and dementia, with higher scores indicating greater risk (range: –2.7 to +12.7). Heterogeneity in associations between LIBRA and decline in verbal memory, cognitive flexibility, and mental speed between males and females and individuals with different levels of education were assessed in linear mixed models.Results:Overall, higher LIBRA scores predicted faster decline in verbal memory, cognitive flexibility, and mental speed over 10 years. Higher LIBRA scores were further associated with increased risk for incident cognitive impairment (one-point increase in LIBRA: HR = 1.09, 1.04–1.14, p = 0.001). In general, these effects were similar across gender and educational level.Conclusion:A composite risk score comprising unhealthy lifestyle and relatively poor health in midlife is significantly associated with a worse course of cognition 10 years later. These associations were for the most part unrelated to gender or educational differences.

Can an online curriculum improve the daily socio-emotional lives of middle-aged adults exposed to childhood Trauma?

One pathway linking experiences of childhood trauma to poorer mental and physical health in midlife are disruptions in daily socio-emotional regulation. However, there is a dearth of effective and accessible treatments that meet the needs of trauma-exposed individuals and their communities. Through a randomized controlled trial, this research examines whether an online social intelligence training (SIT) program improves social-emotional regulation compared to an attention-control (AC) condition. During the pre- and post-test phases of the study, participants (N = 230) completed online surveys for 14-days that included measures of social connectedness, emotional awareness, and perspective-taking. In the SIT condition, multi-level analyses revealed significant increases in daily levels of “in-tune” social interactions, emotional awareness, and perspective-taking, and attenuated within-person changes in social engagement on stressful and uplifting days. Participants who reported greater childhood trauma exhibited the strongest increases in daily social engagement and emotional awareness, suggesting that program benefits were largest for those reporting greater exposure to trauma in childhood. Our findings shed light on the potential reversibility of socio-emotional mechanisms linking childhood trauma to poorer mental and physical health in midlife, and support the utility of widely accessible, low-cost intervention methods for individuals and communities.

Cross-Sectional and Longitudinal Associations between Leisure Time Physical Activity, Mental Well-Being and Subjective Health in Middle Adulthood

Previous studies have shown that participation in leisure time physical activity is related to better mental well-being and subjective health. However, the associations between different types of leisure time physical activities and different dimensions of mental well-being have rarely been studied. In addition, longitudinal research, analyzing possible causal relations between these variables, is lacking. To investigate these research questions, data gathered at ages 42 and 50 (present N = 303) for the Finnish Jyväskylä Longitudinal Study of Personality and Social Development were used. Physical activity was assessed as frequency of participation at ages 42 and 50, and at age 50 also as frequency of participation in different types of physical activities. Mental well-being was captured by emotional, psychological and social well-being and subjective health by self-rated health and symptoms. Cross-sectionally, different types of physical activities were related to different dimensions of well-being. Walking had positive associations with psychological and social well-being, rambling in nature with emotional and social well-being, and endurance training with subjective health. Rambling in nature was also positively related to subjective health but only among men. Longitudinally, mental well-being predicted later participation in leisure-time physical activity, whereas no longitudinal associations between subjective health and physical activity were found. The results suggest that leisure time physical activities are related to current mental well-being and subjective health in midlife. Across time, good mental well-being seems to be a resource promoting engagement in physical activity.

Psychobiological Factors of Sexual Functioning in Aging Women - Findings From the Women 40+ Healthy Aging Study.

Background: A variety of biological and psychosocial factors are associated with women’s sexual health in midlife and older age. Evidence suggests a decline in sexual functioning in the context of aging and the menopausal transition, including changes in sexual desire, arousal, lubrication, orgasm, pain, and/or contentment. However, not all women in midlife and older age experience such a decline, and it remains unclear how the endocrine environment and psychosocial aspects contribute to the maintenance of healthy sexual functioning. Therefore, the aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females.Methods: A total of 93 healthy, sexually active women aged 40–73 years completed a battery of validated psychosocial questionnaires, including measures of sexual functioning (Female Sexual Function Index) and of protective psychological traits and interpersonal variables. The steroid hormones estrogen, testosterone, progesterone and dehydroepiandrosterone sulfate were determined in saliva samples, while follicle-stimulating hormone, luteinizing hormone and sex hormone-binding globulin were determined in dried blood spots. The findings were statistically adjusted for multiple testing.Results: Age and postmenopausal status were negatively associated with overall sexual functioning, arousal, and lubrication. Regression analyses revealed that relationship satisfaction, emotional support, self-esteem, optimism, and life satisfaction each significantly predicted overall sexual functioning or specific aspects of sexual functioning, including arousal, contentment, orgasm, and pain (all p < 0.029). For desire and lubrication, no associations were found with the tested psychosocial factors. In terms of steroid hormones, testosterone was positively linked to orgasm (p = 0.012). In this sample, 79.6% reported to have healthy sexual functioning according to the questionnaires’ cutoff. Younger age (OR = 0.911, 95% CI 0.854–0.970, p = 0.004) and a higher level of emotional support (OR = 1.376, 95% CI 1.033–1.833, p = 0.029) were associated with the presence of healthy sexual functioning.Discussion: Although aging and menopause negatively affected aspects of sexual functioning, the accompanying endocrine correlates were not predictive for sexual functioning in this healthy sample of middle-aged and older females. Instead, our findings suggest that sexual functioning is highly dependent on psychosocial aspects related to well-being. Accordingly, personality traits such as optimism, and interpersonal aspects such as emotional support and relationship satisfaction were identified as important predictors of sexual functioning.

Apolipoprotein E4 Mediates the Association Between Midlife Dyslipidemia and Cerebral Amyloid in Aging Women.

Cerebral amyloid-β (Aβ) plaques are the hallmark biomarker of Alzheimer's disease (AD) and are detectable decades before clinical symptoms. Modifying risk factors associated with Aβ accrual offers an opportunity for AD prevention. While midlife vascular health is linked to AD; there is minimal longitudinal evidence regarding the effect of midlife lipids on Aβ. We examined the association between midlife lipids and Aβ 20 years later. One hundred and twenty-two women had serum lipid profiles in midlife (1992, 45-57 years), and cerebral imaging, genotyping, and cognition measured 20 years later (2012/13, 66-77 years). Imaging was performed in 2012/13 via F-18 Florbetaben positron emission tomography (PET) and standard uptake value ratios (SUVR) were calculated. Lipid profiles and other predictors of high PET-SUVR levels (>1.2) were evaluated using multivariable logistic regression. Increases in low-density lipoprotein (LDL) cholesterol in midlife were associated with Aβ, adjusting for age, education, cholesterol medication, and cognition (AdjOR1.81, 95% CI 1.08-3.01, p = 0.024), but attenuated on adjustment for apolipoprotein E4 (APOE ɛ4). Aβ risk increased in women with APOE ɛ4 and midlife cholesterol >6.2 mmol/L (AdjOR9.59, 95% CI 2.94-31.31, p < 0.001), APOE ɛ4 and LDL >3.3 mmol/L (AdjOR9.00, 95% CI 2.89-28.03, p < 0.001), and APOE ɛ4 and cholesterol to high-density lipoprotein ratio ≥3.25 (AdjOR8.32, 95% CI 2.32-29.89, p < 0.001). Presence of APOE ɛ4 and midlife dyslipidemia compounded the risk for Aβ deposition, although no independent effect of midlife lipids was found. Lipid-modifying treatment in midlife could mitigate the risk of Aβ in women with a genetic predisposition for AD. To better inform prevention, future consideration should be given toward managing dyslipidemia in women carrying the APOE ɛ4 allele.

Elizabeth Barrett-Connor: Instrumental Contributor to the Understanding of Midlife Well-being and Health in Both Women and Men.

When asked what her motto or philosophy of life was in an interview for her local newspaper, La Jolla Light , Elizabeth Barrett-Connor’s response was that she did not have any one particular philosophy so much as an attitude: “My defining principle is that I am a pathological optimist.” Boundlessly curious, fearless, challenging, inspiring, and great fun to be with are some of the words her colleagues and mentees might use to describe her. Elizabeth Barrett-Connor, MD, FACP, FAHA, is internationally acclaimed with a stellar record of research accomplishments (over one thousand original research publications), is on all the highly cited researcher lists, has been a principal investigator on numerous major population studies and multicenter clinical trials, and has received extensive grants and awards. Her immense impact is not just in research but is also reflected through her teaching, encouragement, and mentorship of generations of physicians and scientists. Elizabeth Barrett-Connor was born in Evanston, Illinois, to Florence (Hershey) and Willard Barrett. Her father was a Cornell University PhD chemist who worked for ammunition companies during the Second World War years, so the family moved quite a bit, ending up in the little town of Lee, Massachusetts. They spent frequent Sundays on the lawn listening to the Boston Pops at Tanglewood and seeing Leonard Bernstein on orchestra. “Glory days,” she says. Elizabeth was an only child who loved horses, the outdoors, and visiting grandparents. Her Grandmother Barrett was postmistress in a small western New York village. Elizabeth learned to read from the postcards with her grandmother prior to delivery. Her Grandmother Hershey was from Mount Joy, Pennsylvania, and helped run a dairy. Mrs. Barrett, who thought that being lead cheerleader was not sufficient, pulled Elizabeth out of public high school and enrolled her at Northfield Preparatory School. Following Northfield, Elizabeth went …

Women's Health in Midlife: Factors Influencing Menopausal Symptoms among Rural Women in Tiruvallur District of Tamilnadu

Women's Health in Midlife: Factors Influencing Menopausal Symptoms among Rural Women in Tiruvallur District of Tamilnadu

Women’s mid-life health in Low and Middle Income Countries: A comparative analysis of the timing and speed of health deterioration in six countries

BackgroundMid-life is a neglected stage of women’s lives, particularly in Low and Middle Income Countries (LMICs). Birth injuries, menopause and manual labour can contribute to health problems in the mid-life. ObjectivesThis study analyses the relationship between women’s health deterioration and age across socio-economic groups in 6 countries (China, Ghana, Mexico, Russia, South Africa and India). MethodsUsing constrained cubic splines, I analysed data from the WHO SAGE survey to examine age and wealth patterns in the onset of deterioration in objective proxies of ageing. ResultsResults show a clear pattern of deterioration in health in middle-aged women. Ageing processes differ dramatically between rich and poor strata within countries and between countries. DiscussionThis study clearly shows that the onset of ageing in women in LMICs begins in the early forties. The paper highlights the need to focus more on mid-life health of women, in particular poorer ones.

The transition to parenthood as a critical window for adult health.

Becoming a parent is a transformative experience, marked by hormonal changes and neuroplasticity as well as shifts in self-concept, social roles, and daily routines. Although the arrival of a new baby is often a joyful event, the postpartum period can also be a time of heightened psychosocial stress and health behavior changes, including significant sleep disruption and decreased physical activity. Markers of allostatic load, such as physiological stress and inflammation, may also become dysregulated during this time. Given these neurobiological, psychosocial, and behavioral changes, the transition to parenthood may shape health trajectories in midlife. For many mothers and fathers, the transition to parenthood represents an inflection point for obesity, such that perinatal weight gains are retained long-term. Similarly, many individuals experience their 1st episode of major depression during the postpartum period. In sum, the transition to parenthood may represent a critical window for determining both mental and physical health in midlife and beyond. Physical and mental health problems over the transition to parenthood may be exacerbated for parents without access to protected, paid time off from employment. Known disparities in mood disorders, obesity, and allostatic load may be linked to risk factors stemming from the perinatal period. This article relates the importance of the transition to parenthood to population health and discusses parental leave policy as an example of an initiative that can support parents and relieve stress during the perinatal period. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Life course trajectories of cardiovascular risk: Impact on atherosclerotic and metabolic indicators

Background and aimsIn this analysis, we estimated population-level trajectory groups of life course cardiovascular risk to explore their impact on mid-life atherosclerotic and metabolic outcomes. MethodsThis prospective study followed n = 1269 Bogalusa Heart participants, each with at least 4 study visits from childhood in 1973 through adulthood in 2016. We used discrete mixture modeling to determine trajectories of cardiovascular risk percentiles from childhood to adulthood. Outcomes included mid-life subclinical atherosclerotic measures [(carotid intima-media thickness (cIMT), pulse wave velocity (PWV)], metabolic indicators [(diabetes and body mass index (BMI)], and short physical performance battery (SPPB). ResultsBetween the mean ages of 9.6–48.3 years, we estimated five distinct trajectory groups of life course cardiovascular risk (High-Low, High-High, Mid-Low, Low-Low, and Low-High). Adult metabolic and vascular outcomes were significantly determined by life course cardiovascular risk trajectory groups (all p < 0.01). Those in the High-Low group had lower risks of diabetes (20% vs. 28%, respectively; p = .12) and lower BMIs (32.4 kg/m2vs. 34.6 kg/m2; p = .06) than those who remained at high risk (High-High) throughout life. However, the High-Low group had better cIMT (0.89 mm vs. 1.05 mm; p < .0001) and PWV (7.8 m/s vs. 8.2 m/s; p = .03) than the High-High group. For all outcomes, those in the Low-Low group fared best. ConclusionsWe found considerable movement between low- and high-relative cardiovascular risk strata over the life course. Children who improved their relative cardiovascular risk over the life course achieved better mid-life atherosclerotic health despite maintaining relatively poor metabolic health through adulthood.

PSYCHOSOCIAL STRESSORS AND HEALTH DURING MIDIFE

Midlife is an important period in the lifecourse trajectory and heath outcomes during this period can have long-term implications into late adulthood. Hence, it is important that modifiable factors relating to these health outcomes in midlife are identified. Psychosocial stressors influence physical and mental health outcomes; these experiences may have differential impacts during midlife. Further, understanding of these associations may offer insight into how they may impact health in midlife. Thus, the objective of this symposium is to highlight the influence of psychosocial stressors on health outcomes in midlife. All of the presentations use the Midlife in the United States Study (MIDUS) to examine the influence of psychosocial stress for each respective research inquiry. Parker and colleagues examine the association between everyday discrimination and executive function, and whether this association differs by age among a racially diverse sample of adults. Nkimbeng and colleagues discuss the relationship between everyday discrimination and generalized pain among middle-aged African American adults. Nersesian and colleagues discuss the relationship between perceived neighborhood quality and loneliness among middle-aged adults. Understanding the influence of psychosocial stressors on health in midlife may be useful in informing relevant interventions to thwart the negative impact of such stressors on health during midlife.

Occupational cognitive complexity in earlier adulthood is associated with brain structure and cognitive health in midlife: The CARDIA study.

In line with cognitive reserve theory, higher occupational cognitive complexity is associated with reduced cognitive decline in older adulthood. How and when occupational cognitive complexity first exerts protective effects during the life span remains unclear. We investigated associations between occupational cognitive complexity during early to midadulthood and brain structure and cognition in midlife. Participants were 669 adults from the Coronary Artery Risk Development in Young Adults study (aged 18-30 years at baseline, 52% female, 38% Black). We calculated scores reflecting occupational cognitive complexity using Census Occupation Codes (years 10 and 15) and Occupational Information Network (O*NET) data. At year 25, participants had structural brain magnetic resonance imaging, diffusion tensor imaging, and cognitive testing (Rey Auditory Verbal Learning Test, Digit Symbol Substitution Test, Stroop). In adjusted mixed models, we examined associations between occupational cognitive complexity during early to midadulthood and midlife brain structure, specifically gray matter volume and white matter fractional anisotropy, and cognition in midlife (all outcomes converted to z-scores). Higher occupational cognitive complexity was associated with greater white matter fractional anisotropy (estimate = 0.10, p = .01) but not gray matter volume. Higher occupational cognitive complexity was associated with better Digit Symbol Substitution Test (estimate = 0.13, p < .001) and Stroop (estimate = 0.09, p = .01) performance but not Rey Auditory Verbal Learning Test performance. Occupational cognitive complexity earlier in adulthood is associated with better white matter integrity, processing speed, and executive function in midlife. These associations may capture how occupational cognitive complexity contributes to cognitive reserve. (PsycINFO Database Record (c) 2018 APA, all rights reserved).