Middle-aged Participants Research Articles

Dietary Choline Intake Is Directly Associated with Bone Mineral Density in the Hordaland Health Study

BackgroundCholine is an important nutrient either obtained from a variety of foods or synthesized endogenously, and it is the precursor of betaine. We previously reported positive associations between plasma free choline and bone mineral density (BMD). Animal studies suggest an impact of dietary choline on bone metabolism, but the role of dietary intake of choline and betaine for human bone health is unknown. ObjectiveThe main aims were to examine the associations of dietary choline, choline species, and betaine with BMD and to study the relations between dietary and plasma free choline and betaine. MethodsStudy subjects were participants in the Hordaland Health Study, including 2649 women and 1983 men (aged 46–49 or 71–74 y). BMD was measured by dual-energy X-ray absorptiometry, and dietary intake was obtained by using a validated 169-item food-frequency questionnaire. Risk associations were assessed by logistic regression and correlations by ρ (Spearman's bivariate rank order correlation). ResultsSubjects in the lowest compared with the highest tertile of dietary total choline, free choline, glycerophosphocholine, phosphocholine, phosphatidylcholine, and sphingomyelin had a higher risk of low–femoral neck BMD, defined as the lowest BMD quintile. Particularly strong associations were found among middle-aged men for intake of free choline (OR: 1.83; 95% CI: 1.24, 2.69; P = 0.002) and glycerophosphocholine (OR: 2.13; 95% CI: 1.43, 3.16; P < 0.001) and among elderly women for total choline (OR: 1.96; 95% CI: 1.33, 2.88; P = 0.001) and phosphatidylcholine (OR: 1.94; 95% CI: 1.33, 2.84: P = 0.001) intake. No significant associations were observed between dietary betaine and BMD. Dietary total choline, free choline, glycerophosphocholine, phosphatidylcholine, and sphingomyelin correlated weakly with plasma free choline (ρ: 0.07, 0.05, 0.07, 0.07, and 0.05, respectively; P < 0.01). Dietary betaine correlated with plasma betaine (ρ: 0.23; P < 0.001). ConclusionsDietary choline was positively associated with BMD in middle-aged and elderly participants.

Age- and sex-related differences in cortical morphology and their relationships with cognitive performance in healthy middle-aged and older adults.

The impacts of age and sex on brain structures related to cognitive function may be important for understanding the role of aging in Alzheimer disease for both sexes. We intended to investigate the age and sex differences of cortical morphology in middle-aged and older adults and their relationships with the decline of cognitive function. In this cross-sectional study, we examined the cortical morphology in 204 healthy middle-aged and older adult participants aged 45 to 89 years using structural magnetic resonance imaging (sMRI) data from the Dallas Lifespan Brain Study data set. Brain cortical thickness, surface complexity, and gyrification index were analyzed through a completely automated surface-based morphometric analysis using the CAT12 toolbox. Furthermore, we explored the correlation between cortical morphology differences and test scores for processing speed and working memory. There were no significant interactions of age and sex with cortical thickness, fractal dimension, or gyrification index. Rather, we found that both males and females showed age-related decreases in cortical thickness, fractal dimension, and gyrification index. There were significant sex differences in the fractal dimension in middle-aged participants and the gyrification index in older adult participants. In addition, there were significant positive correlations between the cortical thickness of the right superior frontal gyrus and Wechsler Adult Intelligence Scale (WAIS)-III Letter-Number Sequencing test scores in males (r=0.394; P<0.001; 95% CI for r values 0.216-0.577) and females (r=0.344; P<0.001; 95% CI for r values 0.197-0.491), respectively. Furthermore, a significant relationship between the gyrification index of the right supramarginal gyrus (SupraMG) and WAIS-III Digit Symbol test scores was observed in older adult participants (r=0.375; P<0.001; 95% CI for r values 0.203-0.522). The results suggest that, compared with males, females have more extensive differences in cortical morphology. The gyrification index of the right SupraMG can be used as an imaging marker of sexual cognitive differences between males and females in older adults. This study helps to further understand sex differences in the aging of the brain and cognition.

Abstract 57: Sleep Duration Is Associated With Clinically Silent Brain Injury In Middle-aged Persons Without Stroke

Background: Evidence indicates that optimization of cardiovascular health during middle age leads to brain health benefits later in life. The AHA Life’s Simple 7, a research and public health construct capturing determinants of cardiovascular health, recently added sleep as a risk factor, becoming the Life’s Essential 8 (LE8). We hypothesize that suboptimal sleep duration worsens neuroimaging brain health profiles in middle-aged persons without stroke. Methods: We conducted a nested, cross-sectional neuroimaging analysis within the UK Biobank, a large population study conducted in the United Kingdom. We included participants without stroke/dementia who underwent a research brain MRI. We created a 6-category sleep score according to hours of sleep (best to worse): 7 to &lt;9h; 9 to &lt;10h; 6 to &lt;7h; 5 to &lt;6 or &gt;=10h; 4 to &lt;5h; and &lt;4h. We evaluated 3 neuroimaging traits: white matter hyperintensity volume (natural log-transformed), fractional anisotropy (FA) and mean diffusivity (MD). For the last two traits, we evaluated the first principal component of measurements obtained across 48 neuroanatomical regions. Results: Of 502,408 participants enrolled in the UKB, 39,937 (7.9%) stroke/dementia-free enrollees participated in the brain MRI study (mean age 55, 53% female). The distribution of sleep categories was: 1 (n=28,958, 72.51%), 2 (n=2060, 5.16%), 3 (n=7165, 17.94%), 4 (n=1,562, 3.91%), 5 (n=163, 0.41%) and 6 (n=29, 0.07%). In multivariable linear regression analyses, a higher (worse) sleep score was associated with larger WMH volume (beta 0.026, SE=0.0046; p&lt;0.001) and worse FA profile (beta 0.003, SE=0.0008; p&lt;0.001), with no association observed for MD (p=0.77). For FA, when evaluating the 48 neuroanatomical regions separately, the most compromised areas were the right cerebral peduncle (p&lt;0.001) and left and right cerebellar peduncles (p&lt;0.001). Conclusion: Among middle-aged participants enrolled in the UKB, suboptimal sleep duration was significantly associated with adverse neuroimaging brain health profiles. These results emphasize the importance of sleep duration, the new component of the LE8, in determining brain health in middle-aged persons who have not developed clinically evident manifestations of poor brain health (stroke).

Mitochondrial DNA and inflammatory proteins are higher in extracellular vesicles from frail individuals

BackgroundFrailty, a clinical syndrome commencing at midlife, is a risk for morbidity and mortality. Little is known about the factors that contribute to the chronic inflammatory state associated with frailty. Extracellular vesicles (EVs) are small, membrane-bound vesicles that are released into the circulation and are mediators of intercellular communication. We examined whether mitochondrial DNA (mtDNA) and inflammatory proteins in EVs may act as damage-associated molecular pattern (DAMP) molecules in frailty.ResultsTo address whether EVs and their associated mtDNA and inflammatory protein cargo are altered with frailty, EVs were isolated from non-frail (n = 90) and frail (n = 87) middle-aged (45–55 years) participants from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. EV concentration was highest in frail White participants. EV mtDNA levels were significantly higher in frail individuals compared to non-frail individuals. The presence of six inflammatory proteins in EVs (FGF-21, HGF, IL-12B, PD-L1, PRDX3, and STAMBP) were significantly associated with frailty. EV inflammatory proteins were significantly altered by frailty status, race, sex, and poverty status. Notably, frail White participants had higher levels of EV-associated CD5, CD8A, CD244, CXCL1, CXCL6, CXCL11, LAP-TGF-beta-1 and MCP-4 compared to frail and non-frail African American participants. Frail White participants living below poverty had higher levels of EV-associated uPA. EV-associated CCL28 levels were highest in non-frail women and CXCL1 were highest in non-frail men. Men living below poverty had higher levels of CD5, CD8A, CXCL1, LAP-TGF-beta-1, and uPA. CXCL6 levels were significantly higher in individuals living above poverty. There was a significant correlation between EV mtDNA levels and the presence of inflammatory proteins.ConclusionsThese data suggest that mtDNA within EVs may act as a DAMP molecule in frailty. Its association with chemokines and other inflammatory EV cargo proteins, may contribute to the frailty phenotype. In addition, the social determinant of health, poverty, influences the inflammatory cargo of EVs in midlife.

The national health program for vitamin D supplementation in a developing country

Previous studies have reported a high frequency of vitamin D deficiency (VDD) among different age groups in Iran. In this study, the current coverage, status of vitamin D supplement taking, and program efficacy have been evaluated by the Office of Nutrition Department Society in Iran since 2014. This study was conducted in collaboration with the International UNESCO center for Health-Related Basic Sciences and Human Nutrition and the Office of Nutrition Department Society. Sixty three medical universities were included in the current study to calculate the availability, accessibility and acceptability coverages. Furthermore, 3 medical universities including Mashhad (MUMS), Qom (QUMS) and Zahedan (ZAUMS) University of Medical Sciences were selected based on the results of the National Integrated Micronutrient Survey 2012 (NIMS-II study), in order to assess the status of vitamin D supplement intake in all age ranges. Quantitative analysis showed that availability coverage was 74.96% and 77.56% and accessibility was 80.70% and 83.26% in elderly and middle-aged subjects, respectively in 2018. The acceptability was approximately 43.7% and 43.9% among elderly and middle-aged participants, respectively. The availability and acceptability coverage was 80.99% and 85.0% among students in high schools. The mean vitamin D supplement uptake frequency was 27.0% (n=387); 20.7% and 29.2% in rural and urban area, respectively (P=0.001). The results showed that there was no significant difference in serum vitamin D levels between urban (20.41±6.43ng/ml) and rural areas, (P=0.887). There was no significant difference in the serum vitamin D concentrations between men and women (P=0.461). The frequency of taking vitamin D supplements was 27.0% in Iran in 2018. The frequency of taking of vitamin D supplements among vitamin D deficient group (serum vitamin D levels <19.99ng/ml) was 43.6%. Lack of knowledge was the most important reason for not taking vitamin D supplement. Moreover, the serum vitamin D levels have increased in subjects aged 18-30 years old after the implementation of the vitamin D supplementary program.

Nitric Oxide Precursors and Dimethylarginines as Risk Markers for Accelerated Measured GFR Decline in the General Population

Nitric oxide (NO) deficiency is associated with endothelial dysfunction, hypertension, atherosclerosis, and chronic kidney disease (CKD). Reduced NO bioavailability is hypothesized to play a vital role in kidney function impairment and CKD. We investigated the association of serum levels of endogenous inhibitors of NO, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), and precursors of NO, arginine, citrulline, and ornithine, with a decline in glomerular filtration rate (GFR) and new-onset CKD. In a prospective cohort study of 1407 healthy, middle-aged participants of Northern European origin in the Renal Iohexol Clearance Survey (RENIS), GFR was measured repeatedly with iohexol clearance during a median follow-up time of 11 years. GFR decline rates were analyzed using a linear mixed model, new-onset CKD (GFR< 60 ml/min per 1.73 m2) was analyzed with interval-censored Cox regression, and accelerated GFR decline (the 10% with the steepest GFR decline) was analyzed with logistic regression. Higher SDMA was associated with slower annual GFR decline. Higher levels of citrulline and ornithine were associated with accelerated GFR decline (odds ratio [OR], 1.43; 95% confidence interval [CI] 1.16-1.76 per SD higher citrulline and OR 1.23; 95% CI 1.01 to 1.49 per SD higher ornithine). Higher citrulline was associated with new-onset CKD, with a hazard ratio of 1.33 (95% CI 1.07-1.66) per SD higher citrulline. Associations between NO precursors and the outcomes suggest that NO metabolism plays a significant role in the pathogenesis of age-related GFR decline and the development of CKD in middle-aged people.

Associations of prematurity and low birth weight with blood pressure and kidney function in middle-aged participants of the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

An adverse intrauterine environment reflected by low birth weight (LBW) and prematurity may induce fetal programming that favors kidney dysfunction in adulthood. We examined the association of LBW and prematurity with blood pressure (BP) and kidney function markers in non-diabetic, middle-aged adults without kidney disease from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A cross-sectional analysis of 768 subjects aged 35-54years was conducted. Comparisons were performed according to self-reported birth weight: LBW (< 2.5kg) or normal birth weight (2.5-4.0kg). Associations of LBW and prematurity with BP levels and kidney function markers "(estimated glomerular filtration rate [eGFR], albumin-creatinine ratio [ACR] and serum cystatin-C) were tested by multiple linear regression using adjustments based on Directed Acyclic Graphs. Propensity score matching was applied to control imbalances. Mean age of participants was 45.5 ± 4.6years and 56.8% were female; 64 (8.3%) participants reported LBW and 39 (5.0%) prematurity. The LBW group had higher systolic (p = 0.015) and diastolic BP (p = 0.014) and ACR values (p = 0.031) and lower eGFR (p = 0.015) than the normal birth weight group, but no group difference for cystatin-C was found. The preterm group had higher mean levels of systolic and diastolic BP, but no difference in kidney function markers was evident. In a regression model adjusted for sex, skin color and family history of hypertension, both systolic and diastolic BP levels were associated with LBW, but this association disappeared after adding forprematurity, which remained associated with BP (p = 0.017). Having applied apropensity score matching, LBW was associated with ACR values (p = 0.003), but not with eGFR or BP levels. The study findings of independent associations of prematurity with higher BP levels, and of LBW with markers of kidney function in adulthood, support that early life events maypredict risk for hypertension and kidney dysfunction in adulthood. The study design precluded the inferring of causality, and prospective studies are needed to further investigate this hypothesis.

Perceptions of and Reflections on Aesthetic Education Training from the Perspective of Taiwanese Preschool Educators

Many studies have demonstrated that music has many benefits for children’s physical and mental development. However, many preschool educators have scant preparation for or a lack of experience in aesthetic education. The purpose of this study is to explore preschool educators’ perceptions of and reflections on aesthetic education training. We conducted a survey associated with three aspects: “aesthetics appreciation”, “aesthetics implementation”, and “aesthetics evaluation”. The results of the study show the majority of participants agreed that (1) musical participation would strengthen participants’ attitudes toward aesthetic appreciation through proper aesthetic training programs and (2) musical engagement would benefit young children by enhancing their aesthetic experiences. The attitudes toward aesthetic implementation for young children were more favorable among the middle-aged and experienced participants; (3) musical activities are also a good way to improve young children’s aesthetic abilities, which helps to create an aesthetic atmosphere in educational practice. These results indicate that it is vital for preschool educators to receive the appropriate training in aesthetics and continuous assessment to provide high-quality early education to young children.

The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups.

Whole-body vibration (WBV) is a novel exercise training measure that promotes the muscle strength, flexibility, and balance abilities of elderly groups. The feasibility and applicability of 20-30 min (lowering a heat pack at 73 °C by wrapping it in multiple layers of towels to 40-43 °C before it touched the skin) thermotherapy are increasingly being demonstrated by applications and clinical trials. Studies show that it increases the flexibility of macules and ligament. However, no studies have examined the interactions between the pre-exercise and post-exercise application of heat therapy (duration a training course). Therefore, this study investigates the effects of WBV and heat therapy on the muscle strength, flexibility, and balance abilities of elderly groups. Eighty middle-age and elderly participants with no regular exercise habits were enrolled in this study. They were randomly assigned to a WBV group, a WBV plus heat therapy group, a heat therapy alone group, and a control group. The WBV groups underwent 5-min, fixed-amplitude (4 mm), thrice-weekly WBV training sessions for 3 consecutive months on a WBV training machine. Participants' balance was measured using the limits of stability (LOS) test on a balance system. The pretest and posttest knee extensor and flexor strength were tested using an isokinetic lower extremity dynamometer. Pretest and posttest flexibility changes were measured using the sit-and-reach test. Significantly larger pretest and posttest differences in flexibility and muscle strength were observed in the WBV and WBV plus heat therapy groups. The addition of heat therapy to WBV resulted in the largest flexibility improvements.

Association of vitamin and/or nutritional supplements with fall among patients with diabetes: A prospective study based on ACCORD and UK Biobank.

To assess the associations of vitamin and/or nutritional supplements (VNS) with falls among patients with diabetes. 9,141 and 21,489 middle-aged participants with diabetes from Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and UK Biobank were included. Use of VNS was collected at baseline, and fall events were recorded using annual questionnaires in ACCORD and electric records in UK Biobank during follow-up. The associations of VNS use with fall risk were analyzed using logistic regression models in ACCORD and Fine-Gray sub-distribution hazard models in UK Biobank. The role of specific supplements was also estimated in UK Biobank, adjusting for confounding factors and multiple comparisons. 45.9% (4,193/9,141, 5.5 median follow-up years) patients in ACCORD and 10.5% (2,251/21,489, 11.9 median follow-up years) in UK Biobank experienced fall and in-patient events during follow-up, respectively. In ACCORD, VNS using was associated with an increased risk of fall (full-adjusted odds ratio [OR]: 1.26, P < 0.05). In UK Biobank, despite no significant association between VNS overall and in-patient fall, vitamin B, calcium, and iron using increased the risk of falls significantly (full-adjusted hazard ratio range: 1.31-1.37, P < 0.05). Use of specific VNS increased the risk of fall among patients with diabetes. The non-indicative use of nutritional supplements for patients with diabetes might be inadvisable.

Dust in the Wind: Ageism as Portrayed in Attitudes Toward Songs in Adulthood and Old Age.

Ageism was found to be prevalent across various life domains, but not in the music domain. This study aimed to examine whether negative ageist attitudes toward older adults are associated with music preferences across life. Subjects (n = 214, age range 30-92, M = 56.14, SD = 16.39) were exposed to old (1910-1946), intermediate (1979-1987), and new (2014-2018) songs, chosen by a focus group, rated each song, and completed scales assessing ageism and socio-demographics. Ageist attitudes were negatively associated with liking for old songs among young and middle-aged participants. Young participants demonstrated a negative link between ageist attitudes and liking for intermediate songs. No significant results were reported regarding new songs. This provides an initial indication that ageism may be connected to attitudes toward music. Future studies can examine effects of perceived "oldness" in music on participants' ageist attitudes, and negative attitudes toward new and intermediate songs alongside with examining negative attitudes toward younger adults.

Pro-Inflammatory diet accounts for higher prevalence of retinopathy in diabetes participants rather than normal glucose and prediabetes: Results from NHANES, 2005-2008.

Retinopathy is a chronic inflammatory disease whose prognosis could be improved with dietary interventions. However, the association between a pro-inflammatory diet and the prevalence of retinopathy has not been fully elucidated. We assess the association between the dietary inflammatory index (DII), which is a comprehensive index determining inflammatory potential derived from food parameters according to literature, and the prevalence of retinopathy based on the data from the National Health and Nutritional Examination Survey (NHANES) 2005-2008 involving 2,403 participants. Energy-adjusted DII (E-DII) was not related to the occurrence of retinopathy in the general, non-diabetic, or middle-aged participants. In the diabetic and aged participants, one unit increment of E-DII accounted for 14 and 15% higher the prevalence of retinopathy respectively. The highest E-DII group had a 78 and 79% higher prevalence of retinopathy than the lowest group respectively. After adjusting for several covariables, the highest E-DII group was still associated with a 68% increase in retinopathy in diabetic patients. These results suggest that E-DII is positively associated with the prevalence of diabetic retinopathy among diabetic patients.

Association between sedentary time and plasma leptin levels in middle-aged and older adult population in Taiwan: A community-based, cross-sectional study.

Association of sedentary behavior and plasma leptin levels is a popular topic in recent research. Aged populations often suffer from cardiometabolic diseases, and leptin is considered a novel marker for many cardiometabolic diseases. To further explore this topic, our research investigates the relationship between sedentary time and serum leptin levels in middle-aged and older populations. A total of 396 middle-aged and older adult Taiwanese participants were included in this study. We recorded their self-reported sitting time as sedentary time. Participants were categorized into low leptin, medium leptin group, and high leptin groups according to the tertile of serum leptin level in the study. We also analyzed the anthropometric and cardiometabolic parameters between the three groups. Spearman's correlation coefficient was used to analyze the correlation between leptin level, sedentary time, and other cardiometabolic risk factors. The relationsip between leptin and sedentary time was also shown in a scatter plot. Multivariate linear regression was performed to determine the association between serum leptin levels and sedentary time after adjusting for age, sex, alcohol consumption, smoking, triglycerides, body mass index (BMI), fasting plasma glucose, systolic blood pressure, uric acid, creatinine, and alanine transaminase (ALT). In our study, data from a total of 396 participants were analyzed. The average age of participants was 64.75 (±8.75) years, and ~41.4% were male. A longer period of sedentary time was observed in the high leptin group. A positive correlation was found between serum leptin level and sedentary time in Spearman's correlation, in all BMI groups. Serum leptin levels were positively associated with sedentary time (B = 0.603, p = 0.016) in the multivariate linear regression after adjusting for age, sex, alcohol consumption, smoking, triglycerides, BMI, fasting plasma glucose, systolic blood pressure, uric acid, creatinine, and ALT. Prolonged sedentary time can be an independent risk factor for high serum leptin levels, and high leptin levels can be a novel marker in future healthcare to screen the individual with prolonged sedentary time. Furthermore, based on our study, future research can further explore the relationship between leptin levels and health promotion, especially decreasing sedentary time in the middle-aged and elder population, which is vulnerable to cardiometabolic diseases.

Solid Fuel Use and the Progression of Multimorbidity in Middle-Aged Chinese Participants: A Prospective Cohort Study.

Objectives: This study aimed to examine the association of solid fuel use for cooking and heating with the progression of multimorbidity. Methods: A total of 5,437 participants from the China Health and Retirement Longitudinal Study were included. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of the independent and joint effects of solid fuel use for cooking and heating with the progression of multimorbidity. Results: The proportion of participants reporting solid fuel use for both cooking and heating was 59.0% at baseline. Solid fuel use for both cooking and heating was associated with the progression of multimorbidity (adjusted OR: 1.42, 95% CI: 1.19-1.70), compared with clean fuel use for both. Conclusion: Solid fuel use for cooking and heating play an important role in the progression of multimorbidity. Therefore, solid fuel reduction should be considered in developing multimorbidity control and prevention programmes.

Association between Different Types of Plant-Based Diets and Dyslipidemia in Middle-Aged and Elderly Chinese Participants

Plant-based dietary patterns may reduce the risk of dyslipidemia. However, not all plant-based foods are beneficial, and limited data exist for the Chinese population. We investigated the association between different plant-based dietary indices and the risk of dyslipidemia in a Chinese middle-aged and elderly population. The study participants (n = 4096) consisted of adults between 35 and 74 years of age from Xinjiang, China. Dietary consumption of the study participants was evaluated using a semi-quantitative food-frequency questionnaire (FFQ). Three different plant-based dietary indices were calculated using data from dietary surveys, including overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Based on these indices, we created an adjusted plant-based diet index (aPDI) based on the Xinjiang population actual dietary behavior and health effects of food. We measured the levels of total cholesterol, triglyceride, LDL-C, and HDL-C in the blood of the study participants. We used multivariable logistic regression and restricted cubic spline to analyze the relationship between plant-based diets and dyslipidemia. The findings showed that 36.6% of the participants had dyslipidemia. Higher PDI adherence was related to lower odds of dyslipidemia (Q3 vs. Q1, OR: 0.780, 95% CI: 0.641-0.949; Q4 vs. Q1, OR: 0.799, 95% CI: 0.659-0.970). High aPDI was related to lower odds of dyslipidemia (Q4 vs. Q1, OR: 0.770, 95% CI: 0.628-0.945; Q5 vs. Q1, OR: 0.748, 95% CI: 0.607-0.921). High scores for PDI, hPDI, and aPDI were all related to a reduced risk of low HDL-C (OR: 0.638, 95% CI: 0.491-0.823; OR: 0.661, 95% CI: 0.502-0.870; OR: 0.580, 95% CI: 0.443-0.758). Conversely, a high uPDI score was associated with an increased risk of low HDL-C (OR: 1.349, 95% CI: 1.046-1.740). There was no non-linear relationship between PDI, hPDI, uPDI, and aPDI and the risk of different types of dyslipidemia. Plant-based dietary indices are related to specific types of dyslipidemia risk. Appropriately increasing the consumption of plant-based foods while improving the quality of plant-based dietary patterns is critical for the prevention of dyslipidemia, especially low HDL-C, in the population.

PS-C23-8: COFFEE INTAKE AND RISK OF HYPERTENSION IN KOREAN ADULTS: RESULTS FROM KNHANES 2012–2016

Introduction: Coffee is the most popular and widely consumed drink in South Korea. Coffee consumption seems to have both benefits and risk with respect to hypertension. But, results from studies evaluating effect of frequency of coffee consumption on risk of hypertension are mixed and inconsistent. Hence, this study investigated the effect of frequency of coffee consumption on risk of hypertension in Korean adults. Methods: Data from Korean National Health and Nutrition Examination Survey (KNHANES 2012–2016) was obtained and 12133 eligible participants were selected. The consumption of coffee was obtained at baseline using a food frequency questionnaire (FFQ). Subsequently coffee intake was categorized into three categories (cups/day): &lt; 1, 1–3, and &gt; 3 cups/day. Hypertension status was defined as a systolic blood pressure &gt; 140 mmHg or a diastolic blood pressure &gt; 90 mmHg, use of antihypertensive drug treatment, or both. Multivariable logistic regression analysis was used to examine the effect of coffee consumption on risk of hypertension. Results: Fifty-five percent participants drank coffee 1–3 cups coffee/day. A total of 2359 participants had hypertension. In all participants more than 3 cups of coffee intake in a day was significantly reduced the risk of hypertension with Odds Ratio (OR) 0.76 (95%C.I. 0.65,0.89). Participants in middle age (40–59 years) group OR 0.76 (95% C.I. 0.63,0.93), normal range BMI OR 0.65 (95% C.I. 0.52,0.80), not diabetic OR 0.79 (95% C.I. 0.64,0.98), normal cholesterol OR 0.76 (95% C.I. 0.63,0.94) had protective effect of coffee consumption against risk of hypertension. Conclusion: The beneficial effect of &gt; 3 cups of coffee intake in a day were seen in middle age, normal BMI, not diabetic and normal cholesterol participants compared to consumption of &lt; 1 cup/day.

Lack of Time is Still the Main Barrier to Exercise and Physical Activity in the Elderly, Although Less So than Younger and Middle-Aged Participants

The purpose of this study was to examine the main motivators and barriers to Physical Activity (PA) and Exercise (EX) of an elderly population in South Carolina compared to their younger and middle-aged counterparts. Males and females ages 18 years and older representing 13 diverse groups from Cherokee County, South Carolina participated in this study.

Alzheimer's Disease Genetic Risk, Cognition, and Brain Aging in Midlife.

We examined associations of an Alzheimer's disease (AD) Genetic Risk Score (AD-GRS) and midlife cognitive and neuroimaging outcomes in 1,252 middle-aged participants (311 with brain MRI). A higher AD-GRS based on 25 previously identified loci (excluding apolipoprotein E [APOE]) was associated with worse Montreal Cognitive Assessment (-0.14 standard deviation [SD] [95% confidence interval {CI}: -0.26, -0.02]), older machine learning predicted brain age (2.35 years[95%CI: 0.01, 4.69]), and white matter hyperintensity volume (0.35 SD [95% CI: 0.00, 0.71]), but not with a composite cognitive outcome, total brain, or hippocampal volume. APOE ε4 allele was not associated with any outcomes. AD risk genes beyond APOE may contribute to subclinical differences in cognition and brain health in midlife. ANN NEUROL 2023;93:629-634.

The healthful plant-based diet index as a tool for obesity prevention-The healthy lifestyle community program cohort 3 study.

World-wide the prevalence of obesity is high, and promoting a shift toward more healthful and more plant-based dietary patterns appears to be one promising strategy to address this issue. A dietary score to assess adherence to a healthy plant-based diet is the healthful plant-based diet index. While there is evidence from cohort studies that an increased healthful plant-based diet index is associated with improved risk markers, evidence from intervention studies is still lacking. A lifestyle intervention was conducted with mostly middle-aged and elderly participants from the general population (n=115). The intervention consisted of a 16-month lifestyle program focusing on a healthy plant-based diet, physical activity, stress management, and community support. After 10weeks, significant improvements were seen in dietary quality, body weight, body mass index, waist circumference, total cholesterol, measured and calculated low-density lipoprotein (LDL) cholesterol, oxidized LDL particles, non-high-density lipoprotein cholesterol, remnant cholesterol, glucose, insulin, blood pressure, and pulse pressure. After 16months, significant decreases were seen in body weight (-1.8kg), body mass index (-0.6kg/m2), and measured LDL cholesterol (-12mg/dl). Increases in the healthful plant-based diet index were associated with risk marker improvements. The recommendation of moving toward a plant-based diet appears acceptable and actionable and may improve body weight. The healthful plant-based diet index can be a useful parameter for intervention studies.

Experiences of participating in a vocational rehabilitation program in Singapore

Purpose The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury and (ii) identify salient features of the program that facilitated their return-to-work process. Materials and methods This was a qualitative phenomenological study. Participants were invited to complete an interview about their return-to-work process after acquiring a disability vis-à-vis their participation in a local VR program. The qualitative data were analyzed inductively. Results Twenty-four middle-aged participants with a stroke or spinal cord injury completed the interviews. The participants’ experiences with the local VR program were largely positive. Several key features of the VR program were identified. These were: (i) providing a multi-disciplinary and individualized program; (ii) building positive collaborations between service providers and participants; and (iii) supporting personal growth among participants. Conclusion The Singaporean VR program demonstrated internationally recommended best practices. These best practices were beneficial for the participants’ return-to-work process, as reflected by their positive feedback about the program. Our study emphasizes the need for comprehensive and evidence-based VR programs to meet the complex needs of individuals with disabilities who want to return to work. Implications for rehabilitation Multi- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients. VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work process VR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goals VR service providers should address concurrent or future concerns that could impact on their clients’ ability to return to or remain at work.