Frailty is a risk factor for disability and mortality, and is more prevalent among African American (AA) elderly than whites. We examined frailty in middle-aged racially and economically diverse adults, and investigated how race, poverty and frailty were associated with mortality. Data were from 2541 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span study in Baltimore, Maryland; 35-64 years old at initial assessment (56% women; 58% AA). Frailty was assessed using a modified FRAIL scale of fatigue, resistance, ambulation, illness and weight loss, and compared with difficulties in physical functioning and daily activities. Frailty prevalence was calculated across race and age groups, and associations with survival were assessed by Cox Regression. 278 participants were frail (11%); 924 pre-frail (36%); 1339 not frail (53%). For those aged 45-54, a higher proportion of whites (13%) than AAs (8%) were frail; while the proportions were similar for those 55-64 (14%,16%). Frailty was associated with overall survival with an average follow-up of 6.6 years, independent of race, sex and poverty status (HR = 2.30; 95%CI 1.67-3.18). In this sample of economically and racially diverse older adults, the known association of frailty prevalence and age differed across race with whites having higher prevalence at younger ages. Frailty was associated with survival beyond the risk factors of race and poverty status in this middle-aged group. Early recognition of frailty at these younger ages may provide an effective method for preventing or delaying disabilities. Although incidence rates are well documented for traumatic brain injury, lifetime prevalence in a demographically diverse sample is unknown. We examined the prevalence of self-reported traumatic brain injury (TBI) in a demographically diverse sample. History of TBI was examined in 2881 African-Americans and Whites in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study-a community-based, epidemiological investigation of urban-dwelling adults. Logistic regression analyses examined the odds of TBI as a function of sex, race, poverty status, age quintile and their interactions. A significant 3-way interaction was noted amongst race, poverty status and age (odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.07-2.31, p = 0.021). Amongst Whites living in poverty, younger (30-36 years of age) individuals had greater odds of TBI than older (58-64 years of age) individuals, whereas older African-Americans living in poverty had greater odds of TBI. Additionally, a main effect of sex (OR = 2.36, 95% CI 1.85-3.03, p < 0.001) indicated that men had greater odds of TBI. History of TBI is most prevalent in men, older African-Americans in poverty, and younger Whites in poverty. Preventive measures targeting relevant TBI risk factors in these populations are warranted. Nutritional choices are associated with morbidity and mortality over the lifespan and are thought to vary by sex, race, ethnic background, and educational attainment. Knowledge of the contribution of supplements to overall nutritional health is limited. In this study, we investigated motivations for using dietary supplements by African Americans and Whites examined in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study and to determine if supplements provided beneficial effects to micronutrient diet quality and nutritional and cardiovascular biomarkers. The majority of the HANDLS study population were smokers, overweight or obese, and self-reported their health as poor to good. The top two reasons for their supplement use were to supplement the diet and to improve overall health. Micronutrient intake was calculated from two 24-hour recalls and a supplement questionnaire. Diet quality was assessed by the Mean Adequacy Ratio (MAR) Maximum score = 100 derived from the Nutrient Adequacy Ratio (NAR) for 17 micronutrients. The MAR score for nonusers was 73.12, for supplement users based on diet alone was 74.89, and for food and supplements was 86.61. Dietary supplements significantly increased each NAR score and MAR score. However, there were no significant differences between the population proportions with inadequate or excessive blood levels for any biomarkers examined. Nutrition education programs and intervention strategies addressing dietary supplement intake might lead to healthier food choices and may improve the health of this population. In a second study, we characterized botanical dietary supplement (BDS) use and compared the motivations for botanical supplement (BS) use to the efficacy of the botanical in a socioeconomically and racially diverse urban adult population. Participants were from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, a 20-year prospective health disparities study with African American and white adults from Baltimore, Maryland. All study participants completed two dietary recalls and a dietary supplement (DS) questionnaire in Wave 3 (n = 2140). Diet quality was evaluated by the Healthy Eating Index-2010 and the Mean Adequacy Ratio for 17 micronutrients. A comparison of reported motivations to efficacy reported in the literature of single BS was conducted. Approximately 50% (1062/2140) of participants took DS. Of these, 8% (n = 178) reported taking either BS or BDS. BDS users had better diet quality than DS users as well as nonusers of DS. The top three motivations for BDS users were to improve overall health, to maintain health, and to supplement the diet. There is limited evidence for the efficacy of most BS. Review of the efficacy of the 15 BS reported by 5% of the study population revealed beneficial health roles for only fiber, gingko biloba extract EGb 761, and hawthorn berry. This study is the first to report a better quality diet with BDS use for a racially diverse urban population. Yet, improvement in diet is needed because overall quality did not achieve current recommendations. To improve overall health, it may be beneficial for this population to focus on dietary modifications to reduce the risks associated with chronic diseases. In general, the reported motivations for BS use were not supported by clinical evidence.
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