Background Cardiovascular disease is a risk factor for severe COVID‐19 (ie, hospitalization or death). Whether better cardiovascular health (CVH) is associated with lower risk of severe COVID‐19 among adults without cardiovascular disease is unknown. We aimed to test if the American Heart Association's Life's Essential 8 (LE8) metric and its components were associated with severe COVID‐19 in the C4R (Collaborative Cohort of Cohorts for COVID‐19 Research) consortium. Methods Participants with cardiovascular disease were excluded. Two waves of questionnaires, events surveillance, and a serosurvey identified COVID‐19 infections. Associations of incident severe COVID‐19 with continuous LE8, categorical LE8 (low [<50], moderate [50 to <80], and high [≥80] CVH), and individual LE8 components, were tested in adjusted cause‐specific hazards models. Results Among 29 740 participants in 9 cohorts (mean age, 66±14 years; 61% women; 35% White race; 22% Black race; 34% Hispanic ethnicity), there were 681 severe COVID‐19 cases between March 1, 2020, and February 28, 2023. There was a 20% lower hazard of severe COVID‐19 per each 1‐SD higher LE8 (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.73–0.88]). Relative to low CVH, high CVH was associated with lower risk of severe COVID‐19 (aHR, 0.54 [95% CI, 0.37–0.78]); this was not seen for moderate CVH (aHR, 0.81 [95% CI, 0.64–1.04]). Of LE8 components, better physical activity, body mass index, blood pressure, and sleep were associated with a lower hazard of severe COVID‐19. Conclusions Better CVH was associated with lower severe COVID‐19 risk among cardiovascular disease–free adults. Whether CVH optimization could mitigate adverse risk from COVID‐19 and other harmful viruses warrants further investigation.

Background/Objectives: As individuals age, they experience declines in multiple physiological domains, which increases their vulnerability to health challenges and frailty. While adherence to healthy dietary patterns has been shown to protect against frailty, consuming ultra-processed foods (UPFs)—which are high in added sugars and saturated fat—may contribute to frailty risk. This study investigates the association between UPF consumption and frailty progression among 938 participants aged 65 years and older who were in the InCHIANTI study, Italy. Methods: The patients’ dietary intakes over the past year were assessed using a validated food frequency questionnaire, with items categorized into food groups based on the Nova classification. Frailty was operationalized using a 42-item frailty index (FI). Multivariable linear regression was used to examine the association between the baseline UPF consumption frequency and baseline frailty status, while linear mixed-effects models were used to examine the frailty progression over time. Results: Overall, the participants with the lowest UPF consumption frequency were younger, had more years of education, and had a lower baseline FI. Higher UPF consumption was significantly associated with a greater baseline FI after adjustments for the sociodemographic and health characteristics (β = 0.026, 95% CI = 0.010–0.041, p = 0.001), and this difference persisted over a 16.1-year follow-up period (β = 0.022, 95% CI = 0.006–0.037, p = 0.006). Conclusions: These findings underscore the potential negative health impacts of UPF on frailty prevalence and progression in older adults.

South Asians are among the fastest-growing immigrant population group in the United States (U.S.) with a unique disease risk profile. Due in part to immigration and acculturation factors, South Asians engage differently with behavioural risk factors (e.g. smoking, alcohol intake, physical activity, sedentary behaviour, and diet) for hypertension, which may be modified for the primary prevention of cardiovascular disease. Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, we conducted a cross-sectional analysis to evaluate the association between behavioural risk factors for cardiovascular disease and diet. We created a behavioural risk factor score based on smoking status, alcohol consumption, physical activity, and TV watching. We also calculated a Dietary Approaches to Stop Hypertension (DASH) dietary score based on inclusion of relevant dietary components. We used both scores to examine the association between engaging with risk factors for hypertension and the DASH diet among a cohort of South Asian adults. We found that participants with 3-4 behavioural risk factors had a DASH diet score that was 3 units lower than those with no behavioural risk factors (aβ: -3.25; 95% CI: -4.28, -2.21) and were 86% less likely to have a DASH diet score in the highest category compared to the lowest DASH diet score category (aOR: 0.14; 95% CI: 0.05, 0.37) in the fully adjusted models. These findings highlight the relationship between behavioural risk factors for hypertension among South Asians in the U.S.

INTRODUCTION:Research suggests that chronic stress is associated with individual cardiovascular health metrics (e.g., physical activity and diet quality); however, the association between chronic stress and overall cardiovascular health is less well understood. Furthermore, minoritized racial and ethnic groups experience a disproportionate stress burden. Therefore, this study assessed the association between chronic stress and cardiovascular health within 2 racially and ethnically diverse cohorts. METHODS:This study utilized pooled data from 7,978 participants of the Multi-Ethnic Study of Atherosclerosis and the Mediators of Atherosclerosis in South Asians Living in America studies collected in 2000-2011 and 2010-2018, respectively. The associations between chronic stress and the cross-sectional and annualized change in Life's Essential 8 cardiovascular health score, excluding sleep (range=0-100), were assessed using linear regression to adjust for sociodemographic factors. Anxiety, depression, and social support were assessed as potential moderators of this association. Analyses were repeated using individual cardiovascular health metrics as the outcome. Analyses were conducted in 2025. RESULTS:In cross-sectional analyses, individuals with high chronic stress had a 2.7-point lower (-2.71, 95% CI= -3.46, -1.95) cardiovascular health score than those with no chronic stress after adjustments. No association between chronic stress and annualized change in cardiovascular health score was observed. In addition, there was no moderation by anxiety, depression, or social support. CONCLUSIONS:Elevated chronic stress is adversely associated with concurrent cardiovascular health. These results highlight the important relationship between chronic stress and health.

Introduction: South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease. Methods: Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up. Results: The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score >100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score >100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models. Conclusions: The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men. AJPM Focus 2025;4(1):100288. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Our study examined the associations between overall cardiovascular health (CVH) and the risk of disability in older adults over 16 years of follow-up. Data from the InCHIANTI study were used and included 928 participants aged 65 years and older. Overall CVH was measured using the “Life’s Essential 8” (LE8) metric. Disability status was assessed by the Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL). Higher overall LE8 score at baseline was associated with lower risks of having the first ADL among males (hazard ratio [HR] = 0.66, p = 0.001) and IADL disability event (HR = 0.89, p = 0.016) using the Cox proportional hazards model. Higher LE8 scores were also associated with ADL (odds ratio [OR] (females) = 0.80, p = 0.034; OR (males) = 0.55, p < 0.001) and IADL worsening (OR = 0.72, p < 0.001) using Generalized Estimating Equation models. Among older adults, better CVH assessed by the LE8 metric was associated with lower risk of ADL and IADL disabilities and their worsening over time. These findings underscore the importance of promoting CVH as a key strategy to support healthy aging and reduce disability burden. Public health interventions that target CVH components may be effective in preserving functional independence among older populations.

The older population is growing fast, and it is important to investigate the cardiovascular health factors and behaviors that are associated with cardiovascular disease (CVD) and mortality among older individuals. A total of 920 older adults (mean age: 74 years, 55% women) from the InCHIANTI study were included for analysis. Cardiovascular health (CVH) was assessed using the Life's Essential 8 (LE8) developed by the American Heart Association, including 8 health behaviors (smoking, diet, physical activity, sleep) and factors (body mass index, blood cholesterol, blood glucose, blood pressure). The LE8 score ranges from 0 to 100, with higher score indicating better CVH. CVH was analyzed on both a continuous scale [per 1 standard deviation (SD) increase] and categorical scale [low (CVH) score < 50 vs. moderate/high (CVH) score ≥ 50]. Cox hazard models were used to calculate the hazard ratios (HRs) of CVD and all-cause mortality associated with CVH and its components adjusting for age, sex, study site, education, presence of ADL and IADL limitations, cognitive impairment, depression, and presence of chronic disease. The median follow-up time was 14.5 years. Participants with moderate/high CVH had better survival rates for both CVD and all-cause mortality compared to those with low CVH. One SD increase in LE8 score was associated with 28% (p = 0.001) and 17% (p < 0.001) lower risk of CVD and all-cause mortality, respectively. Among older community dwelling men and women, better CVH is inversely associated with CVD and all-cause mortality, and this lends credence to the importance of prioritizing health factors and behaviors in preventing chronic disease and promoting healthier lives among older adults.

What people eat is a major contributor to health outcomes, including development of metabolic, cardiovascular, and other chronic diseases. Dietary quality varies widely is influenced by factors including sex, race, geographic location, socioeconomic status, self-perception of community standing, and occupation. These factors potentially interact, making an understanding of dietary quality difficult to fully disaggregate and therefore challenging to modify from a population health perspective. This study sought to analyze the interaction between subjective social status (SSS) and occupation on dietary quality among African Americans in the Deep South, as well as assess their marginal effects. Hypotheses Dietary quality will vary by occupational groups and levels of SSS. There will be an interaction between occupational groups and (SSS) on dietary quality. Methods: A cross-sectional analysis of data from participants of the Jackson Heart Study was completed. Participants ( n = 4,727) who had complete data for occupation, the alternative healthy eating index (AHEI, a measure of diet quality) score, and SSS (as measured by the Community MacArthur Scale) at exam 1 were included in the analysis. A general linear model with main and interaction effects for SSS and occupation group was fit to AHEI. Results: Type III F -tests from ANOVA showed no significant interaction between SSS and occupational groups with respect to mean AHEI scores ( p = 0.7635). Significant main effects were found for both the occupational groups and SSS level ( p < 0.0001). Pairwise comparisons of occupational groups revealed significantly different mean AHEI scores among several groups. Most notably, those in the management/professional occupation appeared to have higher mean AHEI compared to all the other groups. Mean AHEI was estimated to increase by 0.3723 units (SE = 0.0781) for every one-unit increase in SSS. Residual diagnostics and goodness-of-fit methods verified model adequacy. Conclusions In conclusion, occupation and SSS each contribute significantly to dietary quality as measured by AHEI; some occupational groups show significant differences in dietary quality; and there is no evidence of an interaction between occupation groups and SSS, indicating that the positive association between subjective social status and dietary quality is the same for each occupational group.

BACKGROUND:Diet affects the development of chronic diseases such as type 2 diabetes, but the underlying biological mechanisms are only partly understood. OBJECTIVES:This study aimed to identify proteomic markers of the Alternative Healthy Eating Index (AHEI) and the Dietary Approaches to Stop Hypertension (DASH) diet and their association with type 2 diabetes risk. METHODS:We examined the associations between the AHEI and DASH diet quality scores and 1317 plasma proteins in African American participants of the Jackson Heart Study (JHS, n = 1878). These findings were validated in a Singapore Multi-Ethnic Cohort (n = 2395) and examined in relation to type 2 diabetes incidence (n = 539 cases). We adjusted for multiple testing by using false discovery rate-adjusted q values. RESULTS:We identified 13 proteins consistently associated with the AHEI or DASH scores with the strongest associations for the AHEI score and epidermal growth factor receptor (β:0.089; SE: 0.017; q < 0.001) and for the DASH score and tissue factor (β: -0.114; SE: 0.022; q < 0.001). Most of these proteins were related to inflammation, thrombosis, adipogenesis, and glucose metabolism. Concentrations of myeloperoxidase, epidermal growth factor receptor, hepatocyte growth factor receptor, coagulation factor Xa, contactin 4, kynureninase, neurogenic locus notch homolog protein 1, and vesicular integral-membrane protein VIP36 were associated with the risk of type 2 diabetes in the Asian cohort. The diabetes odds ratio for a 2-fold higher protein abundance concentration ranged from 0.03 (95% CI: 0.01, 0.08) for neurogenic locus notch homolog protein 1 to 3.04 (95% CI: 2.13, 4.33) for kynureninase. Furthermore, genetic markers for myeloperoxidase and hepatocyte growth factor receptor were significantly associated with diabetes risk. CONCLUSIONS:Our study across geographically and ethnically diverse populations identified robust protein biomarkers for healthy dietary patterns. Furthermore, our findings suggest novel biological mechanisms linking dietary patterns with type 2 diabetes development.

Background: Anemia is associated with fatigue, low physical activity, and poor quality of life. The purpose of this study was to determine the effects of a field trial on 6-month change in anemia and physical activity among nonpregnant women living in rural India.Methods: The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized controlled trial of a social norms-based intervention to reduce anemia among women (15-49 years). Participants (n = 292) performed a modified Queen's College Step Test (QCST) and wore an ActivPAL accelerometer for 3 days. Hemoglobin concentrations (g/dL) were determined using a HemoCue 301 photometer. Linear regression tested the effects of the intervention on 6-month change in hemoglobin and physical activity, while adjusting for age, body mass index, education, parity, and predicted VO2max.Results: We observed no differences in hemoglobin (11.8 +/- 1.2 vs.11.6 +/- 1.4 g/dL) or overall physical activity (36.6 +/- 2.1 vs. 35.3 +/- 5.8 metabolic equivalent of task-hours/day) at 6 months between the treatment and control groups, respectively. In contrast, steps/day was significantly higher in the treatment, compared with the control group (beta = 1353.83; 95% confidence interval: 372.46, 2335.31), independent of other covariables.Conclusion: The potential to modify walking and other health-seeking behaviors using a social norms approach is worthy of further investigation among women living in rural India.Clinical Trial Registry - India: CTRI/2018/10/016186.

Background: Plant-based diets are associated with various health benefits; however, their impact on physical performance in aging populations remains unclear. Objectives: To investigate the associations between adherence to plant-based diets and physical performance, focusing on their potential protective effects against age-related declines in function. Methods: Data were obtained from men and women aged 40 years or older in the Baltimore Longitudinal Study of Aging (BLSA) (mean ± SD age: 68 ± 13 years at the first dietary visit; n = 1389). Dietary intake was assessed using a food frequency questionnaire (FFQ). Plant-based diets, calculated from 18 food groups, were categorized as overall (PDI), healthful (hPDI), or unhealthful (uPDI), and their tertiles across visits were analyzed. Multivariable linear mixed-effects models were used to examine the association between repeated measurements of three physical performance outcomes—Short Physical Performance Battery (SPPB), grip strength (kg), and gait speed (m/s)—and adherence to each plant-based diet. Results: In fully adjusted models, SPPB and grip strength were significantly associated with both hPDI and uPDI, but not with PDI. For hPDI, the intermediate tertile showed the greatest benefit, with SPPB scores 0.5 points higher (βT2vs.T1 = 0.50, 95% CI: 0.30–0.70, p < 0.001) over the follow-up period. In contrast, for uPDI, a 0.27-point lower SPPB score was seen (βT3vs.T1 = −0.27, 95% CI: −0.48 to −0.07, p = 0.009). Longitudinally, grip strength was positively associated with hPDI (βT3vs.T1 = 1.14, 95% CI: 0.24–2.05, p = 0.0013). Similar results were observed in older adults aged ≥65 years. Conclusions: Adherence to hPDI may benefit lower body function and muscle strength, while uPDI appears to have adverse effects. This suggests that the quality of plant-based foods is essential for maintaining functional well-being in older adults. Further research is needed to confirm these findings, explore underlying mechanisms, and identify strategies to optimize plant-based dietary patterns for aging populations.

Background: Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition. Methods: A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the "Life's Essential 8" (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including "low LE8" (0-49), indicating low CVH, "moderate LE8 (50-79)", indicating moderate CVH, and "high LE8 (80-100)", indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years. Results: Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46-0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73-0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53-0.72, p < 0.001). Conclusion: While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.

Background: Hearing loss, a public health issue in older populations, is closely related to functional decline. Objective: To investigate the longitudinal associations between 4 dietary indices and hearing status. Methods: Data from the Baltimore Longitudinal Study of Aging were used and included 882 participants >= 45 y of age. Dietary intake was assessed using a validated food frequency questionnaire, and 4 dietary scores (Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet [MIND], Mediterranean style diet score [MDS], Alternative Healthy Eating Index [AHEI], and Healthy Eating Index [HEI]) were calculated as averages over time. Hearing status was examined using pure -tone audiometry, and pure -tone average (PTA) of hearing thresholds were calculated at speech-level (PTA (500, 1000, 2000, 4000 Hz) ), low (PTA (500, 1000 Hz) ), and high (PTA (4000, 8000 Hz) ) frequencies, with lower thresholds indicating better hearing. Multivariable linear mixed-effect models were used to examine associations between dietary indices and hearing threshold change over time adjusted for confounders. Results: At baseline, the mean age of participants was 67 y and 55% were female. Over a median of 8 y of follow-up, MDS >= 7 was associated with 3.5 (95% CI: - 6.5, - 0.4) and 5.0 (95% CI: - 9.1, - 1.0) dB lower PTA (500, 1000, 2000, 4000 Hz) and PTA (4000, 8000 Hz) , respectively, compared with MDS <= 3; the highest tertile of the AHEI was associated with 2.3 (95% CI: - 4.6, - 0.1) and 5.0 (95% CI: - 8.0, - 2.0) dB lower PTA (500, 1000, 2000, 4000 Hz) and PTA (4000, 8000 Hz) ; and each standard deviation increment in HEI was associated with 1.6 dB (95% CI: - 2.7, - 0.6), 1.1 dB (95% CI: - 2.1, - 0.1), and 2.1 dB (95% CI: - 3.5, - 0.6) lower PTA (500, 1000, 2000, 4000 Hz) , PTA (500, 1000 Hz) , and PTA (4000, 8000 Hz) , respectively. Conclusions: Adherence to healthy dietary patterns was associated with better hearing status, with stronger associations at high frequencies. Am J Clin Nutr 20xx;x:xx.

Background and aims: South Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. Methods: We assessed the distribution of CVH metrics (inadequate: score 0-8, average: 9-10, optimal: 11-14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). Results: We included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14-0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19-0.53), p < 0.01]. Conclusions: Optimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.

Background: Dietary guidance is set on the basis of age and life stage and defines older adults as >60 y. Yet, little is known about if and/or how diet quality differs beyond the age of 60. Objective: The objective of this study was to compare the dietary intakes of 60-69 (n = 2079), 70-79 (n = 1181), and 80+ y old (n = 644) noninstitutionalized men and women in the United States using the Healthy Eating Index 2015 (HEI) and the What We Eat in America food categories. Methods: Data were obtained from National Health and Nutrition Examination Survey 2015-2016 and 2017-March 2020. HEI and component scores were calculated using the population ratio method. Population estimates for dietary intake were calculated as the average reported over 2 separate nonconsecutive 24-h dietary recalls. Results: In men and women, the reported energy intake was lower among the 80+ y olds (kcal/d men-80+: 1884 +/- 30, 70-79: 2022 +/- 33, 60-69: 2142 +/- 39; women-80+: 1523 +/- 36; 70-79: 1525 +/- 33, 60-69: 1650 +/- 25; P -trend < 0.001). Total HEI scores did not differ significantly across the 3 age categories, but the 80+ y olds had significantly lower scores for the green vegetables and beans component than the 60-69 y olds [men-mean (95% confidence interval): 2.0 (1.5, 2.5) compared with 3.4 (2.6, 4.1); women-2.3 (1.8, 2.8) compared with 4.4 (3.7, 5.0)]. In women, the percentage of daily calories from protein was significantly lower in the 80+ y olds than in the 60-69 and 70-79 y olds (12.9% +/- 0.6%, compared with 17.0% +/- 0.9% and 15.6% +/- 0.6%, respectively). Protein intake did not differ significantly among the 3 age groups in men. The 80+ y old men and women reported consuming a significantly higher percentage of calories from snacks and sweets compared with the 60-69 y olds (men-80+: 18.1% +/- 0.8%, 60-69: 15.4% +/- 0.7%; women-80+: 19.6% +/- 0.8%, 60-69: 15.5% +/- 0.7%). Conclusion: The diet of 80+ y olds differed from that of 60-69 y olds in some key components, including energy, snacks and sweets, protein, and green vegetables. Future research is needed to determine if there are health -related consequences to these differences.

Background: Mounting evidence indicates that although some plant-based diets are healthful, others are not. Changes in the gut microbiome and microbiome-dependent metabolites, such as trimethylamine N-oxide (TMAO), may explain differential health effects of plant-based diets. However, human data are sparse on whether qualitatively distinct types of plant-based diets differentially affect gut microbiome diversity, composition, particularly at the species level, and/or metabolites. Objectives: We aimed to examine cross-sectional associations of different plant-based indices with adult gut microbiome diversity, composition, and the metabolite TMAO. Methods: We studied 705 adults in the Baltimore Longitudinal Study of Aging with data for diet, fecal microbiome (shotgun metagenomic sequencing), and key covariates. We derived healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI) using data from food frequency questionnaires. We examined plant-based diet indices with microbiome alpha-diversity (richness and evenness measures), beta-diversity (Bray-Curtis and UniFrac measures), composition (species level), and plasma TMAO. We used regression models to determine associations before and after adjustment for age, sex, education, physical activity, smoking status, body mass index, and total energy intake. Results: The analytic sample (mean age, 71.0 years, SD 1/4 12.8 years) comprised 55.6% female and 67.5% non-Hispanic White participants. hPDI was positively and uPDI negatively associated with microbiome alpha-diversity, driven by microbial evenness (Pielou P < 0.05). hPDI was also positively associated with relative abundance of 3 polysaccharide-degrading bacterial species (Faecalibacterium prausnitzii, Eubacterium eligens, and Bacteroides thetaiotaomicron) and inversely associated with 6 species (Blautia hydrogenotrophica, Dorea sp CAG 317, Eisenbergiella massiliensis, Sellimonas intestinalis, Blautia wexlerae, and Alistipes shahii). Furthermore, hPDI was inversely associated with TMAO. Associations did not differ by age, sex, or race. Conclusions: Greater adherence to a healthful plant-based diet is associated with microbiome features that have been linked to positive health; adherence to an unhealthful plant-based diet has opposing or null associations with these features.

Background: Social and psychosocial factors are associated with cardiovascular health (CVH) and may underlie race/ethnic differences in CVH. Quantifying the contribution of individual-level social and psychosocial factors to racial and ethnic differences in CVH may guide strategies to reduce disparities. Methods: In the MESA and MASALA cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14, with 14 indicating optimal CVH) in Black, Chinese, Hispanic, or South Asian compared with White participants. Results: Among 7,978 adults (mean age 61 [SE 10] years, 52% female), there were 1,892 Black (mean CVH score 7.96), 804 Chinese (CVH 9.69), 1,496 Hispanic (CVH 8.00), 1,164 South Asian (CVH 9.16), and 2,622 White (CVH 8.91) participants. The factors that statistically contributed the most to explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equivalent to White participants, Black participants’ mean CVH score would be 0.14 points higher, p<0.05); place of birth for Chinese participants (if proportion of US-born and foreign-born individuals among Chinese adults were equivalent to White participants, Chinese participants’ mean CVH score would be 0.22 points lower, p<0.05); and education for Hispanic and South Asian participants (if educational attainment were equivalent to White participants, Hispanic and South Asian participants’ mean CVH score would be 0.55 points higher and 0.37 points lower, respectively, p<0.05 for both). Conclusions: In this multiethnic US cohort, social and psychosocial factors statistically explained racial and ethnic differences in CVH. Socioeconomic and immigration-related factors contributed the largest magnitude to CVH differences between race and ethnic groups.