Healthy Lifestyle Behaviors and Biological Aging in the U.S. National Health and Nutrition Examination Surveys 1999-2018

Diet, Pace of Biological Aging, and Risk of Dementia in the Framingham Heart Study

OBJECTIVE

People who eat healthier diets are less likely to develop dementia, but the biological mechanism of this protection is not well understood. We tested the hypothesis that healthy diet protects against dementia because it slows the pace of biological aging.

METHODS

We analyzed Framingham Offspring Cohort data. We included participants ≥60 years-old, free of dementia and having dietary, epigenetic, and follow-up data. We assessed healthy diet as long-term adherence to the Mediterranean-Dash Intervention for Neurodegenerative Delay diet (MIND, over 4 visits spanning 1991-2008). We measured the pace of aging from blood DNA methylation data collected in 2005-2008 using the DunedinPACE epigenetic clock. Incident dementia and mortality were defined using study records compiled from 2005 to 2008 visit through 2018.

RESULTS

Of n = 1,644 included participants (mean age 69.6, 54% female), n = 140 developed dementia and n = 471 died over 14 years of follow-up. Greater MIND score was associated with slower DunedinPACE and reduced risks for dementia and mortality. Slower DunedinPACE was associated with reduced risks for dementia and mortality. In mediation analysis, slower DunedinPACE accounted for 27% of the diet-dementia association and 57% of the diet-mortality association.

INTERPRETATION

Findings suggest that slower pace of aging mediates part of the relationship of healthy diet with reduced dementia risk. Monitoring pace of aging may inform dementia prevention. However, a large fraction of the diet-dementia association remains unexplained and may reflect direct connections between diet and brain aging that do not overlap other organ systems. Investigation of brain-specific mechanisms in well-designed mediation studies is warranted. ANN NEUROL 2024;95:1069-1079.

Decreased cobalamin sensitivity and biological aging acceleration in the general population

BACKGROUND

The evidence on the association between cobalamin (Cbl) and aging or relevant outcomes is limited and controversial. We aimed to investigate the relationships between cobalamin intake- and function-related biomarkers and biological aging.

METHODS

The study encompassed 22,812 participants aged 20 years and older from the National Health and Nutrition Examination Survey. A panel of biomarkers or algorithms was used to assess biological aging, including Klemera-Doubal Age Acceleration (KDMAccel), Phenotypic age acceleration (PhenoAgeAccel), telomere length, α-Klotho, and PhenoAge advancement. Weighted generalized linear regression analysis was used to assess the associations between cobalamin-intake biomarkers (serum cobalamin, cobalamin intake from food, cobalamin supplement use, serum methylmalonic acid [MMA], and homocysteine [Hcy]) and function-related biomarkers (functional cobalamin deficiency and cobalamin insensitivity index).

RESULTS

Among the 22,812 individuals, the weighted mean (SE) age was 48.3 (0.2) years and 48.0% were males. Unexpectedly, serum and dietary cobalamin as well as serum MMA and Hcy levels were positively associated with most indicators of biological aging. Cobalamin sensitivity was assessed by the combination of binary Cbllow/high and MMAlow/high or Hcylow/high (cutoff values: 400 pg/mL for cobalamin, 250 nmol/L for MMA, and 12.1 μmol/l for Hcy) and a newly constructed cobalamin insensitivity index (based on the multiplicative term of serum cobalamin and serum MMA or Hcy). The multivariable-adjusted β (95%CIs) of KDMAccel in the MMAlowCbllow, MMAlowCblhigh, MMAhighCbllow, and MMAhighCblhigh groups were reference, 0.27 (0.03 to 0.51), 0.85 (0.41 to 1.29), and 7.97 years (5.77 to 10.17) respectively, which were consistent for the combination of serum Hcy and cobalamin. Both cobalamin insensitivity indices were robustly associated with biological aging acceleration in a dose-response pattern (each p < 0.001).

CONCLUSIONS

Decreased cobalamin sensitivity but not cobalamin insufficiency might be associated with biological aging acceleration. Further studies would improve understanding of the underlying mechanisms between decreased cobalamin sensitivity and biological aging acceleration.

Synergistic impact of 25-hydroxyvitamin D concentrations and physical activity on delaying aging

OBJECTIVE

Our study aims to examine the independent and combined associations of serum 25-hydroxyvitamin D [25(OH)D] concentrations and physical activity (PA) status with phenotypic age (PhenoAge).

METHOD

The analysis included 18,738 participants from the NHANES 2007-2010 & 2015-2018. Phenotypic Age Acceleration (PhenoAgeAccel) was calculated as the residuals from regressing PhenoAge on chronological age. Weighted multivariable logistic regression models were used to analysis the relationship between 25(OH)D and PA with PhenoAgeAccel. Population attributable fraction (PAF) was used to estimate the proportion of PhenoAgeAccel which could be avoided if exposure were eliminated.

RESULTS

The multivariate-adjusted OR (95%CI) for PhenoAgeAccel with high 25(OH)D and adequate PA were 0.657 (0.549,0.787) (p < 0.001) for all, 0.663 (0.538,0.818) (p < 0.001) for participants whose age ≤65years old. Furthermore, there was multiplicative interaction between 25(OH)D and PA in age ≤65 years old group (0.729 (0.542,0.979), p = 0.036). High 25(OH)D level and adequate PA reduced the risk of PhenoAgeAccel by 14.3 % and 14.2 %, respectively. Notably, 30.7 % decrease was attributable to both high 25(OH)D level and engaging in adequate PA concurrently. Combining 25(OH)D above 80.4 nmol/l with PA decreased PhenoAge by 1.291 years (p < 0.001).

CONCLUSION

Higher 25(OH)D level was associated with lower risk of biological ageing. Combining 25(OH)D and PA demonstrated enhanced protective effects, especially in middle or young adults. These findings underscore the importance of outdoor PA in slowing down the aging process.

Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging

BACKGROUND

People living with HIV (PLHIV) on effective antiretroviral therapy are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases. In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether epigenetic aging (i.e., the residual between regressing epigenetic age on chronological age) was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated epigenetic aging focusing on the Horvath, Hannum, PhenoAge and GrimAge epigenetic clocks, and a pace of biological aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini.

RESULTS

Age at HIV diagnosis was associated with Hannum epigenetic age acceleration (EAA) (β-coefficient [95% Confidence Interval]; 0.53 [0.05, 1.00], p = 0.03) and longer duration since HIV diagnosis was associated with slower Hannum EAA (- 0.53 [- 1.00, - 0.05], p = 0.03). The average daily dietary intake of fruits and vegetables was associated with DunedinPACE (0.12 [0.03, 0.22], p = 0.01). The associations of Hannum EAA with the age at HIV diagnosis and duration of time since HIV diagnosis were attenuated when the average daily intake of fruits and vegetables or physical activity were included in our models. Diet and self-perceived quality of life measures modified the relationship between CD4+ T cell counts at participant enrollment and Hannum EAA.

CONCLUSIONS

Epigenetic age is more advanced in OPLHIV in Eswatini in those diagnosed with HIV at an older age and slowed in those who have lived for a longer time with diagnosed HIV. Lifestyle and quality of life factors may differentially affect epigenetic aging in OPLHIV. To our knowledge, this is the first study to assess epigenetic aging in OPLHIV in Eswatini and one of the few in sub-Saharan Africa.

Relationship between dietary macronutrients intake and biological aging: a cross-sectional analysis of NHANES data

PURPOSE

This study aimed to investigate the association between macronutrient intake and biological age.

METHODS

Data were collected from 26,381 adults who participated in the United States National Health and Nutrition Examination Survey (NHANES). Two biological ages were estimated using the Klemera-Doubal method (KDM) and PhenoAge algorithms. Biological age acceleration (AA) was computed as the difference between biological age and chronological age. The associations between macronutrient intakes and AA were investigated.

RESULTS

After fully adjusting for confounding factors, negative associations were observed between AA and fiber intake (KDM-AA: β - 0.53, 95% CI - 0.62, - 0.43, P < 0.05; PhenoAge acceleration: β - 0.30, 95% CI - 0.35, - 0.25, P < 0.05). High-quality carbohydrate intake was associated with decreased AA (KDM-AA: β - 0.57, 95% CI - 0.67, - 0.47, P < 0.05; PhenoAge acceleration: β - 0.32, 95% CI - 0.37, - 0.26, P < 0.05), while low-quality carbohydrate was associated with increased AA (KDM-AA: β 0.30, 95% CI 0.21, 0.38, P < 0.05; PhenoAge acceleration: β 0.16, 95% CI 0.11, 0.21, P < 0.05). Plant protein was associated with decreased AA (KDM-AA: β - 0.39, 95% CI - 0.51, - 0.27, P < 0.05; PhenoAge acceleration: β - 0.21, 95% CI - 0.26, - 0.15, P < 0.05). Long-chain SFA intake increased AA (KDM-AA: β 0.16, 95% CI 0.08, 0.24, P < 0.05; PhenoAge acceleration: β 0.11, 95% CI 0.07, 0.15, P < 0.05). ω-3 PUFA was associated with decreased KDM-AA (β - 0.18, 95% CI - 0.27, - 0.08, P < 0.05) and PhenoAge acceleration (β - 0.09, 95% CI - 0.13, - 0.04, P < 0.05).

CONCLUSION

Our findings suggest that dietary fiber, high-quality carbohydrate, plant protein, and ω-3 PUFA intake may have a protective effect against AA, while low-quality carbohydrate and long-chain SFA intake may increase AA. Therefore, dietary interventions aimed at modifying macronutrient intakes may be useful in preventing or delaying age-related disease and improving overall health.

Composite dietary antioxidant index associated with delayed biological aging: a population-based study

OBJECTIVE

The objective of this study was to explore the potential correlation between the composite dietary antioxidant index (CDAI) and biological aging, addressing the insufficient epidemiological evidence in this area.

METHODS

Participants meeting eligibility criteria were selected from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2001 and 2018. CDAI was determined based on dietary antioxidants obtained from 24-hour dietary recalls. Biological age was determined using PhenoAge algorithms incorporating various clinical features. Weighted multiple models were employed to investigate and assess the association between CDAI and biological age.

RESULTS

Analysis of the CDAI quartile revealed disparities in terms of age, gender, ethnicity, educational level, marital status, poverty, dietary calories intakes, smoking, drinking status, BMI, physical activity, and PhenoAge. After adjusting for potential confounding factors, a significant inverse relationship was found between CDAI and Phenotypic Age, with each standard deviation increase in CDAI score correlating with a 0.18-year decrease in Phenotypic Age. These negative correlations between CDAI and PhenoAge advancement were observed regardless of age, gender, physical activity status, smoking status, and body mass index.

CONCLUSIONS

Our findings demonstrate a positive relationship between higher CDAI scores and delayed biological aging. These results have significant implications for public health initiatives aimed at promoting healthy aging through dietary interventions.

Geroscience-Centric Perspective for Geriatric Psychiatry: Integrating Aging Biology With Geriatric Mental Health Research

The geroscience hypothesis asserts that physiological aging is caused by a small number of biological pathways. Despite the explosion of geroscience research over the past couple of decades, the research on how serious mental illnesses (SMI) affects the biological aging processes is still in its infancy. In this review, we aim to provide a critical appraisal of the emerging literature focusing on how we measure biological aging systematically, and in the brain and how SMIs affect biological aging measures in older adults. We will also review recent developments in the field of cellular senescence and potential targets for interventions for SMIs in older adults, based on the geroscience hypothesis.

Single- and combined-phthalate exposures are associated with biological ageing among adults

BACKGROUND

Previous research has emphasized the effects of lifestyle and genetics on ageing. However, the association between exposure to phthalates, which are extensively used in cosmetics and personal care products, and ageing is still unclear.

METHOD

Data for 4711 subjects from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010 were incorporated in the present study. The acceleration of the Klemera-Doubal method-biological age (KDM-BA) and phenotypic Age (PhenoAge) were measured by the composite of 13 biomarkers. Multiple-linear and weighted-quantile sum (WQS) regression models were constructed to explore the relationships of single- and combined-phthalate exposures, as indicated by urinary phthalate metabolites, with KDM-BA and PhenoAge. A generalized additive model (GAM) was fitted to explore the potential nonlinear relationships among the above variables.

RESULTS

Except for mono-(carboxynonyl), all urinary phthalate metabolites were associated with biological ageing, with correlation coefficients ranging from 0.241 to 0.526; however, mono-ethyl presented a negative correlation. The WQS models revealed mixed effects of combined urinary phthalate metabolites on ageing, with a 0.22-year ((95 % CI) 0.09, 0.32) increase in KDM-BA acceleration and a 0.27-year ((95 % CI) 0.13, 0.37) increase in PhenoAge acceleration for each decile increase in urinary phthalate metabolites. Moreover, MCPP, MEOHP, and MBzP seemed to be the top three phthalates in terms of biological ageing, with weights of 33.3 % and 32.2 %, 29.2 % and 17.2 %, and 21.5 % and 30.1 % in KDM-BA and PhenoAge acceleration, respectively.

CONCLUSION

Single-phthalate exposure was mostly associated with the ageing process, and combined-phthalate exposure presented mixed effects on biological ageing, emphasizing phthalate exposure as a significant risk factor for ageing.

Partnership status and positive DNA methylation age acceleration across the adult lifespan in the UK

Although a significant body of research has shown that married people are healthier and live longer, empirical research on sex differences in the link between marital status and health suggests results are mixed. Moreover, the sex disparities in marital status and health relationships vary across adulthood. The literature on partnership status and measures of ageing is largely focused on older age groups and is limited in its view of early adulthood. Data from waves 2 and 3 (2010-2012) of Understanding Society: UKHLS were used to examine the association of current partnership status with epigenetic age acceleration (AA) assessed with DNA methylation (DNAm) algorithms 'Phenoage' and ' DunedinPACE ' in 3492 participants (aged 16-97). Regression models were estimated separately for men and women, and further stratified by age groups. Divorced/separated and widowed people showed positive age acceleration compared to the married/cohabiting people (reference group). Some sex differences were apparent, especially, among the single and divorced/separated groups. Age differences were also apparent, for example in men, being single was negatively associated with DNAmAA in the youngest group, but positively in the oldest group compared to partnered counterparts. These findings illustrate the importance of partnerships on the ageing process, in particular marital change through divorce and widowhood for positive age acceleration in adults. For single groups, observations were heterogenous by age and sex.

Associations between the New DNA-Methylation-Based Telomere Length Estimator, the Mediterranean Diet and Genetics in a Spanish Population at High Cardiovascular Risk

Biological aging is a relevant risk factor for chronic diseases, and several indicators for measuring this factor have been proposed, with telomere length (TL) among the most studied. Oxidative stress may regulate telomere shortening, which is implicated in the increased risk. Using a novel estimator for TL, we examined whether adherence to the Mediterranean diet (MedDiet), a highly antioxidant-rich dietary pattern, is associated with longer TL. We determined TL using DNA methylation algorithms (DNAmTL) in 414 subjects at high cardiovascular risk from Spain. Adherence to the MedDiet was assessed by a validated score, and genetic variants in candidate genes and at the genome-wide level were analyzed. We observed several significant associations (p < 0.05) between DNAmTL and candidate genes (TERT, TERF2, RTEL1, and DCAF4), contributing to the validity of DNAmTL as a biomarker in this population. Higher adherence to the MedDiet was associated with lower odds of having a shorter TL in the whole sample (OR = 0.93; 95% CI: 0.85-0.99; p = 0.049 after fully multivariate adjustment). Nevertheless, this association was stronger in women than in men. Likewise, in women, we observed a direct association between adherence to the MedDiet score and DNAmTL as a continuous variable (beta = 0.015; SE: 0.005; p = 0.003), indicating that a one-point increase in adherence was related to an average increase of 0.015 ± 0.005 kb in TL. Upon examination of specific dietary items within the global score, we found that fruits, fish, "sofrito", and whole grains exhibited the strongest associations in women. The novel score combining these items was significantly associated in the whole population. In the genome-wide association study (GWAS), we identified ten polymorphisms at the suggestive level of significance (p < 1 × 10-5) for DNAmTL (intergenics, in the IQSEC1, NCAPG2, and ABI3BP genes) and detected some gene-MedDiet modulations on DNAmTL. As this is the first study analyzing the DNAmTL estimator, genetics, and modulation by the MedDiet, more studies are needed to confirm these findings.

Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging

Background

People living with HIV (PLHIV) on effective antiretroviral therapy (ART) are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases (NCD). In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether biological aging (i.e., the difference between epigenetic age and chronological age, termed 'epigenetic age acceleration [EAA]') was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated EAA focusing on the second-generation epigenetic clocks, PhenoAge and GrimAge, and a pace of aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini.

Results

Among participants, the PhenoAge clock showed older epigenetic age (68 years old [63, 77]) but a younger GrimAge epigenetic age (median=56 years old [interquartile range=50, 61]) compared to the chronological age (59 years old [54, 66]). Participants diagnosed with HIV at an older age showed slower DunedinPACE (β-coefficient [95% Confidence Interval]; -0.02 [-0.04, -0.01], p=0.002) and longer duration since HIV diagnosis was associated with faster DunedinPACE (0.02 [0.01, 0.04], p=0.002). The average daily dietary intake of fruits and vegetables was associated with faster DunedinPACE (0.12 [0.03, 0.22], p=0.01) and modified the relationship between HIV status variables (number of years living with HIV since diagnosis, age at HIV diagnosis, CD4+ T cell counts) and PhenoAge EAA, and DunedinPACE.

Conclusions

Biological age is accelerated in OPLHIV in Eswatini, with those living with HIV for a longer duration at risk for faster biological aging. Lifestyle factors, especially healthier diets, may attenuate biological aging in OPLHIV. To our knowledge, this is the first study to assess biological aging in Eswatini and one of the few in sub-Saharan Africa.

Aging measures and cancer: Findings from the Health and Retirement Study

Background

Compared to cancer-free persons, cancer survivors of the same chronological age (CA) have increased physiological dysfunction, i.e., higher biological age (BA), which may lead to higher morbidity and mortality. We estimated BA using eight aging metrics: BA computed by Klemera Doubal method (KDM-BA), phenotypic age (PhenoAge), five epigenetic clocks (ECs, Horvath, Hannum, Levine, GrimAge, and pace of aging (POA)), and subjective age (SA). We tested if aging constructs were associated with total cancer prevalence and all-cause mortality in cancer survivors and controls, i.e., cancer-free persons, in the Health and Retirement Study (HRS), a large population-based study.

Methods

In 2016, data on BA-KDM, PhenoAge, and SA were available for 946 cancer survivors and 4,555 controls; data for the five ECs were available for 582 cancer survivors and 2,805 controls. Weighted logistic regression was used to estimate the association between each aging construct and cancer prevalence (odds ratio, OR, 95%CI). Weighted Cox proportional hazards regression was used to estimate the associations between each aging construct and cancer incidence as well as all-cause mortality (hazard ratio, HR, 95%CI). To study all BA metrics (except for POA) independent of CA, we estimated age acceleration as residuals of BA regressed on CA.

Results

Age acceleration for each aging construct and POA were higher in cancer survivors than controls. In a multivariable-adjusted model, five aging constructs (age acceleration for Hannum, Horvath, Levine, GrimAge, and SA) were associated with cancer prevalence. Among all cancer survivors, age acceleration for PhenoAge and four ECs (Hannum, Horvath, Levine, and GrimAge), was associated with higher all-cause mortality over 4 years of follow-up. PhenoAge, Hannum, and GrimAge were also associated with all-cause mortality in controls. The highest HR was observed for GrimAge acceleration in cancer survivors: 2.03 (95% CI, 1.58-2.60). In contrast, acceleration for KDM-BA and POA was significantly associated with mortality in controls but not in cancer survivors. When all eight aging constructs were included in the same model, two of them (Levine and GrimAge) were significantly associated with mortality among cancers survivors. None of the aging constructs were associated with cancer incidence.

Conclusion

Variations in the associations between aging constructs and mortality in cancer survivors and controls suggests that aging constructs may capture different aspects of aging and that cancer survivors may be experiencing age-related physiologic dysfunctions differently than controls. Future work should evaluate how these aging constructs predict mortality for specific cancer types.

Diet, pace of biological aging, and risk of dementia in the Framingham Heart Study

INTRODUCTION

We tested the hypothesis that healthy diet protects against dementia because it slows the pace of biological aging.

METHODS

We analyzed Framingham Offspring Cohort data (≥60y). We measured healthy diet using the Dietary Guideline for Americans (DGA, 3 visits 1991-2008), pace of aging using the DunedinPACE epigenetic clock (2005-2008), and incident dementia and mortality using records (compiled 2005-2018).

RESULTS

Of n=1,525 included participants (mean age 69.7, 54% female), n=129 developed dementia and n=432 died over follow-up. Greater DGA adherence was associated with slower DunedinPACE and reduced risks for dementia and mortality. Slower DunedinPACE was associated with reduced risks for dementia and mortality. Slower DunedinPACE accounted for 15% of the DGA association with dementia and 39% of the DGA association with mortality.

DISCUSSION

Findings suggest that slower pace of aging mediates part of the relationship of healthy diet with reduced dementia risk. Monitoring pace of aging may inform dementia prevention.