Dietary patterns are associated with cognitive function in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort

Western Mediterranean diet predicts 9-year changes in episodic memory in an adult lifespan sample of Americans

BackgroundThe Mediterranean Diet (MD) is well-studied for slowing cognitive declines. Few studies have examined how a Western MD (wMD) may impact cognitive function.ObjectiveThis study examined whether a wMD predicted less cognitive decline over 9 years in a national sample of American adults. The measures were episodic memory (EM) and executive functioning (EF) at baseline and 9 years follow-up.MethodsThis is a secondary analysis of the Midlife in the United States Study (MIDUS), using a longitudinal cohort design with cross-sectional dietary data. Participants in this study had data from Waves 2 and 3 of MIDUS (n = 833, 46 ± 12 years; 45% male). Regression analyses tested whether wMD adherence predicted 9-year changes in EM and EF. Moderator analyses determined whether the relationship between wMD, EM, and EF differed across sociodemographic characteristics.ResultswMD score at Wave 2 predicted attenuated declines in EM 9 years later (β = 0.06, p = 0.04). The association between wMD and EM was not moderated by age, sex, race, education, or income and thus is consistent across sociodemographic subpopulations. wMD did not predict EF (fully adjusted wMD β = 0.00, p = 0.86). Contextualized effect sizes showed that individuals who strongly adhered to the wMD (+1 SD) experienced ∼50-60% less decline in 9-year EM when compared to those with average adherence.ConclusionsA wMD was related to slowed EM declines across sociodemographic populations in a national U.S. sample. Education is needed about healthful dietary habits, including increased fruit and vegetable intake.

Association between dietary patterns and anemia in older adults: the 2015 China adults chronic diseases and nutrition surveillance

BACKGROUND

Anemia is a condition that has been affected 1.92 billion people worldwide in 2021, leading physical decline, functional limitation and cognitive impairment. However, there are currently fewer studies focusing on the relationship between anemia and dietary patterns in older adults. This study aimed to analysis the dietary patterns in older adults aged 60 and above in China and their association with anemia.

METHODS

The data was obtained from the 2015 Chinese Adults Chronic Diseases and Nutrition Surveillance (2015 CACDNS), dietary information was collected using the food frequency method within the past year, exploratory factor analysis was used to extract dietary patterns, and logistic regression was used to analyze the relationship between dietary patterns and anemia.

RESULTS

A total of 48,955 elderly people were included, and the number of anemia patients was 4,417 (9.02%). Four dietary patterns were categorized by the exploratory factor analysis, two dietary patterns have been found to have a statistically significant relationship with the prevalence of anemia. Compared to the first quintile, the fifth quintile of dietary pattern 2 (DP2), characterized by high intake of rice and flour, fresh vegetables, livestock and poultry meat, aquatic products, was associated with higher prevalence of anemia in older adults (OR = 1.412, 95%CI: 1.273-1.567, P < 0.0001), and the trend test results showed that score of this dietary pattern was associated with higher prevalence of anemia (p for trend < 0.0001). Compared to the first quintile, Dietary Pattern 4 (DP4), rich in fungi and algae, fried dough products, other grains, various beans, and rice and flour, was linked to lower prevalence of anemia of the fifth quintile (OR = 0.768, 95% CI: 0.674-0.874, P < 0.0001). And DP4 score was associated with lower prevalence of anemia (P for trend < 0.0001).

CONCLUSIONS

There were differences in dietary patterns among elderly people over 60 in China, and the prevalence of anemia in older adults was related to DP2, and DP4.

Association of Adherence to a MIND-Style Diet With the Risk of Cognitive Impairment and Decline in the REGARDS Cohort

BACKGROUND AND OBJECTIVES

Diet may influence the development of cognitive impairment and affect cognitive decline, but whether this relationship varies between Black American and White American people is unclear. This study examined the association of Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) and incident cognitive impairment and cognitive trajectories in a biracial prospective cohort study.

METHODS

Using data derived from the Food Frequency Questionnaire in the REasons for Geographic and Racial Differences in Stroke study, we compared MIND diet adherence with incident cognitive impairment and cognitive trajectory in Black participants and White participants. Logistic regression was used to model MIND diet score (continuous variable and using tertiles) and incident cognitive impairment after adjusting for age, sex, race, region, education, income, total energy, hypertension history, dyslipidemia, diabetes, estimated glomerular filtration rate, ischemic heart conditions, atrial fibrillation, and lifestyle factors including sedentary, obesity, and smoking. Mixed-effects models were used to examine the association between cognitive trajectory and MIND diet adherence.

RESULTS

Dietary data to calculate the MIND diet score and cognitive data were available on 14,145 participants with a mean age of 64 years (SD 9.0 years) that was 56.7% female. Greater MIND diet adherence was associated with a decreased incidence of cognitive impairment (odds ratio [OR] 0.96, 95% CI 0.93-0.99, p = 0.02) after adjusting for all covariates. In the fully adjusted model, greater MIND diet adherence was associated with decreased risk of cognitive impairment in female participants (OR 0.92, 95% CI 0.89-0.96, p < 0.001) but not in male participants (OR 1.01, 95% CI 0.97-1.06, p = 0.64). In all models, greater MIND diet adherence was associated with decreased risk of cognitive decline. MIND diet adherence was a better predictor of cognitive decline in Black participants (β = 0.04, SE = 0.007, p < 0.001) than in White participants (β = 0.03, SE = 0.004, p < 0.001).

DISCUSSION

Greater MIND diet adherence was associated with decreased risk of cognitive impairment in female participants but not male participants, with no difference between Black participants and White participants. However, MIND diet adherence was a better predictor of cognitive trajectory in Black participants than in White participants.

Associations of empirically derived dietary patterns and cognitive performance in older men: Results of the Osteoporotic Fractures in Men (MrOS) study

OBJECTIVE

The aim of this study was to examine associations between empirically derived dietary pattern scores and cognition, as well as risk of cognitive decline, over an average of 4.6 (± 0.3) years in older men.

MATERIALS AND METHODS

This analysis was conducted as part of the Osteoporotic Fractures in Men (MrOS) prospective cohort study. Diet was assessed at Visit 1 (3/2000-4/2002) by food frequency questionnaire, and dietary patterns (Western and Prudent) were derived by factor analysis. The analytic cohort comprised 4231 community-dwelling American men who were aged 65 years or more. Cognitive function was assessed with the Modified Mini-Mental State exam (3MS) and the Trails B test at Visit 1 and at Visit 2 (3/2005-5/2006). Associations between dietary pattern score and cognition and risk of cognitive decline were estimated using mixed effects regression models. Model 1 was adjusted for age, clinic site and total energy intake (TEI). Model 2 was further adjusted for calcium and vitamin D supplement use, body mass index (BMI), physical activity, smoking, diabetes and hypertension (Western diet group) and education, calcium and vitamin D supplement use, depression, BMI, physical activity, smoking and stroke (Prudent diet group).

RESULTS

Adherence to the Western dietary pattern was associated with higher 3MS scores and shorter Trails B test time at Visit 1 in Model 2. Adherence to the Prudent dietary pattern was associated with higher 3MS scores in Model 1 but not Model 2. There were no independent associations between dietary pattern scores and risk of cognitive decline 4.6 (± 0.3) years later at Visit 2.

CONCLUSION

The results do not support a robust protective effect of the Prudent dietary pattern on cognition in the MrOS cohort. Associations between the Western dietary pattern and better cognitive scores should be interpreted with caution. Further research is needed to understand the complex interactions between dietary patterns and cognition in older men.

High intake of ultra-processed food is associated with dementia in adults: a systematic review and meta-analysis of observational studies

BACKGROUND AND AIMS

Poor cardiometabolic health is associated with dementia. Considering previous meta-analyses have confirmed associations between ultra-processed foods (UPFs) and cardiometabolic disease, we were interested in the contribution of UPF consumption to the risk of developing dementia.

METHODS

We performed a systematic review and meta-analysis of all records registered on Ovid Medline and Web of Science from inception until December 2022 [PROSPERO (CRD42023388363)]. Studies that assessed UPF consumption in adults, determined according to NOVA, and that reported dementia (Alzheimer's disease, vascular dementia and mild cognitive impairment) determined by clearly stated diagnostic criteria (including formal assessment of dementia or use of diagnostic codes) were included. The association between UPF consumption and dementia was assessed using random-effects meta-analysis, controlling for confounding variables. Study quality was assessed using the Newcastle Ottawa Scale and evidence credibility evaluated using the NutriGrade system.

RESULTS

Seven thousand ten records were screened, and 122 records underwent full text review. From these, 10 observational (8 longitudinal) studies, analysing 867,316 individuals, were included. Included studies adjusted for age, socioeconomic status and co-morbidity, alongside other confounders. High (vs. low) intake of UPF was associated with increased risk of dementia (pooled relative risk 1.44 (95% confidence interval 1.09-1.90) (p = 0.02)) (I2 = 97.0%), although moderate (vs. low) intake of UPF was not (1.12 (0.96-1.31) (0.13)) (85.0%). Funnel plots demonstrate low risk of publication bias.

CONCLUSION

High UPF consumption is associated with dementia. Public health measures to reduce overconsumption of UPFs are imperative to reduce the burden of dementia.

The role of caregiving in cognitive function and change: The REGARDS study

Chronic stress is associated with negative health outcomes, including poorer cognition. Some studies found stress from caregiving associated with worse cognitive functioning; however, findings are mixed. The present study examined the relationship between caregiving, caregiving strain, and cognitive functioning. We identified participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were family caregivers at baseline assessment and used propensity matching on 14 sociodemographic and health variables to identify matched noncaregivers for comparison. Data included up to 14 years of repeated assessments of global cognitive functioning, learning and memory, and executive functioning. Our results showed that when compared to noncaregivers, caregivers had better baseline scores on global cognitive functioning and word list learning (WLL). Among caregivers, a lot of strain was associated with better WLL and delayed word recall in the unadjusted model only. Caregivers with a lot of strain had higher depressive symptoms but not significantly higher high-sensitivity c-reactive protein (hsCRP) at baseline compared to caregivers with no or some strain after covariate adjustment. Although caregiving can be highly stressful, we found caregiving status and caregiving strain were not associated with cognitive decline. More methodologically rigorous studies are needed, and conclusions that caregiving has negative effects on cognition should be viewed with caution. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between dietary folate intake and cognitive impairment in older US adults: National Health and Nutrition Examination Survey

OBJECTIVE

To determine the association between dietary folate intake and low cognitive performance in older adults.

METHODS

In this cross-sectional observational study, 2011-2014 data from the 2010 National Health and Nutrition Examination Survey, including 2,524 adults aged 60 years and older, included 24-hour dietary intakes. Total folic acid intake was calculated as the sum of folic acid supplements and dietary folic acid. Cognitive function was assessed using three tests. The association between folate intake and cognitive function was assessed using a multivariate conditional logistic regression model.

RESULTS

2524 participants from two survey cycles (2011-2014) in the NHANES aged 60 years and over. In the multivariate logistic regression, the OR of developing folate was 0.96 (95% CI: 0.94∼0.98) in participants with Z test. Folate intake was negatively associated with cognitive function. Compared with Q1, Q4(≥ 616.3mg/day) in the AFT and DSST tests reduced the risk of cognitive impairment by 31% (OR = 0.69, 95% CI: 0.52-0.93) and 44% (OR = 0.56). 95% confidence interval: 0.44-0.7). In the comprehensive evaluation of IR and AFT scores, the association between dietary folate intake and low cognitive performance in US adults is linear. We also found a significant interaction between gender and cognitive ability (P value for the interaction was 0.021).

CONCLUSIONS

Dietary intake of folic acid may be inversely associated with cognitive impairment. The DSST study found an L-shaped association between dietary folate intake and cognitive decline in US adults, with an inflection point of approximately 510,383 mg/day.

Whole Dietary Patterns, Cognitive Decline and Cognitive Disorders: A Systematic Review of Prospective and Intervention Studies

Dementia prevalence is a global public health concern. Adherence towards a healthy dietary pattern (DP) may reduce the risk of cognitive decline and dementia. This narrative systematic review aimed to synthesise prospective and intervention study data to evaluate the impact of a-posteriori and a-priori derived DPs on cognitive ageing, from cognitive decline to incident dementia. Ninety-three studies were included: 83 prospective studies and 10 randomised controlled trials (RCT). Most prospective studies (77%) examined a-priori DPs, with the Mediterranean diet examined most frequently. A total of 52% of prospective and 50% of RCTs reported a protective relationship between 'healthy' DPs and global cognitive decline. Overall, 59% of prospective studies reported positive associations between healthy DPs and risk of cognitive disorder. Incident cognitive disorder was examined by only one intervention study (subgroup analysis) which reported a beneficial effect of a low-fat diet on risk of probable dementia in women. Unhealthy DPs were examined less frequently (n = 17; 21%), with 41% of these studies reporting associations between adherence and poorer cognitive outcomes. Overall, there were mixed results for healthy and unhealthy DPs on cognition, likely due to between-study heterogeneity. Standardisation of diet exposure and cognitive outcome measurement would help to reduce this. Future research would benefit from investigating effects of culturally appropriate DPs on individual cognitive domains and incident cognitive disorders in diverse and high-risk populations.

Associations of Telomere Length and Change With Cognitive Decline Were Modified by Sex and Race: The REGARDS Study

INTRODUCTION

We examined the associations of baseline telomere length (TL) and TL change with cognitive function over time in older US adults, as well as differences by sex and race.

METHODS

A total of 1820 cognitively healthy individuals (median baseline age: 63 years) were included. Telomere length was measured using qPCR-based method at baseline and among 614 participants in the follow-up examination 10 years later. Cognitive function was assessed by a four-test battery every 2 years.

RESULTS

In multivariable-adjusted linear mixed models, longer baseline TL and smaller attrition/lengthening of TL over time were associated with better Animal Fluency Test score. Longer baseline TL was also linearly associated with better Letter Fluency Test score. The observed associations were consistently more pronounced in women than men and in Black compared to White participants.

DISCUSSION

Telomere length may be a biomarker that predicts long-term verbal fluency and executive function, particularly in women and Black Americans.

Association of Dietary Patterns with Metabolic Syndrome in Chinese Children and Adolescents Aged 7–17: The China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017

This study aims to determine the associations of dietary patterns with metabolic syndrome (MetS) and its components in Chinese children and adolescents aged 7–17 in 2016–2017. Using the data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, the sociodemographic information, diet, anthropometric measurements and clinical examinations of subjects were obtained, and a total of 13,071 school-aged children and adolescents were included in this study. The Cook criteria were used to define MetS and its components. Dietary intake was derived from 24-h dietary records for three consecutive days, combined with the weighing method. Factor analysis was used to identify major dietary patterns. The associations of dietary patterns with MetS and its components were examined by logistic regression analysis. Consequently, five distinct dietary patterns were identified by factor analysis, and the relationships between dietary patterns with MetS and its components were observed. After adjusting for covariates, the animal product and vegetable patterns may have a positive association with MetS; the condiment pattern was positively associated with low HDL-C; the fruit and junk food patterns had positive relationships with MetS, abdominal obesity and high TG; the cereals and tubers pattern was positively associated with MetS, abdominal obesity, high TG and low HDL-C; the beans pattern was positively associated with high TG.

A healthy plant-based diet was associated with slower cognitive decline in African American older adults: a biracial community-based cohort

BACKGROUND

African American (AA) adults have about twice the risk of developing dementia compared with white adults. However, evidence on dietary modification in preventing cognitive decline from diverse populations focusing on AA adults is minimal.

OBJECTIVES

We aimed to evaluate the association between a plant-based diet and the rate of cognitive decline in a population-based sample of AA and white adults.

METHODS

This study consisted of 3337 participants from the Chicago Health and Aging Project (60% AA participants, 64% female). Plant-based diet quality was evaluated by the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Global cognition was assessed using a composite score of 4 individual tests of cognition. We used mixed models to examine the associations of PDI, hPDI, and uPDI with the rates of decline in global cognition, perceptual speed, and episodic memory. Models were adjusted for age, sex, presence of apoE e4 allele, lifestyle factors including education, cognitive activities, smoking status, calorie intake, risk factors for cardiovascular disease, time, and the interaction terms of time × each covariate.

RESULTS

AA and white participants had various dietary patterns. Higher hPDI was associated with a slower rate of decline in global cognition, perceptual speed, and episodic memory in AA participants but not white participants. AA study participants in the highest quintile of hPDI had significantly slower rates of global cognitive decline (β: 0.0183 ± 0.0086; P = 0.032), perceptual speed (β: 0.0179 ± 0.0088; P = 0.04), and episodic memory (β: 0.0163 ± 0.0118; P = 0.04) than individuals in the lowest quintile of hPDI. There were no associations of either PDI or uPDI with the rate of cognitive decline in either racial group.

CONCLUSIONS

A healthy plant-based diet was associated with a slower rate of decline in global cognition, perceptual speed, and episodic memory in AA adults.

Relationship between diet and relative risk of pain in a cross-sectional analysis of the REGARDS longitudinal study

Aim: Determine if dietary patterns affect risk of pain. Methods: Data from 16,061 participants (55.4% females, 32.3% Black, age 65 ± 9 years) in the REGARDS study were categorized based on the adherence to previous dietary patterns reflecting the prevalent foods within each (convenience, alcohol/salads, plant-based, sweets/fats and 'Southern'). A modified Poisson regression model was used to determine whether dietary patterns were associated with relative risk (RR) of pain. Results: High adherence to 'Southern' dietary pattern was associated with a 41% (95% CI: 23, 61%) increase in RR of pain. High adherence to a plant-based dietary pattern showed a 22% (95% CI: 11, 31%) decrease in the RR of pain. Conclusion: Poor quality dietary patterns increase the RR of pain, while plant-based patterns lowered the RR. Diet patterns should be incorporated into medical history.

Dietary Pattern Associated with the Risk of Hyperuricemia in Chinese Elderly: Result from China Nutrition and Health Surveillance 2015–2017

Our current study aimed to estimate the relationship between dietary patterns and hyperuricemia among the Chinese elderly over 60 years old. All the data were obtained from China Nutrition and Health Surveillance during 2015–2017. A total of 18,691 participants who completed the whole survey were included in our statistical analysis. The definition of hyperuricemia was 420 μmmol/L (7 mg/dL) for male and 360 μmmol/L (6 mg/dL) for female. Exploratory factor analysis was applied to explore posterior dietary patterns in our samples, and five dietary patterns were recognized, namely “Typical Chinese”, “Modern Chinese”, “Western”, “Animal products and alcohol”, and “Tuber and fermented vegetables”. After multiple adjusted logistic regression, participants in the highest quartile of “typical Chinese” (Q4 vs. Q1, OR = 0.32, 95% CI: 0.28–0.37, p-trend < 0.0001), “modern Chinese” (Q4 vs. Q1, OR = 0.81, 95% CI: 0.71–0.93, p-trend = 0.0021) and “tuber and fermented vegetables” (Q4 vs. Q1, OR = 0.78, 95% CI: 0.69–0.88, p-trend < 0.0001) showed a lower risk of hyperuricemia, while animal products and alcohol was positively associated with hyperuricemia (Q4 vs. Q1, OR = 1.49, 95% CI: 1.31–1.7, p-trend < 0.0001). We also found that participants who mainly ate a modern Chinese diet tended to meet the RNI/AI of nutrients we discuss in this paper, which may supply some information for hyperuricemia prevention and management by dietary methods.

Adherence to a MIND-Like Dietary Pattern, Long-Term Exposure to Fine Particulate Matter Air Pollution, and MRI-Based Measures of Brain Volume: The Women's Health Initiative Memory Study-MRI

BACKGROUND

Previous studies suggest that certain dietary patterns and constituents may be beneficial to brain health. Airborne exposures to fine particulate matter [particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 )] are neurotoxic, but the combined effects of dietary patterns and PM 2.5 have not been investigated.

OBJECTIVES

We examined whether previously reported association between PM 2.5 exposure and lower white matter volume (WMV) differed between women whose usual diet during the last 3 months before baseline was more or less consistent with a Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)-like diet, a dietary pattern that may slow neurodegenerative changes.

METHODS

This study included 1,302 U.S. women who were 65-79 y old and free of dementia in the period 1996-1998 (baseline). In the period 2005-2006, structural brain magnetic resonance imaging (MRI) scans were performed to estimate normal-appearing brain volumes (excluding areas with evidence of small vessel ischemic disease). Baseline MIND diet scores were derived from a food frequency questionnaire. Three-year average PM 2.5 exposure prior to MRI was estimated using geocoded participant addresses and a spatiotemporal model.

RESULTS

Average total and temporal lobe WMVs were 0.74   cm 3 [95% confidence interval (CI): 0.001, 1.48) and 0.19   cm 3 (95% CI: 0.002, 0.37) higher, respectively, with each 0.5-point increase in the MIND score and were 4.16   cm 3 (95% CI: - 6.99 , - 1.33 ) and 1.46   cm 3 (95% CI: - 2.16 , - 0.76 ) lower, respectively, with each interquartile range (IQR) (IQR = 3.22   μ g / m 3 ) increase in PM 2.5 . The inverse association between PM 2.5 per IQR and WMV was stronger (p -interaction < 0.001 ) among women with MIND scores below the median (for total WMV, - 12.47   cm 3 ; 95% CI: - 17.17 , - 7.78 ), but absent in women with scores above the median (0.16   cm 3 ; 95% CI: - 3.41 , 3.72), with similar patterns for WMV in the frontal, parietal, and temporal lobes. For total cerebral and hippocampus brain volumes or WMV in the corpus callosum, the associations with PM 2.5 were not significantly different for women with high MIND scores and women with low MIND scores.

DISCUSSION

In this cohort of U.S. women, PM 2.5 exposure was associated with lower MRI-based WMV, an indication of brain aging, only among women whose usual diet was less consistent with the MIND-like dietary pattern at baseline. https://doi.org/10.1289/EHP8036.

Dietary patterns in middle age: effects on concurrent neurocognition and risk of age-related cognitive decline

Context

Diet plays a critical role in cognitive integrity and decline in older adults. However, little is known about the relationship between diet and cognitive integrity in middle age.

Objective

To investigate the relationship between dietary patterns in healthy middle-aged adults and neurocognition both in middle age and later in life.

Data Sources

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the following electronic databases were searched: Web of Science, Scopus, PubMed, and PsychInfo.

Data Extraction

Data from eligible articles was extracted by 2 reviewers.

Data Analysis

Articles included in the systematic review were synthesized (based on the synthesis without meta-analysis reporting guidelines) and assessed for quality (using the Joanna Briggs Institute checklist for randomized controlled trials, cohort studies, and cross-sectional studies) by 2 reviewers.

Results

Of 1558 studies identified, 34 met the eligibility criteria for inclusion. These comprised 9 cross-sectional studies, 23 longitudinal or prospective cohort studies, and 2 randomized controlled trials. Findings were mixed, with some studies reporting a significant positive relationship between adherence to various “healthy” dietary patterns and neurocognition, but others reporting no such relationship.

Conclusion

This systematic review demonstrated that adherence to the Mediterranean diet and other healthy dietary patterns in middle age can protect neurocognition later in life.

Systematic Review Registration

PROSPERO registration no. CRD42020153179.

Serum magnesium concentration and incident cognitive impairment: the reasons for geographic and racial differences in stroke study

PURPOSE

To examine the prospective association between serum Mg level and the incidence of cognitive impairment.

METHODS

A random sub-cohort (n = 2063) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort was included in this study. Baseline serum Mg concentration was measured using inductively coupled plasma mass spectrometry. According to the current reference interval of serum magnesium (0.75-0.95 mmol/L), we classified participants below the interval as Level 1 and used it as the referent. The rest of the study population were equally divided into three groups, named Level 2 to 4. Incident cognitive impairment was identified using the Six-Item Screener. Multivariable-adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using logistic regression models.

RESULTS

After adjustment for potential confounders, an inverse threshold association between serum Mg level and incident cognitive impairment was observed. Compared to those with hypomagnesemia (Level 1: < 0.75 mmol/L), the relative odds of incident cognitive impairment was reduced by 41% in the second level [OR (95% CI) = 0.59 (0.37, 0.94)]; higher serum Mg level did not provide further benefits [Level 3 and 4 versus Level 1: OR (95% CI) = 0.54 (0.34, 0.88) and 0.59 (0.36, 0.96), P for linear trend = 0.08].

CONCLUSIONS

Findings from this prospective study suggest that sufficient Mg status within the normal range may be beneficial to cognitive health in the US general population.

Correlates of a southern diet pattern in a national cohort study of blacks and whites: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterised by high consumption of added fats, fried food, organ meats, processed meats and sugar-sweetened beverages and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. We analysed data from REGARDS, a national cohort of 30 239 black and white adults ≥45 years of age living in the USA. Dietary data were collected using the Block 98 FFQ. Multivariable linear regression was used to calculate standardised beta coefficients across all covariates for the entire sample and stratified by race and region. We included 16 781 participants with complete dietary data. Among these, 34·6 % were black, 45·6 % male, 55·2 % resided in stroke belt region and the average age was 65 years. Black race was the factor with the largest magnitude of association with the Southern dietary pattern (Δ = 0·76 sd, P < 0·0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0·75 sd, non-belt Δ = 0·77 sd). There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.

Age- and Sex-Specific Prevalence and Modifiable Risk Factors of Mild Cognitive Impairment Among Older Adults in China: A Population-Based Observational Study

Background

Minimal data are available on the prevalence of mild cognitive impairment (MCI) in older Chinese adults. Moreover, the current information on MCI shows important geographical variations.

Objective

We aimed to assess the prevalence and risk factors for MCI by age and sex among older adults in a North Chinese population.

Methods

In this population-based cross-sectional study, we enrolled a random sample of 4,943 adults aged ≥ 60 years between March 2018 and June 2019 in Tianjin, China. Of these, 312 individuals were excluded due to a lack of data (e.g., fasting blood test). As a result, 4,631 subjects were assessed. Individuals with MCI were identified using neuropsychological assessments, including the Mini-Mental State Examination and Activities of Daily Living scale, based on a modified version of the Petersen’s criteria.

Results

The mean (SD) age of the 4,631 participants was 67.6 (4.89) years, and 2,579 (55.7%) were female. The overall age- and sex-standardized prevalence of MCI in our study population was 10.7%. There were significant associations of MCI with age [65–69 vs. 60–64 years, OR = 0.74; 95% confidence interval (CI): 0.58, 0.96], physical activity (≥23.0 vs. <23.0 MET-hours/week, OR = 0.79; 95% CI: 0.64, 0.96), body mass index (BMI) (OR = 0.92; 95% CI: 0.89, 0.95), grip strength (OR = 0.50; 95% CI: 0.38, 0.67), hypertension (yes vs. no, OR = 1.44; 95% CI: 1.18, 1.77), higher levels of sleepiness (OR = 1.80; 95% CI: 1.36, 2.37), and longer sleep duration (OR = 1.40; 95% CI: 1.14, 1.72). The inverse association between BMI and MCI was stronger in older age groups (P for heterogeneity = 0.003). Moreover, the magnitude of association between triglycerides and MCI was different between the sexes (P for heterogeneity = 0.029).

Conclusion

The age- and sex-standardized prevalence of MCI was 10.7% in the study sample. Physical activity, BMI, grip strength, sleepiness, sleep duration, and hypertension were associated with the prevalence of MCI. Additionally, triglycerides and BMI might be differently associated with the presence of MCI for different sexes and age stages, respectively.

Racial Differences in Dietary Relations to Cognitive Decline and Alzheimer's Disease Risk: Do We Know Enough?

The elderly population in the US is increasing and projected to be 44% minority by 2060. African Americans and Hispanics are at increased risk of cognitive impairment and Alzheimer’s disease compared to non-Hispanic whites. These conditions are associated with many other adverse health outcomes, lower quality of life, and substantial economic burden. In the past few decades, diet has been identified as an important modifiable risk factor for cognitive decline and Alzheimer’s disease. Some studies report poor diet quality among African American and Hispanic older adult populations compared to their white counterparts. We have a limited understanding of how diet affects brain health in different racial-ethnic groups. One primary reason for our lack of knowledge is that most cohort studies are of majority non-Hispanic white participants. Moreover, those that do include minority participants do not publish their findings stratified by racial-ethnic groups, and likely have a less accurate measurement of dietary intake among minority groups. In this review, we summarize the current, albeit limited, literature on racial/ethnic differences in dietary relations to dementia outcomes. We will also discuss methodological issues in conducting nutrition studies in diverse cultures, and suggestions for future research directions. Overcoming the gaps will make it possible to make dietary recommendations for Alzheimer’s prevention that are more relevant for different racial/ethnic groups and set us on a faster track to reduce health disparities.

Vascular-brain Injury Progression after Stroke (VIPS) study: concept for understanding racial and geographic determinants of cognitive decline after stroke

Cognitive impairment and dementia (CID) are major public health problems with substantial personal, social, and financial burdens. African Americans are at a heightened risk for Vascular Cognitive Impairment (VCI) compared to European Americans. Recent lines of evidence also suggest a high burden of Post-stroke VCI among indigenous Africans. A better understanding of the cause(s) of the racial disparity in CID, specifically VCI, is needed in order to develop strategies to reduce it. We propose and discuss the conceptual framework for a unique tri-population, trans-continental study titled The Vascular brain Injury Progression after Stroke (VIPS) study. The overarching objective of the VIPS Study will be to explore the interplay of multiple factors (racial, geographical, vascular, lifestyle, nutritional, psychosocial and inflammatory) influencing the level and trajectory of post-stroke cognitive outcomes and examine whether differences between indigenous Africans, African Americans and European Americans exist. We hypothesize that differences which might be due to racial factors will be observed in African Americans versus European Americans as well as Indigenous Africans versus European Americans but not in African Americans versus Indigenous Americans; differences due to geographical factors will be observed in Indigenous Americans versus African Americans and Indigenous Africans versus European Americans but not in African Americans versus European Americans. This overarching objective could be accomplished by building upon existing National Institutes of Health investments in the REasons for Geographical And Racial Differences in Stroke (REGARDS) study (based in the United States of America) and the Stroke Investigative Research and educational Network (SIREN) study (based in Sub-Saharan Africa).

The Potential for Plant-Based Diets to Promote Health Among Blacks Living in the United States

Plant-based diets are associated with reduced risks of various chronic diseases in the general population. However, it is unclear how these benefits translate to Blacks living in the United States, who are disproportionately burdened with heart disease, cancer, diabetes, obesity, and chronic kidney disease. The objectives of this study were to: (1) review the general evidence of plant-based diets and health outcomes; (2) discuss how this evidence translates to Blacks following a plant-based diet; and (3) provide recommendations and considerations for future studies in this area. Interestingly, although the evidence supporting plant-based diets in the general population is robust, little research has been done on Blacks specifically. However, the available data suggests that following a plant-based diet may reduce the risk of heart disease and possibly cancer in this population. More research is needed on cardiovascular disease risk factors, cancer subtypes, and other chronic diseases. Further, attention must be given to the unique individual, familial, communal, and environmental needs that Blacks who follow plant-based diets may have. Interventions must be culturally appropriate in order to achieve long-term success, and providing low-cost, flavorful, and nutritious options will be important.

Dietary total antioxidant capacity in relation to stroke among Iranian adults

Objective: This study was conducted to investigate the association between dietary TAC and odds of stroke among Iranian adults.Methods: This case-control study was done on 195 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Stroke was confirmed by a trained neurologist using standard imaging methods.Results: Mean dietary TAC was not significantly different comparing cases and controls (10.2 ± 6.0 vs. 10.4 ± 4.8, P = 0.61). However, after adjustment for potential confounders including dietary intakes of fiber and omega-3 fatty acids, we found an almost significant inverse association between dietary TAC and odds of stroke; such that each unit increase in dietary TAC was associated with 29% reduced odds of stroke (OR: 0.71; 95% CI: 0.50-1.01, P = 0.06). When we examined the association across tertiles of dietary TAC, we found that after controlling for potential confounders, those in the top tertile of dietary TAC were 51% less likely to have a stroke than those in the bottom tertile (0.49; 0.23-1.00).Discussion: We found an almost significant inverse association between dietary TAC and odds of stroke.

Health Biomarkers in Adults Are More Closely Linked to Diet Quality Attributes Than to Plant-Based Diet Categorization

Although plant-based diets are promoted for healthy outcomes, these diets are not synonymous with high-quality diets. Plant-based diets can include highly processed, less healthful foods, including savory snacks, pastries, and sugary fruit drinks. This cross-sectional study examined the diet quality of vegetarian and omnivorous adults, matched for gender, age, and adiposity, and related diet quality to standard health biomarkers. Diet quality was assessed using the Rapid Eating and Activity Assessment for Participants Short Version questionnaire. Participants (17 vegetarians and 16 omnivores; 28.2 ± 8.9 years; 22.5 ± 2.7 kg/m²) were non-smokers and healthy by self-report. The median duration of adherence to the vegetarian diet was 27 months. Physical activity level and diet quality did not differ significantly between diet groups. Moreover, health biomarkers did not differ by diet groups. When participants were regrouped by low versus high diet quality, health biomarkers differed significantly between groups for fasting insulin, HOMA-IR, triglyceride (TG)/HDL ratio, and blood folate, with more favorable levels in the group with high diet quality. These data suggest that health biomarkers more closely align with diet quality attributes than with plant-based diet categorization. Thus, messaging focused on healthy diet attributes may lead to better health outcomes than the simple promotion of plant-based diets.

Dietary intake and cognitive function: evidence from the Bogalusa Heart Study

BACKGROUND

Dementia and late-life cognitive decline are leading causes of death and disability in the United States. Prevention of these diseases, by maintaining brain health throughout the life course, is essential. Diet and lifestyle changes are the chief strategies aimed at primary prevention for many of the risk factors of cognitive decline.

OBJECTIVE

The aim of this study was to examine the potential impact of dietary factors on cognitive function.

METHODS

This prospective cohort study followed 516 young adults through midlife. The Youth/Adolescent Questionnaire was used to collect habitual nutrition data (mean age: 32.03 ± 5.96 y) at baseline. Scores from a neurocognitive battery were used to assess cognitive function (mean age: 49.03 ± 4.86 y) at follow-up and were transformed to z scores. Separate multivariable-adjusted linear regression models were fitted. The trend across quintiles for each dietary variable was assessed.

RESULTS

Vitamin B-6, whole grains, processed meats, and foods fried at home all displayed significant linear trends in their relation with cognitive function. Dietary intake of vitamin B-6 and whole grains was directly associated with better cognitive function after adjustment for age, race, sex, and total calorie intake (β coefficient from linear regression and SE: 1.755 ± 0.621, P = 0.005, and 0.001 ± 0.000, P = 0.018, respectively). Processed meat and foods fried at home consistently displayed inverse associations with cognitive function across crude and adjusted models (linear trend P values were 0.05 and <0.0001, respectively).

CONCLUSIONS

Our findings suggest that dietary consumption in young adulthood may affect cognitive function in midlife. Strong associations between dietary intake and cognition were observed in our analysis, but as with all observational studies, the possibility of residual confounding cannot be excluded.

The impact of nutrient-based dietary patterns on cognitive decline in older adults

BACKGROUND & AIMS

The impact of nutrient patterns on cognitive decline is complex and findings are still inconclusive. We aimed to identify major nutrient patterns and to explore their association with cognitive decline over time among older adults.

METHODS

In a population-based cohort, 2250 cognitively healthy people aged ≥60 years were identified at baseline (2001-2004), and followed-up to 9 years. Global cognitive function was tested with the Mini-Mental State Examination (MMSE) at baseline and follow-ups. Nutrients intake was assessed on the basis of food intake using a 98-semi-quantitative food frequency questionnaire at baseline, and nutrient-based patterns were identified by principal components analysis based on 30 nutrients. Mixed-effects linear regression models were used to determine their association with change in cognitive function taking into account potential confounders.

RESULTS

Four major patterns (the plant-, animal-, dairy-derived nutrients and animal/plants-derived fats) were identified. Over the follow-up time, each one unit increment in plant- (β = 0.081, P = 0.002) and animal-derived nutrients pattern scores (β = 0.098, P < 0.001) was associated with slower decline in MMSE score. On the other hand, one-unit higher in dairy-derived nutrients pattern was related to a faster decline in global cognitive function (β = -0.064, P = 0.014). No significant association between animal/plants fats pattern and cognitive decline was observed. In stratified analyses, the association of high scores of plants- and animal-derived nutrient pattern with slower cognitive decline was stronger in APOE ε4 carriers than in ε4 non-carriers.

CONCLUSIONS

Plant- and animal -derived nutrients are associated with preserved cognitive function, especially among the APOE ε4 carriers, whereas nutrients derived from dairy products may accelerate cognitive decline in older adults.

Association of Clinical and Social Factors With Excess Hypertension Risk in Black Compared With White US Adults

IMPORTANCE

The high prevalence of hypertension among the US black population is a major contributor to disparities in life expectancy; however, the causes for higher incidence of hypertension among black adults are unknown.

OBJECTIVE

To evaluate potential factors associated with higher risk of incident hypertension among black adults.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of black and white adults selected from a longitudinal cohort study of 30 239 participants as not having hypertension at baseline (2003-2007) and participating in a follow-up visit 9.4 years (median) later.

EXPOSURES

There were 12 clinical and social factors, including score for the Southern diet (range, -4.5 to 8.2; higher values reflect higher level of adherence to the dietary pattern), including higher fried and related food intake.

MAIN OUTCOMES AND MEASURES

Incident hypertension (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medications) at the follow-up visit.

RESULTS

Of 6897 participants (mean [SD] age, 62 [8] years; 26% were black adults; and 55% were women), 46% of black participants and 33% of white participants developed hypertension. Black men had an adjusted mean Southern diet score of 0.81 (95% CI, 0.72 to 0.90); white men, -0.26 (95% CI, -0.31 to -0.21); black women, 0.27 (95% CI, 0.20 to 0.33); and white women, -0.57 (95% CI, -0.61 to -0.54). The Southern diet score was significantly associated with incident hypertension for men (odds ratio [OR], 1.16 per 1 SD [95% CI, 1.06 to 1.27]; incidence of 32.4% at the 25th percentile and 36.1% at the 75th percentile; difference, 3.7% [95% CI, 1.4% to 6.2%]) and women (OR, 1.17 per 1 SD [95% CI, 1.08 to 1.28]; incidence of 31.0% at the 25th percentile and 34.8% at the 75th percentile; difference, 3.8% [95% CI, 1.5% to 5.8%]). The Southern dietary pattern was the largest mediating factor for differences in the incidence of hypertension, accounting for 51.6% (95% CI, 18.8% to 84.4%) of the excess risk among black men and 29.2% (95% CI, 13.4% to 44.9%) of the excess risk among black women. Among black men, a higher dietary ratio of sodium to potassium and an education level of high school graduate or less each mediated 12.3% of the excess risk of incident hypertension. Among black women, higher body mass index mediated 18.3% of the excess risk; a larger waist, 15.2%; less adherence to the Dietary Approaches to Stop Hypertension diet, 11.2%; income level of $35 000 or less, 9.3%; higher dietary ratio of sodium to potassium, 6.8%; and an education level of high school graduate or less, 4.1%.

CONCLUSIONS AND RELEVANCE

In a mediation analysis comparing incident hypertension among black adults vs white adults in the United States, key factors statistically mediating the racial difference for both men and women included Southern diet score, dietary ratio of sodium to potassium, and education level. Among women, waist circumference and body mass index also were key factors.

The Association between Residence in a Food Desert Census Tract and Adherence to Dietary Patterns in the REGARDS Cohort

Increased interest in determining areas in need of improved food access led the U.S Department of Agriculture (USDA) to define food desert census tracts; however, no nationwide studies have compared dietary patterns in food desert tracts to other tracts. Our objective was to examine dietary patterns in residents of food desert and non-food desert census tracts. We performed a cross-sectional analysis of 19,179 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled January 2003-October 2007. We used participants' geocoded address with USDA Food Desert Locator to identify food deserts and multivariable-adjusted odds ratios (ORs) to calculate adherence to Southern, Plant-based, and Mediterranean dietary patterns. Odds of adherence to the Southern dietary pattern were higher among white high school graduates (OR=1.41; 95% CI: 1.20-1.67), white college graduates (OR=1.91; 95% CI: 1.55-2.35) and black college graduates (OR=1.38; 95% CI: 1.14-1.68) who reside in a food desert versus non-food desert. Odds of adherence to the Plant-based dietary pattern were 15% lower among non-southeastern residents (OR=0.85; 95% CI: 0.72-0.99), who reside in food desert versus non-food desert. No statistically significant differences were observed for the Mediterranean dietary pattern. Residents living in food deserts had lower adherence to healthy dietary pattern than residents not living in food deserts; the association may vary by race, education, and region.

The Role of Dietary and Lifestyle Factors in Maintaining Cognitive Health

Concern over loss of cognitive function, including descent into Alzheimer's disease or dementia, grips a growing percentage of men and women worldwide as the global population ages. Many studies, though not all, suggest that maintaining cognitive health, as well as slowing and even preventing cognitive decline, dementia, and Alzheimer's disease, can be achieved by consuming healthy diets over a long enough period of time. This appears to be the case even for those who initiated dietary changes later in life, as evidenced by an intervention study assessing consumption of a healthy diet among those who were >50 years of age. All such diets share the common traits of being rich in fruits, vegetables, whole grains, and fish or seafood, while also being low in red meat and sweets. A Mediterranean-style diet shares these characteristics and has been associated with an estimated 40% lower risk of cognitive impairment, including mild cognitive impairment, dementia, and Alzheimer's disease in prospective studies, in addition to being associated with both a 65% lower risk of mild cognitive impairment and improved cognitive performance in a notable randomized controlled trial.