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Kolanu ND, Ahmed S, Kerimkulova MK, Stańczak M, Aguirre Vera GDJ, Shaikh N, Addula AR, Cheran M, Chilla SP, Oliveira Souza Lima SR, Shehryar A, Rehman A. Influence of Nutritional Interventions on Functional Outcomes in Stroke Rehabilitation: A Systematic Review. Cureus 2024; 16:e53711. [PMID: 38455777 PMCID: PMC10918289 DOI: 10.7759/cureus.53711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Stroke, a major cause of disability worldwide, necessitates comprehensive rehabilitation, with nutrition playing a pivotal role in recovery. Our systematic review assesses the impact of nutritional interventions on stroke survivors' rehabilitation. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Embase, Web of Science, and Scopus, using keywords related to stroke rehabilitation and nutrition. Studies were selected based on criteria emphasizing dietary interventions and their effect on functional recovery in stroke patients. The review involved detailed data extraction and synthesis, covering study design, participant characteristics, interventions, and outcomes. Five studies met our inclusion criteria, encompassing longitudinal and prospective studies, retrospective cohorts, and randomized controlled trials. These studies highlighted the importance of early nutritional assessment, particularly for sarcopenic patients, and the role of energy and protein intake soon after a stroke. Findings indicated high nutritional risk correlated with poorer functional outcomes and increased inflammation. Tailored dietary support appeared beneficial for muscle mass maintenance and overall functional recovery, especially in older patients. Our review emphasizes the critical role of nutritional interventions in stroke rehabilitation. It suggests that personalized nutritional strategies can positively impact functional recovery, notably in older and nutritionally vulnerable stroke survivors. These insights underscore the necessity of integrating dietary assessments and interventions into standard stroke rehabilitation protocols, advocating a holistic approach to patient care.
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Affiliation(s)
| | - Sheraz Ahmed
- Medicine, Islamic International Medical College, Islamabad, PAK
| | | | - Mikołaj Stańczak
- Medicine, Kharkiv Institute of Medicine and Biomedical Sciences, Kharkiv, UKR
| | | | | | | | - Meher Cheran
- Internal Medicine, American International Medical University, Chicago, USA
| | - Srikar P Chilla
- Medicine, CARE Hospitals, Hyderabad, IND
- School of Health Sciences, University of East London, London, GBR
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Loef B, Herber GCM, Wong A, Janssen NAH, Hoekstra J, Picavet HSJ, Verschuren WMM. Predictors of healthy physiological aging across generations in a 30-year population-based cohort study: the Doetinchem Cohort Study. BMC Geriatr 2023; 23:107. [PMID: 36823523 PMCID: PMC9948415 DOI: 10.1186/s12877-023-03789-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Predicting healthy physiological aging is of major interest within public health research. However, longitudinal studies into predictors of healthy physiological aging that include numerous exposures from different domains (i.e. the exposome) are scarce. Our aim is to identify the most important exposome-related predictors of healthy physiological aging over the life course and across generations. METHODS Data were used from 2815 participants from four generations (generation 1960s/1950s/1940s/1930s aged respectively 20-29/30-39/40-49/50-59 years old at baseline, wave 1) of the Doetinchem Cohort Study who were measured every 5 years for 30 years. The Healthy Aging Index, a physiological aging index consisting of blood pressure, glucose, creatinine, lung function, and cognitive functioning, was measured at age 46-85 years (wave 6). The average exposure and trend of exposure over time of demographic, lifestyle, environmental, and biological exposures were included, resulting in 86 exposures. Random forest was used to identify important predictors. RESULTS The most important predictors of healthy physiological aging were overweight-related (BMI, waist circumference, waist/hip ratio) and cholesterol-related (using cholesterol lowering medication, HDL and total cholesterol) measures. Diet and educational level also ranked in the top of important exposures. No substantial differences were observed in the predictors of healthy physiological aging across generations. The final prediction model's performance was modest with an R2 of 17%. CONCLUSIONS Taken together, our findings suggest that longitudinal cardiometabolic exposures (i.e. overweight- and cholesterol-related measures) are most important in predicting healthy physiological aging. This finding was similar across generations. More work is needed to confirm our findings in other study populations.
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Affiliation(s)
- Bette Loef
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - Gerrie-Cor M. Herber
- grid.31147.300000 0001 2208 0118Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Albert Wong
- grid.31147.300000 0001 2208 0118Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nicole A. H. Janssen
- grid.31147.300000 0001 2208 0118Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jurriaan Hoekstra
- grid.31147.300000 0001 2208 0118Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H. Susan J. Picavet
- grid.31147.300000 0001 2208 0118Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - W. M. Monique Verschuren
- grid.31147.300000 0001 2208 0118Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands ,grid.5477.10000000120346234Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Li X, Li Y, Zhao S, Chen X, Wang L, Zhang X. Early cognitive dysfunction after stroke and related risk factors in the high-altitude and multi-ethnic region of Qinghai, China: A multi-center cross-sectional study. Clin Neurol Neurosurg 2023; 225:107607. [PMID: 36696845 DOI: 10.1016/j.clineuro.2023.107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Cognitive impairment is a common outcome of stroke, but there is limited evidence regarding its prevalence at high altitude, especially within the context of specific ethnic groups or lifestyle habits. This prospective exploratory study investigated early cognitive impairment after stroke in Qinghai Province, 3000 m above sea level. METHODS Patients with acute stroke (n = 1047) were enrolled from 3 hospitals in Qinghai Province. Cognitive performance was measured by Montreal Cognitive Assessment (MoCA) scores within 5 days of stroke symptom onset; MoCA < 26 defined impairment. Patient data included demographics, education, vascular risk factors, diet, and activities of daily living rated by Barthel index. RESULTS Cognitive impairment within 5 days of stroke symptom onset affected 77.65% of these patients. The factors independently associated with early cognitive impairment were: older age (mean difference [MD]: -4.857, 95% confidence interval [CI]: 6.685-3.030, P < 0.001); female gender (odds ratio [OR]: 1.674, 95% CI: 1.212-2.313, P = 0.002); and a diet containing yak butter (OR: 1.587, 95% CI: 1.247-2.021, P < 0.001). Progressively lesser odds were accounted to beef (Yak) and mutton consumption (OR: 0.804, 95% CI: 0.655-0.987, P = 0.037); fruit (OR: 0.792, 95% CI: 0.672-0.933, P = 0.005); status as an immigrant (OR: 0.666, 95% CI: 0.445-0.996, P = 0.048); education (OR: 0.514, 95% CI: 0.400-0.660, P < 0.001); and multiple daily leisure activities (OR: 0.999, 95% CI: 0.999-0.999, P < 0.001). CONCLUSION Persons in Qinghai province who experience stroke are likely to show signs of early cognitive dysfunction. Preventive modifiable features include diet and daily activities.
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Affiliation(s)
- Xiaofang Li
- Qinghai Provincial People's Hospital, Xining 81007, China
| | - Yuemei Li
- Qinghai Provincial People's Hospital, Xining 81007, China
| | - Shengxiu Zhao
- Qinghai Provincial People's Hospital, Xining 81007, China.
| | | | - Limei Wang
- Third People's Hospital of Xining, Xining 81000, China
| | - Xiaoxia Zhang
- Qinghai Provincial People's Hospital, Xining 81007, China
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Townsend RF, Logan D, O’Neill RF, Prinelli F, Woodside JV, McEvoy CT. Whole Dietary Patterns, Cognitive Decline and Cognitive Disorders: A Systematic Review of Prospective and Intervention Studies. Nutrients 2023; 15:nu15020333. [PMID: 36678204 PMCID: PMC9865080 DOI: 10.3390/nu15020333] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
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.
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Affiliation(s)
| | - Danielle Logan
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Roisin F. O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Federica Prinelli
- Epidemiology Unit, Institute of Biomedical Technologies, National Research Council, 93 20054 Milan, Italy
| | - Jayne V. Woodside
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast BT9 5DL, UK
| | - Claire T. McEvoy
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast BT9 5DL, UK
- Correspondence:
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Unión-Caballero A, Meroño T, Andrés-Lacueva C, Hidalgo-Liberona N, Rabassa M, Bandinelli S, Ferrucci L, Fedecostante M, Zamora-Ros R, Cherubini A. Apolipoprotein E gene variants shape the association between dietary fibre intake and cognitive decline risk in community-dwelling older adults. Age Ageing 2023; 52:7008633. [PMID: 36729469 PMCID: PMC10144730 DOI: 10.1093/ageing/afac329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND healthy dietary patterns have been associated with lower risk for age-related cognitive decline. However, little is known about the specific role of dietary fibre on cognitive decline in older adults. OBJECTIVE this study aimed to examine the association between dietary fibre and cognitive decline in older adults and to assess the influence of genetic, lifestyle and clinical characteristics in this association. DESIGN AND PARTICIPANTS the Invecchiare in Chianti, aging in the Chianti area study is a cohort study of community-dwelling older adults from Italy. Cognitive function, dietary and clinical data were collected at baseline and years 3, 6, 9 and 15. Our study comprised 848 participants aged ≥ 65 years (56% female) with 2,038 observations. MAIN OUTCOME AND MEASURES cognitive decline was defined as a decrease ≥3 units in the Mini-Mental State Examination score during consecutive visits. Hazard ratios for cognitive decline were estimated using time-dependent Cox regression models. RESULTS energy-adjusted fibre intake was not associated with cognitive decline during the 15-years follow-up (P > 0.05). However, fibre intake showed a significant interaction with Apolipoprotein E (APOE) haplotype for cognitive decline (P = 0.02). In participants with APOE-ɛ4 haplotype, an increase in 5 g/d of fibre intake was significantly associated with a 30% lower risk for cognitive decline. No association was observed in participants with APOE-ɛ2 and APOE-ɛ3 haplotypes. CONCLUSIONS AND RELEVANCE dietary fibre intake was not associated with cognitive decline amongst older adults for 15 years of follow-up. Nonetheless, older subjects with APOE-ɛ4 haplotype may benefit from higher fibre intakes based on the reduced risk for cognitive decline in this high-risk group.
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Affiliation(s)
- Andrea Unión-Caballero
- Biomarkers and Nutrimetabolomics Laboratory, Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Xarxa d'Innovació Alimentària (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Tomás Meroño
- Biomarkers and Nutrimetabolomics Laboratory, Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Xarxa d'Innovació Alimentària (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Cristina Andrés-Lacueva
- Biomarkers and Nutrimetabolomics Laboratory, Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Xarxa d'Innovació Alimentària (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Nicole Hidalgo-Liberona
- Biomarkers and Nutrimetabolomics Laboratory, Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Xarxa d'Innovació Alimentària (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Montserrat Rabassa
- Biomarkers and Nutrimetabolomics Laboratory, Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Xarxa d'Innovació Alimentària (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain
| | | | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging (NIH), Baltimore, MD, USA
| | - Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Raúl Zamora-Ros
- Biomarkers and Nutrimetabolomics Laboratory, Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Xarxa d'Innovació Alimentària (XIA), Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain.,Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
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Galluzzi S, Zanardini R, Ferrari C, Gipponi S, Passeggia I, Rampini M, Sgrò G, Genovese S, Fiorito S, Palumbo L, Pievani M, Frisoni GB, Epifano F. Cognitive and biological effects of citrus phytochemicals in subjective cognitive decline: a 36-week, randomized, placebo-controlled trial. Nutr J 2022; 21:64. [PMID: 36253765 PMCID: PMC9575277 DOI: 10.1186/s12937-022-00817-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Auraptene (AUR) and naringenin (NAR) are citrus-derived phytochemicals that influence several biological mechanisms associated with cognitive decline, including neuronal damage, oxidative stress and inflammation. Clinical evidence of the efficacy of a nutraceutical with the potential to enhance cognitive function in cohorts at risk of cognitive decline would be of great value from a preventive perspective. The primary aim of this study is to determine the cognitive effects of a 36-week treatment with citrus peel extract standardized in levels of AUR and NAR in older adults experiencing subjective cognitive decline (SCD). The secondary aim is to determine the effects of these phytochemicals on blood-based biomarkers indicative of neuronal damage, oxidative stress, and inflammation. Methods Eighty older persons with SCD will be recruited and randomly assigned to receive the active treatment (400 mg of citrus peel extract containing 0.1 mg of AUR and 3 mg of NAR) or the placebo at a 1:1 ratio for 36 weeks. The primary endpoint is a change in the Repeatable Battery for the Assessment of Neuropsychological Status score from baseline to weeks 18 and 36. Other cognitive outcomes will include changes in verbal and nonverbal memory, attention, executive and visuospatial functions. Blood samples will be collected from a consecutive subsample of 60 participants. The secondary endpoint is a change in interleukin-8 levels over the 36-week period. Other biological outcomes include changes in markers of neuronal damage, oxidative stress, and pro- and anti-inflammatory cytokines. Conclusion This study will evaluate whether an intervention with citrus peel extract standardized in levels of AUR and NAR has cognitive and biological effects in older adults with SCD, facilitating the establishment of nutrition intervention in people at risk of cognitive decline. Trial registration The trial is registered with the United States National Library of Medicine at the National Institutes of Health Registry of Clinical Trials under the code NCT04744922 on February 9th, 2021 (https://www.clinicaltrials.gov/ct2/show/NCT04744922).
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Affiliation(s)
- Samantha Galluzzi
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy.
| | - Roberta Zanardini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Sara Gipponi
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Ilaria Passeggia
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Michela Rampini
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni Sgrò
- Clinical Trial Service, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | - Salvatore Genovese
- Laboratory of Phytochemistry and Chemistry of Natural Products, Department of Pharmacy, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Serena Fiorito
- Laboratory of Phytochemistry and Chemistry of Natural Products, Department of Pharmacy, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Lucia Palumbo
- Laboratory of Phytochemistry and Chemistry of Natural Products, Department of Pharmacy, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Michela Pievani
- Laboratory Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Brescia, Italy
| | | | - Francesco Epifano
- Laboratory of Phytochemistry and Chemistry of Natural Products, Department of Pharmacy, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Liu D, Zhang WT, Wang JH, Shen D, Zhang PD, Li ZH, Chen PL, Zhang XR, Huang QM, Zhong WF, Shi XM, Mao C. Association between Dietary Diversity Changes and Cognitive Impairment among Older People: Findings from a Nationwide Cohort Study. Nutrients 2022; 14:1251. [PMID: 35334911 PMCID: PMC8952508 DOI: 10.3390/nu14061251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about the role of dietary diversity changes in affecting cognitive function among older people. Therefore, we aimed to evaluate the associations between dietary diversity scores (DDS) changes with cognitive impairment among older adults in a large prospective cohort. METHODS Cognitive function was assessed using the Mini-Mental State Examination questionnaire at baseline and follow-up. A total of 9726 participants without Parkinson's disease, dementia, or cognitive impairment were enrolled at baseline. Nine food groups were collected using simplified FFQ at baseline and follow-up surveys. Then nine food groups change patterns and DDS change patterns (overall, plant-based and animal-based) were assessed. The associations of above DDS changes patterns with subsequent cognitive impairment were evaluated. A multivariable-adjusted Cox proportional hazards model was used to estimate HRs and 95%CIs. RESULTS We documented 2805 cognitive impairments during 52,325 person-years of follow-up. Compared to high-to-high overall DDS change patterns, the multivariable adjusted HRs (95%CI) for high-to-medium, medium-to-medium, medium-to-low, low-to-medium and low-to-low DDS change patterns were 1.33 (1.12-1.57), 1.11 (0.94-1.32), 1.61 (1.39-1.86), 2.00 (1.66-2.40), 2.30 (1.90-2.78) and 2.80 (2.23-3.53), respectively. Compared with participants with stable DDS change pattern, those who in large improvement of DDS had a 13% lower risk of cognitive impairment (HRs, 0.87; 95%CI: 0.78-0.98). The associations of plant-based DDS, animal-based DDS, or nine food groups DDS change patterns with cognitive impairment were in a similar direction to the main result. CONCLUSIONS Protective associations between maintaining high DDS and a reduced risk of cognitive impairment were observed. In contrast, lowering or maintaining a lower DDS increases the risk of cognitive impairment.
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Affiliation(s)
- Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Wen-Ting Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Jia-Hui Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Pei-Dong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Qing-Mei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Wen-Fang Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
- Department of Laboratory Medicine, Microbiome Medicine Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
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Dreher ML, Cheng FW, Ford NA. A Comprehensive Review of Hass Avocado Clinical Trials, Observational Studies, and Biological Mechanisms. Nutrients 2021; 13:nu13124376. [PMID: 34959933 PMCID: PMC8705026 DOI: 10.3390/nu13124376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 02/06/2023] Open
Abstract
This first comprehensive review of fresh Hass avocados includes 19 clinical trials, five observational studies, and biological mechanisms. We identified four primary avocado health effects: (1) reducing cardiovascular disease risk in healthy overweight or obese adults with dyslipidemia by lowering non-HDL-C profiles, triglycerides, LDL oxidation, small atherogenic LDL particles and promoting postprandial vascular endothelial health for better peripheral blood flow; (2) lowering the risk of being overweight or obese, supporting weight loss, and reducing visceral fat tissue in overweight or obese women; (3) improving cognitive function in older normal-weight adults and in young to middle age overweight or obese adults especially in frontal cortex executive function; and (4) stimulating improved colonic microbiota health in overweight or obese adults by promoting healthier microflora and fecal metabolites. We also identified a unique combination of four Hass avocado nutritional features that appear to be primarily responsible for these health effects: (1) a 6 to 1 unsaturated (rich in oleic acid) to saturated fat ratio similar to olive oil; (2) a source of multifunctional prebiotic and viscous fiber; (3) a relatively low energy density of 1.6 kcal/g (79% of edible Hass avocado weight consists of water and fiber with a creamy, smooth texture); and (4) its oleic acid and water emulsion increases carotenoid absorption from low-fat fruits and vegetables (e.g., salsa or salad) when consumed with avocados. They are also a good source of micronutrients and polyphenols, and are very low in sodium and available carbohydrates supporting secondary health and wellness benefits. Hass avocado health effects are best demonstrated when consumed in a healthy dietary plan such as the Mediterranean diet. More extensive and longer clinical trials are needed to further enhance our understanding of the Hass avocado’s health effects.
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Affiliation(s)
- Mark L. Dreher
- Nutrition Science Solutions, LLC, 900 S Rainbow Ranch Rd., Wimberley, TX 78676, USA;
| | - Feon W. Cheng
- Avocado Nutrition Center, 25212 Marguerite Pkwy Ste. 250, Mission Viejo, CA 92692, USA;
| | - Nikki A. Ford
- Avocado Nutrition Center, 25212 Marguerite Pkwy Ste. 250, Mission Viejo, CA 92692, USA;
- Correspondence: ; Tel.: +1-949-341-3250
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