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McEvoy CT, McClure CD. Nutrition resilience for healthy ageing. Age Ageing 2024; 53:ii1-ii3. [PMID: 38745487 DOI: 10.1093/ageing/afae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Claire T McEvoy
- Queen's University Belfast, School of Medicine Dentistry and Biomedical Sciences, Institute for Global Food Security, Centre for Public Health, Belfast BT12 6BJ, UK
| | - Colin D McClure
- Queen's University Belfast, School of Biological Sciences, Institute for Global Food Security, Belfast BT9 5DL, UK
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Shannon OM, Townsend R, Malcomson FC, Matu J, Griffiths A, Jennings A, Ward N, Papier K, Best N, French C, Scheelbeek P, Kim C, Ochieng B, Jay F, Shepherd K, Corfe B, Fairley A, McEvoy CT, Minihane AM, Sim YJ, Stevenson E, Gregory S. Adherence to the Eatwell Guide and population and planetary health: A Rank Prize Forum report. NUTR BULL 2024; 49:108-119. [PMID: 38294140 DOI: 10.1111/nbu.12661] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
This report summarises a Forum conducted in June 2023 to explore the current state of the knowledge around the Eatwell Guide, which is the UK government's healthy eating tool, in relation to population and planetary health. The 1.5-day Forum highlighted the limited, albeit promising evidence linking higher adherence to the Eatwell Guide with favourable health outcomes, including reduced overall mortality risk, lower abdominal obesity in post-menopausal women and improved cardiometabolic health markers. Similarly, evidence was presented to suggest that higher adherence to the Eatwell Guide is associated with reduced greenhouse gas emissions. Presentations were given around cultural adaptations of the Eatwell Guide, including African Heritage and South Asian versions, which are designed to increase the acceptability and uptake of the Eatwell Guide in these communities in the United Kingdom. Presentations highlighted ongoing work relevant to the applications of the Eatwell Guide in randomised controlled trials and public health settings, including the development of a screening tool to quantify Eatwell Guide adherence. The Forum ended with a World Café-style event, in which the strengths and limitations of the Eatwell Guide were discussed, and directions for future research were identified. This Forum report serves as a primer on the current state of the knowledge on the Eatwell Guide and population and planetary health and will be of interest to researchers, healthcare professionals and public health officials.
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Affiliation(s)
- Oliver M Shannon
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Rebecca Townsend
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Fiona C Malcomson
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Jamie Matu
- School of Health, Leeds Beckett University, Leeds, UK
| | | | - Amy Jennings
- School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicola Ward
- School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Best
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Chloe French
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Scheelbeek
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Curie Kim
- Basic and Clinical Neuroscience, School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bertha Ochieng
- Centre for Primary Care Research, De Montfort University, Leicester, UK
| | | | | | - Bernard Corfe
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Andrea Fairley
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Claire T McEvoy
- School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Anne-Marie Minihane
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Yi Jia Sim
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma Stevenson
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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McEvoy CT, Jennings A, Steves CJ, Macgregor A, Spector T, Cassidy A. Diet patterns and cognitive performance in a UK Female Twin Registry (TwinsUK). Alzheimers Res Ther 2024; 16:17. [PMID: 38263271 PMCID: PMC10804649 DOI: 10.1186/s13195-024-01387-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Plant-based diets may provide protection against cognitive decline and Alzheimer's disease, but observational data have not been consistent. Previous studies include early life confounding from socioeconomic conditions and genetics that are known to influence both cognitive performance and diet behaviour. This study investigated associations between Mediterranean (MED) diet and MIND diets and cognitive performance accounting for shared genotype and early-life environmental exposures in female twins. METHODS Diet scores were examined in 509 female twins enrolled in TwinsUK study. The Cambridge Neuropsychological Test Automated Battery was used to assess cognition at baseline and 10 years later (in n = 275). A co-twin case-control study for discordant monozygotic (MZ) twins examined effects of diet on cognitive performance independent of genetic factors. Differences in relative abundance of taxa at 10-year follow-up were explored in subsamples. RESULTS Each 1-point increase in MIND or MED diet score was associated with 1.75 (95% CI: - 2.96, - 0.54, p = 0.005 and q = 0.11) and 1.67 (95% CI: - 2.71, - 0.65, p = 0.002 and q = 0.02) fewer respective errors in paired-associates learning. Within each MZ pair, the twin with the high diet score had better preservation in spatial span especially for MED diet (p = 0.02). There were no differences between diet scores and 10-year change in the other cognitive tests. MIND diet adherence was associated with higher relative abundance of Ruminococcaceae UCG-010 (0.30% (95% CI 0.17, 0.62), q = 0.05) which was also associated with less decline in global cognition over 10 years (0.22 (95% CI 0.06, 0.39), p = 0.01). CONCLUSIONS MIND or MED diets could help to preserve some cognitive abilities in midlife, particularly episodic and visuospatial working memory. Effects may be mediated by high dietary fibre content and increased abundance of short-chain fatty acid producing gut bacteria. Longer follow-up with repeated measures of cognition will determine whether diet can influence changes in cognition occurring in older age.
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Affiliation(s)
- Claire T McEvoy
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK.
- The Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
- The Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
- Centre for Public Health, Institute of Clinical Sciences B, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - Amy Jennings
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Claire J Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Campus, London, UK
| | | | - Tim Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Campus, London, UK
| | - Aedin Cassidy
- The Institute for Global Food Security, Queen's University Belfast, Belfast, Northern Ireland, UK
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Moore SE, Rooney C, Neville CE, McConville R, Kee F, McEvoy CT, Woodside JV, Hanvey J, McKinley MC. The feasibility and acceptability of a rewards system based on food purchasing behaviour in secondary school cashless canteens: the Eat4Treats (E4T) cluster feasibility, non-randomised, controlled intervention study. Pilot Feasibility Stud 2024; 10:4. [PMID: 38195663 PMCID: PMC10775569 DOI: 10.1186/s40814-023-01436-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Using rewards may be an effective method to positively influence children's eating behaviour but evidence to date is limited, particularly in older children. The cashless canteen systems in schools provides a unique opportunity to implement a food-based reward scheme but intervention development work and feasibility testing is needed. The overall aim of the E4T feasibility study was to examine the feasibility and acceptability of implementing a rewards scheme based on the food purchasing behaviour of pupils in cashless canteens in secondary schools. METHODS A non-randomised, controlled, parallel-group cluster feasibility study conducted in four secondary schools (two intervention and two control) serving areas of the highest social deprivation in Northern Ireland. During the 4-month trial, pupils earned points for foods purchased at the school canteen, with better nutritional choices having a higher value. Pupils could exchange the points they earned for rewards (e.g. stationery, vouchers, sports equipment) via the E4T website. Qualitative and quantitative data was collected from year 9 and 10 pupils (boys and girls aged 12-14 years), teachers and canteen staff to address the feasibility questions. RESULTS Two intervention (one urban, one rural) and one control (urban) school completed the study. Seventy-one percent of 12-14-year-old pupils consented to take part; 1% of parents opted their child out of the study. Questionnaire completion rates were high (6 and 11% of questionnaires were partially completed at baseline and follow-up respectively). Collecting data on food consumed in the canteen was challenging logistically. Focus groups with pupils indicated that the overall concept of E4T was well received and there was a high degree of satisfaction with the rewards available. Pupils and teachers made several suggestions for improvements. CONCLUSIONS E4T was successfully implemented as a result of collaboration between schools, school canteens and cashless canteen providers working with a multidisciplinary research team. It was acceptable to pupils, teachers and canteen staff. The findings suggest a few areas for refining implementation and evaluation processes that would need to be considered in the design of a larger trial, particularly resources required to streamline implementation and ways to optimise pupil engagement. TRIAL REGISTRATION Under review with https://www. CLINICALTRIALS gov (retrospective registration-reg number and weblink to be added).
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Affiliation(s)
- Sarah E Moore
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Ciara Rooney
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Charlotte E Neville
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Ryan McConville
- Department of Engineering Mathematics, University of Bristol, Ada Lovelace Building, University Walk, Bristol, BS8 1TW, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Judith Hanvey
- Education Authority Northern Ireland, 40 Academy Street, Belfast, BT1 2NQ, UK
| | - Michelle C McKinley
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK.
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Ward NA, Reid-McCann R, Brennan L, Cardwell CR, de Groot C, Maggi S, McCaffrey N, McGuinness B, McKinley MC, Noale M, O'Neill RF, Prinelli F, Sergi G, Trevisan C, Volkert D, Woodside JV, McEvoy CT. Effects of PROtein enriched MEDiterranean Diet and EXercise on nutritional status and cognition in adults at risk of undernutrition and cognitive decline: the PROMED-EX Randomised Controlled Trial. BMJ Open 2023; 13:e070689. [PMID: 37880167 PMCID: PMC10603411 DOI: 10.1136/bmjopen-2022-070689] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/31/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Undernutrition leading to unplanned weight loss is common in older age and has been linked to increased dementia risk in later life. Weight loss can precede dementia by a decade or more, providing a unique opportunity for early intervention to correct undernutrition and potentially prevent or delay cognitive impairment. The combined effects of diet and exercise on undernutrition have not yet been evaluated. The objective of this trial is to determine the effect of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in older adults at risk of undernutrition and cognitive decline. METHODS One hundred and five participants aged 60 years and over at risk of undernutrition and with subjective cognitive decline will be recruited to participate in a 6-month, single-blind, parallel-group randomised controlled trial. Participants will be block randomised into one of three groups: group 1-PROMED-EX (diet+exercise), group 2-PROMED (diet only) and group 3-standard care (control). The primary outcome is nutritional status measured using the Mini Nutritional Assessment. Secondary outcomes include cognitive function, nutritional intake, body composition, physical function and quality of life. Mechanistic pathways for potential diet and exercise-induced change in nutritional status and cognition will be explored by measuring inflammatory, metabolic, nutritional and metabolomic biomarkers. ETHICS AND DISSEMINATION The study is approved by the UK Office for Research Ethics Committee (ref: 21/NW/0215). Written informed consent will be obtained from participants prior to recruitment. Research results will be disseminated to the public via meetings and media and the scientific community through conference presentations and publication in academic journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05166564).
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Affiliation(s)
- Nicola Ann Ward
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Lorraine Brennan
- School of Agriculture and Food Science, Institute of Food and Health and Conway Institute, University College Dublin, Dublin, Ireland
| | | | - Cpgm de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Stefania Maggi
- Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy
| | - Noel McCaffrey
- ExWell Medical, Irish Wheelchair Association, Dublin, Ireland
| | | | | | - Marianna Noale
- Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy
| | - Roisin F O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Federica Prinelli
- Institute for Biomedical Technologies, Epidemiology Unit, National Research Council, Segrate, Italy
| | - Giuseppe Sergi
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Nuremberg, Germany
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Global Brain Health Institute, Trinity College Dublin, Ireland & University of California, San Francisco, California, USA
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McEvoy CT, Regan-Moriarty J, Dolan C, Bradshaw C, Mortland V, McCallion M, McCarthy G, Kennelly SP, Kelly J, Heffernan M, Kee F, McGuinness B, Passmore P. A qualitative study to inform adaptations to a brain health intervention for older adults with type 2 diabetes living in rural regions of Ireland. Diabet Med 2023; 40:e15034. [PMID: 36572988 DOI: 10.1111/dme.15034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/10/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
AIMS Type 2 diabetes is a risk factor for late-life dementia, but dementia prevention strategies have yet to be comprehensively evaluated in people with diabetes. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated cognitive benefits of a 2-year multidomain lifestyle intervention. However, given the intensive nature of FINGER, there is uncertainty about whether it can be implemented in other high-risk populations. Our aim was to explore attitudes towards dementia risk, and barriers to an intervention based on the FINGER model in older adults with type 2 diabetes living in rural areas of Ireland. METHODS Focus groups were conducted with 21 adults (11 men and 10 women) aged 60+ years with type 2 diabetes living in border regions of north and south Ireland. Data were analysed using thematic analysis. RESULTS There was limited understanding of diabetes as a risk factor for late-life dementia. The main barriers to engagement with the multidomain intervention were eating foods that were not compatible with cultural norms, time and travel constraints, and perceived lack of self-efficacy and self-motivation for adopting the desired diet, exercise and computerised cognitive training (CCT) behaviours. Facilitators for intervention acceptability included the provision of culturally tailored and personalised education, support from a trusted source, and inclusion of goal setting and self-monitoring behavioural strategies. CONCLUSIONS While there was high acceptability for a brain health intervention, several barriers including cultural food norms and low self-efficacy for adopting the diet, exercise and CCT components would need to be considered in the intervention design. Findings from this study will be used to inform local decisions regarding the adaptation of FINGER for people with type 2 diabetes. The feasibility of the adapted multidomain intervention will then be evaluated in a future pilot trial.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Joanne Regan-Moriarty
- Department of Health and Nutritional Sciences, Atlantic Technological University, Sligo, Ireland
| | - Catherine Dolan
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Caroline Bradshaw
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Valerie Mortland
- Department of Geriatric Medicine, South West Acute Hospital, Enniskillen, UK
| | - Maire McCallion
- Department of Health and Nutritional Sciences, Atlantic Technological University, Sligo, Ireland
| | - Geraldine McCarthy
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Seán P Kennelly
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Jim Kelly
- Department of Geriatric Medicine, South West Acute Hospital, Enniskillen, UK
| | - Margaret Heffernan
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Peeters G, Black IL, Gomersall SR, Fritschi J, Sweeney A, Guedes de Oliveira Y, Panizzutti R, McEvoy CT, Lampit A. Behaviour Change Techniques in Computerized Cognitive Training for Cognitively Healthy Older Adults: A Systematic Review. Neuropsychol Rev 2023; 33:238-254. [PMID: 35157209 PMCID: PMC9998598 DOI: 10.1007/s11065-022-09537-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/25/2020] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
We aimed to describe behaviour change techniques (BCT) used in trials evaluating computerised cognitive training (CCT) in cognitively healthy older adults, and explore whether BCTs are associated with improved adherence and efficacy. The 90 papers included in a recent meta-analysis were reviewed for information about adherence and use of BCTs in accordance with the Behaviour Change Taxonomy. Studies using a specific BCT were compared with studies not using that BCT on efficacy (difference in Hedges' g [Δg]) using three level meta-regression models and on median adherence using the Wilcoxon test. The median number of BCTs per study was 3 (interquartile range [IQR] = 2-5). 'Feedback on behaviour' (if provided by a person; Δg = -0.19, 95% confidence interval [CI] = -0.31;-0.07) and 'non-specific reward' (Δg = -0.19, CI = -0.34;-0.05) were associated with lower efficacy. Certain BCTs that involve personal contact may be beneficial, although none were statistically significantly associated with greater efficacy. The median percentage of adherence was 90% (IQR = 81-95). Adherence was higher in studies using the BCT 'self-monitoring of behaviour' and lower in studies using the BCT 'graded tasks' than studies not using these BCTs (p < 0.001). These findings provide first evidence that BCTs can influence both adherence to and efficacy of CCT programs in cognitively healthy older adults.
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Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland. .,Department of Geriatric Medicine, Radboud Institute of Health Science, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Irene L Black
- Department of Clinical Nutrition and Dietetics, CHI Crumlin, Dublin, Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Sjaan R Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | | | - Aoife Sweeney
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Rogerio Panizzutti
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claire T McEvoy
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Amit Lampit
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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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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Mamidi RR, MacDonald KD, Brumbach BH, Go MDA, McEvoy CT. Nasal continuous positive airway pressure practices in preterm infants: A survey of neonatal providers. J Neonatal Perinatal Med 2023; 16:611-617. [PMID: 38043019 DOI: 10.3233/npm-230006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND The standard of care for respiratory support of preterm infants is nasal continuous positive airway pressure (CPAP), yet practices are not standardized. Our aim was to survey CPAP practices in infants < 32 weeks gestation among the American Academy of Pediatrics Neonatal-Perinatal section. METHODS A US, web-based survey inquired about the initiation, management, and discontinuation of CPAP, and chinstrap use and oral feedings on CPAP. RESULTS 857 providers consented. Regarding criteria to discontinue/wean CPAP: 69% use specific respiratory stability criteria; 22% a specific post-menstrual age; 8% responded other. 64% did not have guidelines for CPAP discontinuation; 54% did not have guidelines for CPAP initiation. 66% believe chinstraps improve CPAP efficacy; however, 11% routinely apply a chinstrap. 22% allow oral feeds on CPAP in certain circumstances. CONCLUSION There are meaningful variabilities in CPAP practices among neonatal providers across the US. Given the potential long-term implications this can have on the growth and development of the preterm lung, further evidence-based research is needed in relation to respiratory outcomes to optimize and standardize CPAP strategies.
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Affiliation(s)
- R R Mamidi
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
| | - K D MacDonald
- Division of Pediatric Pulmonology, Oregon Health & Science University, Portland, OR, USA
| | - B H Brumbach
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - M D A Go
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
| | - C T McEvoy
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
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Woodside JV, Sun Q, de Roos B, Rimm EB, Hu FB, Heinen MM, McEvoy CT, Piernas C, Scheelbeek PFD, Rushton J, Ensaff H, Brennan SF, Brennan L. Meeting report: plant-rich dietary patterns and health. Proc Nutr Soc 2022; 81:288-305. [PMID: 35996940 PMCID: PMC9839575 DOI: 10.1017/s002966512200266x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.
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Affiliation(s)
- Jayne V. Woodside
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- Corresponding author: Jayne V. Woodside,
| | - Qi Sun
- Harvard TH Chan School of Public Health, Boston, USA
| | - Baukje de Roos
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Eric B. Rimm
- Harvard TH Chan School of Public Health, Boston, USA
| | - Frank B. Hu
- Harvard TH Chan School of Public Health, Boston, USA
| | - Mirjam M. Heinen
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Department of Country Health Programmes, WHO Regional Office for Europe, Geneva, Switzerland
| | - Claire T. McEvoy
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Carmen Piernas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pauline F. D. Scheelbeek
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Hannah Ensaff
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sarah F. Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Lorraine Brennan
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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11
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Woodside JV, Sun Q, de Roos B, Rimm EB, Hu FB, Heinen MM, McEvoy CT, Piernas C, Scheelbeek PFD, Rushton J, Ensaff H, Brennan SF, Brennan L. Meeting report: plant-rich dietary patterns and health - ERRATUM. Proc Nutr Soc 2022; 81:318. [PMID: 36273871 DOI: 10.1017/s0029665122002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Qi Sun
- Harvard TH Chan School of Public Health, Boston, USA
| | - Baukje de Roos
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Eric B Rimm
- Harvard TH Chan School of Public Health, Boston, USA
| | - Frank B Hu
- Harvard TH Chan School of Public Health, Boston, USA
| | - Mirjam M Heinen
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Department of Country Health Programmes, WHO Regional Office for Europe, Geneva, Switzerland
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Carmen Piernas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pauline F D Scheelbeek
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Hannah Ensaff
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sarah F Brennan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Lorraine Brennan
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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12
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Thomson K, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O'Keefe H, Mohammed W, Gosney M, Raffle A, Hanratty B, McEvoy CT, Craig D, Ramsay SE. Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review. Health Technol Assess 2022; 26:1-112. [PMID: 36541454 PMCID: PMC9791461 DOI: 10.3310/ccqf1608] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. OBJECTIVE To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021. REVIEW METHODS A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements. RESULTS Eleven studies (n = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, p < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval -0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval -0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m2) using cheaper oral nutritional supplements products that require minimal staff time to administer. LIMITATIONS The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered. CONCLUSIONS Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults. FUTURE WORK Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42020170906. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Thomson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Marshall
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah O'Keefe
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wael Mohammed
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Anne Raffle
- Elders Council of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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13
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Thomson KH, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O'Keefe H, Mohammed W, Raffle A, Hanratty B, McEvoy CT, Craig D, Ramsay SE. Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. Lancet Healthy Longev 2022; 3:e654-e666. [PMID: 36116457 DOI: 10.1016/s2666-7568(22)00171-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Current management of malnutrition can include prescribed oral nutritional supplements (ONS); however, there is uncertainty whether these supplements are effective in people who are older (≥65 years) and frail. We assessed the effectiveness, cost-effectiveness, and adherence and acceptability of ONS in frail older people who are malnourished or at risk of malnutrition. METHODS In this systematic review and meta-analysis, five bibliographic databases (MEDLINE, EMBASE, Cochrane Library, Scopus, and CINAHL) and grey literature sources were searched from inception to Sept 13, 2021, to identify studies assessing the effectiveness and cost-effectiveness of ONS (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. Multiple reviewers independently did study screening, data extraction, and risk of bias assessment. Quality was assessed using version 1.0 of the Cochrane risk of bias tool for randomised controlled trials (RCTs), and the BMJ Drummond checklist was used to assess the quality of the included cost-effectiveness study. A meta-analysis was done for the effectiveness review; for the other reviews, a narrative synthesis approach was used. This systematic review and meta-analysis was registered on PROSPERO, CRD42020170906. FINDINGS Of 8492 records retrieved and screened, we included 11 RCTs involving 822 participants, six of which were fully or partly funded by industry. For the majority of the outcomes for which meta-analyses were possible (11/12), Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments suggested that the evidence was of very low certainty. Results suggested that ONS might have a slightly positive effect on energy (kcal) intake (standardised mean difference 1·02 [95% CI 0·15 to 1·88]; I2=87%; four studies), protein intake (standardised mean difference 1·67 [-0·03 to 3·37; I2=97%; four studies), and mobility (mean difference 0·03 [0·02 to 0·04]; I2=0%; four studies), compared with standard care. Narrative syntheses suggested that the effect of ONS on quality of life, compared with standard care, was mixed. In the identified studies, there was very little information related to active components, determinants, or acceptability of interventions. One economic evaluation, done in a care home setting, showed that ONS could be cost-effective. INTERPRETATION We found little evidence of ONS reducing malnutrition or its associated adverse outcomes in older people who are frail. High-quality, non-industry-funded, adequately powered studies reporting on short-term and long-term health outcomes, determinants, and participant characteristics are needed. FUNDING UK National Institute of Health and Care Research (NIHR) Health Technology Assessment (NIHR128729).
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Affiliation(s)
- Katie H Thomson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Oluwatomi Arisa
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Christopher Marshall
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK; York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Hannah O'Keefe
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Wael Mohammed
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK; School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Raffle
- Elders Council of Newcastle Upon Tyne, Campus for Aging and Vitality, Newcastle Upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Claire T McEvoy
- Centre for Public Health, Institute for Global Food Security, Institute of Clinical Sciences A, Belfast, Northern Ireland
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, The Catalyst, 3 Science Square, Newcastle Helix, Newcastle Upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Baddiley-Clark Building, Newcastle University, Newcastle Upon Tyne, UK.
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14
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O'Neill RF, Brennan L, Prinelli F, Sergi G, Trevisan C, De Groot LCPGM, Volkert D, Maggi S, Noale M, Conti S, Adorni F, Woodside J, McKinley MC, McGuinness B, Cardwell C, McEvoy CT. PROtein enriched MEDiterranean diet to combat undernutrition and promote healthy neuroCOGnitive ageing in older adults: The PROMED-COG consortium project. NUTR BULL 2022; 47:356-365. [PMID: 36045102 PMCID: PMC9544262 DOI: 10.1111/nbu.12571] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
Abstract
Dementia is a major public health challenge owing to its increasing prevalence and recognised impact on disability among older adults. Observational data indicate that weight loss is associated with increased dementia risk of 30%-40% and precedes a diagnosis of cognitive impairment or dementia by at least one decade. Although relatively little is known about the mechanisms of unintentional weight loss in dementia, this provides a window of opportunity to intervene with strategies to counteract undernutrition and delay, or prevent, the onset of dementia. This article provides an overview of the PROMED-COG project and associated work packages. The project aimes to (1) strengthen the epidemiologic evidence to better understand the potential benefits of combating undernutrition for healthy neurocognitive ageing; (2) increase scientific knowledge on the balance between a protein enriched Mediterranean diet (PROMED) and physical exercise to prevent undernutrition and promote healthy neurocognitive ageing, and generate data on mechanistic pathways; (3) stimulate collaboration and capacity building for nutrition and neurocognitive ageing research in Europe; and (4) develop public and practice recommendations to combat undernutrition and promote healthy neurocognitive ageing in older adults. Findings will provide new and critical insights into the role of undernutrition in neurocognitive ageing, how this role can differ by sex, genetic risk and timing of undernutrition exposure, and how modifications of dietary and physical activity behaviour can reduce the burden of undernutrition and neurodegeneration. The research outcomes will be useful to inform policy and practice about the dietary guidelines of older people and provide insight to industry for the development of food-based solutions to prevent undernutrition.
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Affiliation(s)
- Roisin F. O'Neill
- Centre for Public Health, Institute for Global Food SecurityQueen's University BelfastBelfastNorthern Ireland
| | - Lorraine Brennan
- School of Agriculture and Food Science, Institute of Food and Health and Conway InstituteUniversity College DublinDublinIreland
| | - Federica Prinelli
- Institute of Biomedical Technologies, Epidemiology Unit, National Research Council (CNR)SegrateItaly
| | - Giuseppe Sergi
- Geriatric Unit, Department of Medicine, University of PadovaPadovaItaly
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine, University of PadovaPadovaItaly
| | | | - Dorothee Volkert
- Institute for Biomedicine of AgingFriedrich‐Alexander Universität of Erlangen‐NümbergNurembergGermany
| | - Stefania Maggi
- Neuroscience Institute, National Research Council (CNR)PadovaItaly
| | - Marianna Noale
- Neuroscience Institute, National Research Council (CNR)PadovaItaly
| | - Silvia Conti
- Institute of Biomedical Technologies, Epidemiology Unit, National Research Council (CNR)SegrateItaly
| | - Fulvio Adorni
- Institute of Biomedical Technologies, Epidemiology Unit, National Research Council (CNR)SegrateItaly
| | - Jayne V. Woodside
- Centre for Public Health, Institute for Global Food SecurityQueen's University BelfastBelfastNorthern Ireland
| | - Michelle C. McKinley
- Centre for Public Health, Institute for Global Food SecurityQueen's University BelfastBelfastNorthern Ireland
| | - Bernadette McGuinness
- Centre for Public Health, Institute for Global Food SecurityQueen's University BelfastBelfastNorthern Ireland
| | - Chris Cardwell
- Centre for Public Health, Institute for Global Food SecurityQueen's University BelfastBelfastNorthern Ireland
| | - Claire T. McEvoy
- Centre for Public Health, Institute for Global Food SecurityQueen's University BelfastBelfastNorthern Ireland
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15
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Abstract
Given the complex bidirectional communication system that exists between the gut microbiome and the brain, there is growing interest in the gut microbiome as a novel and potentially modifiable risk factor for Alzheimer's disease (AD). Gut dysbiosis has been implicated in the pathogenesis and progression of AD by initiating and prolonging neuroinflammatory processes. The metabolites of gut microbiota appear to be critical in the mechanism of the gut-brain axis. Gut microbiota metabolites, such as trimethylamine-n-oxide, lipopolysaccharide, and short chain fatty acids, are suggested to mediate systemic inflammation and intracerebral amyloidosis via endothelial dysfunction. Emerging data suggest that the fungal microbiota (mycobiome) may also influence AD pathology. Importantly, 60% of variation in the gut microbiome is attributable to diet, therefore modulating the gut microbiome through dietary means could be an effective approach to reduce AD risk. Given that people do not eat isolated nutrients and instead consume a diverse range of foods and combinations of nutrients that are likely to be interactive, studying the effects of whole diets provides the opportunity to account for the interactions between different nutrients. Thus, dietary patterns may be more predictive of real-life effect on gut microbiome and AD risk than foods or nutrients in isolation. Accumulating evidence from experimental and animal studies also show potential effects of gut microbiome on AD pathogenesis. However, data from human dietary interventions are lacking. Well-designed intervention studies are needed in diverse populations to determine the influence of diet on gut microbiome and inform the development of effective dietary strategies for prevention of AD.
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Affiliation(s)
- Andrea McGrattan
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, UK
| | | | - Aedín Cassidy
- Institute For Global Food Security, Queen's University Belfast, UK
| | - Jayne V Woodside
- Institute For Global Food Security, Queen's University Belfast, UK
| | - Claire T McEvoy
- Institute For Global Food Security, Queen's University Belfast, UK.,Global Brain Health Institute, University of California San Francisco, USA and Trinity College Dublin, Ireland
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16
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Townsend RF, Woodside JV, Prinelli F, O'Neill RF, McEvoy CT. Associations Between Dietary Patterns and Neuroimaging Markers: A Systematic Review. Front Nutr 2022; 9:806006. [PMID: 35571887 PMCID: PMC9097077 DOI: 10.3389/fnut.2022.806006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 12/13/2022] Open
Abstract
Dementia is a complex, growing challenge for population health worldwide. Dietary patterns (DPs) may offer an opportunity to beneficially influence cognitive ageing and potentially reduce an individuals’ risk of dementia through diet-related mechanisms. However, previous studies within this area have shown mixed results, which may be partly explained by the lack of sensitivity and accuracy within cognitive testing methods. Novel neuroimaging techniques provide a sensitive method to analyse brain changes preceding cognitive impairment which may have previously remained undetected. The purpose of this systematic review was to elucidate the role of DPs in relation to brain ageing processes, by summarising current prospective and intervention studies. Nine prospective studies met the inclusion criteria for the review, seven evaluated the Mediterranean diet (MeDi), one evaluated the Alternative Healthy Eating Index-2010, and one evaluated a posteriori derived DPs. No intervention studies were eligible for inclusion in this review. There was some evidence of an association between healthy DPs and neuroimaging markers including changes within these markers over time. Consequently, it is plausible that better adherence to such DPs may positively influence brain ageing and neurodegeneration. Future studies may benefit from the use of multi-modal neuroimaging techniques, to further investigate how adherence to a DP influences brain health. The review also highlights the crucial need for further intervention studies within this research area.
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Affiliation(s)
- Rebecca F Townsend
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
| | - Federica Prinelli
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Roisin F O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
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17
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Reid-McCann RJ, Brennan SF, McKinley MC, McEvoy CT. The effect of animal versus plant protein on muscle mass, muscle strength, physical performance and sarcopenia in adults: protocol for a systematic review. Syst Rev 2022; 11:64. [PMID: 35418173 PMCID: PMC9006591 DOI: 10.1186/s13643-022-01951-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/05/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The evidence base for the role of dietary protein in maintaining good muscle health in older age is strong; however, the importance of protein source remains unclear. Plant proteins are generally of lower quality, with a less favourable amino acid profile and reduced bioavailability; therefore, it is possible that their therapeutic effects may be less than that of higher quality animal proteins. This review aims to evaluate the effectiveness of plant and animal protein interventions on muscle health outcomes. METHODS A robust search strategy was developed to include terms relating to dietary protein with a focus on protein source, for example dairy, meat and soy. These were linked to terms related to muscle health outcomes, for example mass, strength, performance and sarcopenia. Five databases will be searched: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Embase and Web of Science. Studies included will be randomised controlled trials with an adult population (≥ 18) living in the community or residential homes for older adults, and only English language articles will be included. Two independent reviewers will assess eligibility of individual studies. The internal validity of included studies will be assessed using Cochrane Risk of Bias 2.0 tool. Results will be synthesised in narrative format. Where applicable, standardised mean differences (SMD) (95% confidence interval [CI]) will be combined using a random-effects meta-analysis, and tests of homogeneity of variance will be calculated. DISCUSSION Dietary guidelines recommend a change towards a plant-based diet that is more sustainable for health and for the environment; however, reduction of animal-based foods may impact protein quality in the diet. High-quality protein is important for maintenance of muscle health in older age; therefore, there is a need to understand whether replacement of animal protein with plant protein will make a significant difference in terms of muscle health outcomes. Findings from this review will be informative for sustainable nutritional guidelines, particularly for older adults and for those following vegan or vegetarian diets. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD420201886582.
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Affiliation(s)
- Rachel J Reid-McCann
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, 1st Floor, Grosvenor Road, Belfast, BT12 6BJ, UK.
| | - Sarah F Brennan
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, 1st Floor, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Michelle C McKinley
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, 1st Floor, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science A, 1st Floor, Grosvenor Road, Belfast, BT12 6BJ, UK
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18
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McEvoy CT, McCrum LA, Woodside JV. 2.9 Vegetarian and Vegan Diets. World Rev Nutr Diet 2022; 124:197-202. [PMID: 35240601 DOI: 10.1159/000516701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Leigh-Ann McCrum
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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19
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Chow YY, Verdonschot M, McEvoy CT, Peeters G. Associations between depression and cognition, mild cognitive impairment and dementia in persons with diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2022; 185:109227. [PMID: 35122905 DOI: 10.1016/j.diabres.2022.109227] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022]
Abstract
AIMS This systematic review aimed to examine whether persons with diabetes and depression had poorer cognition and higher dementia risk than persons with diabetes only. Moreover, the impact of timing, frequency of depressive episodes throughout life, and antidepressant treatment were examined. METHODS PubMed, Embase and PsycINFO were searched to obtain observational studies between August 2015 and June 2021 that examined the association between depression and cognition, mild cognitive impairment or dementia in people with diabetes. Studies published before August 2015 were retrieved from a previous systematic review. Findings were pooled using meta-analyses. RESULTS 10 out of 19 included articles were appropriate for the meta-analyses. Persons with diabetes and depression experienced greater declines in executive function (SMD = -0.39 (-0.69, -0.08)), language (SMD = -0.80 (-1.52, -0.09)), memory (SMD = -0.63 (-1.12, -0.14)) and overall cognition (SMD = -0.77 (-1.33, -0.20)), and greater dementia risk (HR = 1.82 (1.79, 1.85)) than persons with diabetes only. No significant differences were observed for complex attention. No studies examined the role of timing and frequency of depressive episodes and antidepressant treatment. CONCLUSION In persons with diabetes, depression is associated with worse cognition and higher dementia risk. The potential mitigating effect of antidepressant treatment remains unclear.
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Affiliation(s)
- Yeng Yan Chow
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands.
| | - Milou Verdonschot
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands.
| | - Claire T McEvoy
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Llyod Building, Dublin 2, Ireland; Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6 BJ Northern Ireland, United Kingdom.
| | - Geeske Peeters
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Reinier Postlaan 4, 6500 HB Nijmegen, the Netherlands; Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Llyod Building, Dublin 2, Ireland.
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20
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Abstract
Food insecurity has been associated with adverse effects on physical health and well-being in both high and low-income countries, but effects on brain health are not clear. The purpose of this systematic review was to determine the relationship between food insecurity and important brain health outcomes in adults including depression, stroke, cognitive impairment and dementia. Electronic databases were searched to find studies which investigated relations between food insecurity and predefined brain health outcomes. Thirty studies met the inclusion criteria for review of which 23 were conducted in high income countries and seven in low- or middle-income countries. Most studies (n = 24) were cross-sectional, five were prospective and 1 was a case-control design. Seven studies reporting outcomes relating to cognitive performance and 24 relating to depression. No studies investigated relations between food insecurity and stroke or dementia. There was substantial heterogeneity in the populations studied as well as measures of food insecurity and outcomes which made comparisons between studies difficult. Overall, the findings highlighted that individuals who were food insecure had increased likelihood of depressive symptoms and poorer global cognition than those who were food secure. It is possible that social support and food aid programmes attenuate the effects of food insecurity on depressive symptoms. Future research is needed to determine whether interventions to alleviate food insecurity can benefit brain health in vulnerable populations.
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Affiliation(s)
- Alan J McMichael
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Hoang Van Minh
- Centre for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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McGrattan AM, McEvoy CT, Vijayakumar A, Moore SE, Neville CE, McGuinness B, McKinley MC, Woodside JV. A mixed methods pilot randomised controlled trial to develop and evaluate the feasibility of a Mediterranean diet and lifestyle education intervention 'THINK-MED' among people with cognitive impairment. Pilot Feasibility Stud 2021; 7:3. [PMID: 33390187 PMCID: PMC7780397 DOI: 10.1186/s40814-020-00738-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Accumulating evidence supports the role of a Mediterranean diet (MD) in cognition, with a greater adherence to a MD associated with reduced dementia risk. It is important to understand how best to achieve behaviour change towards a MD, particularly in non-Mediterranean and high-risk populations. The aim of this study was to evaluate the feasibility of a MD and lifestyle education intervention (THINK-MED) among older adults with cognitive impairment. METHODS Qualitative interviews (Phase I), conducted with mild cognitive impairment (MCI) participants, evaluated the intervention materials to allow refinement before pilot testing. THINK-MED was a 12-month, pilot RCT (Phase II) whereby MCI participants were randomised into one of three groups: education on one occasion vs education staged and supported by a dietitian vs control. The primary outcome was a change in MD score. Secondary outcome measurements were collected to gather data on variability of the outcomes to inform a full trial power calculation and to test their acceptability. Slower recruitment rates necessitated a change in primary outcome to a revised focus primarily on feasibility. A sub-study of the same THINK-MED intervention and data collection measures was also conducted among community-dwelling participants with subjective cognitive impairment (SCI) (NCT03569319). RESULTS A total of 20 participants (n = 15 MCI; n = 5 SCI) were enrolled in the THINK-MED study. However, there were 10 (50%) participants (n = 9 MCI; n = 1 SCI) who withdrew from the study. Although, those who remained in the intervention rated and evaluated their experience as generally positive, recruitment and retention, especially from a MCI population, was extremely challenging. This highlights the complex needs of this heterogeneous clinical cohort. Recruiting participants from a community-based sample with SCI was more feasible, reaching a wider audience in a shorter time period. There were challenges relating to data collection and incompleteness, with the occurrence of missing data particularly among the questionnaire-based assessments. CONCLUSIONS Owing to the challenges with recruitment and retention of older adults with cognitive impairment in this study, it is difficult to confirm if this intervention is feasible. This research has highlighted considerations for a future trial, including a review of the recruitment strategies used and prioritisation of the outcome measures assessed. TRIAL REGISTRATION Clinical trials registration NCT03265522 / NCT03569319.
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Affiliation(s)
- Andrea M McGrattan
- Centre for Public Health, Queens University Belfast, Belfast, BT12 6BJ, UK.
| | - Claire T McEvoy
- Centre for Public Health, Queens University Belfast, Belfast, BT12 6BJ, UK
| | | | - Sarah E Moore
- Centre for Public Health, Queens University Belfast, Belfast, BT12 6BJ, UK
| | | | | | | | - Jayne V Woodside
- Centre for Public Health, Queens University Belfast, Belfast, BT12 6BJ, UK
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McEvoy CT, Hoang T, Sidney S, Steffen LM, Jacobs DR, Shikany JM, Wilkins JT, Yaffe K. Author response: Dietary patterns during adulthood and cognitive performance in midlife: The CARDIA study. Neurology 2020; 94:636. [DOI: 10.1212/wnl.0000000000009224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Logan D, McEvoy CT, McKenna G, Kee F, Linden G, Woodside JV. Association between oral health status and future dietary intake and diet quality in older men: The PRIME study. J Dent 2019; 92:103265. [PMID: 31862215 DOI: 10.1016/j.jdent.2019.103265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/04/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study investigated whether oral health status, defined as number of natural teeth and subsequent prosthodontic rehabilitation, was associated with future dietary intake and diet quality in older adults in The Prospective Epidemiological Study of Myocardial Infarction (PRIME). METHODS PRIME was originally established to explore cardiovascular risk factors in 50-59 year old men in Northern Ireland (1991-1994). A rescreening phase assessed oral health (2001-2004), while diet was assessed in 2015. Diet quality was characterised by the Dietary Diversity Score and Mediterranean Diet Score. In the current analysis, associations between oral health status, dietary intake and quality were assessed using regression models in 1096 participants. RESULTS Amongst study participants, the overall mean number of teeth was 18.5, 51.5 % had ≥21 natural teeth and 49.6 % wore dentures. Oral health status was categorised into five groups: 21-28 teeth with (n = 111) and without (n = 453) dentures, 1-20 teeth with (n = 354) and without (n = 99) dentures and edentate with dentures (n = 79). After full adjustment, men with ≥21 teeth and dentures had a higher future intake of fruit, vegetables, and nuts, and diet quality scores, compared to those with <21 teeth with dentures. Edentate men with dentures were less likely to achieve the future fruit dietary recommendation. CONCLUSIONS Having ≥21 natural remaining teeth positively affected the future intake of fruit, vegetables, and nuts, as well as diet quality. Dentures may be beneficial in men with ≥21 natural remaining teeth, as they were associated with an increased future intake of fruit, vegetables, and nuts and better diet quality. CLINICAL SIGNIFICANCE Oral health status is associated with dietary intake, after an average time period of 13 years, with those with a larger number of natural teeth having a better diet quality. Further research is required to investigate this relationship in larger, diverse populations with more detailed dietary assessment.
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Affiliation(s)
- D Logan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - C T McEvoy
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - G McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - F Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - G Linden
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
| | - J V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT12 6BA, United Kingdom
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Guzman V, McEvoy CT, McHugh-Power J, Kenny RA, Feeney J. Characterization of alcohol consumption patterns among older adults in Ireland. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Identifying the factors associated with hazardous drinking patterns and problem drinking is imperative to develop appropriate intervention strategies for alcohol harm reduction among the older population. The aim of this study was 1) To explore the patterns of alcohol consumption among older adults in the Republic of Ireland, and 2) To establish possible predictors of hazardous and problem drinking in this population.
Methods
A cross-sectional analysis was carried out on samples of individuals aged >50 years at Wave 3 of The Irish Longitudinal Study on Ageing (N = 4948). Hazardous alcohol consumption was defined as drinking above Irish guidelines [women >11 Standard Irish Drinks (SD)/week; men >17 SD/week], and/or having at least one heavy drinking episode per week (>6 SD/day). Problem drinking was defined as a score of > 2 on the CAGE instrument. Regression analyses investigated outcome differences according to socio-demographic and health characteristics. Sampling weights were applied to account for differential non-response.
Results
The prevalence of drinking patterns was 13% for lifetime alcohol abstainers, 8% for former drinkers, 26% for occasional drinkers and 53% for weekly drinkers. Among weekly drinkers 25% exceeded the guideline threshold, 23% had at least one heavy drinking episode per week and 16% had an alcohol problem according to the CAGE. In fully adjusted models, hazardous drinking and problem drinking were associated with younger older adults, male sex, current or past smoking, higher levels of stress and/or social isolation.
Conclusions
Our findings serve as a starting point to monitor trends of alcohol consumption among older adults in the Republic of Ireland. Our results highlight areas of opportunity for targeted screening and public interventions that seek to reduce alcohol harm among this population.
Key messages
In the Irish context, older adults who are younger, male, current or past smokers, with higher levels of stress and/or social isolation are more likely to engage in hazardous alcohol consumption. Our characterization of drinking patterns highlights areas of opportunity for targeted screening and public interventions that seek to reduce alcohol harm among older adults in Ireland.
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Affiliation(s)
- V Guzman
- Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - C T McEvoy
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | | | - R A Kenny
- Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - J Feeney
- Medical Gerontology, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
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25
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McEvoy CT, Leng Y, Peeters GM, Kaup AR, Allen IE, Yaffe K. Interventions involving a major dietary component improve cognitive function in cognitively healthy adults: a systematic review and meta-analysis. Nutr Res 2019; 66:1-12. [PMID: 31022563 DOI: 10.1016/j.nutres.2019.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/30/2018] [Revised: 12/07/2018] [Accepted: 02/27/2019] [Indexed: 01/12/2023]
Abstract
Accumulating evidence suggests a role for diet in promoting brain health. The purpose of this systematic review was to (1) quantitatively assess whether interventions with a major dietary component can enhance cognition in cognitively healthy adults and (2) identify responsive domains of cognition to inform the design of future dietary trials. Electronic databases were systematically searched to find eligible randomized controlled trials that assessed the effect of interventions with a major dietary component on cognitive function or incident dementia in adults without known cognitive impairment. Standardized mean differences (SMDs) (95% confidence interval [CI]) were combined using a random-effects meta-analysis, and tests of homogeneity of variance were calculated. Two trials reported dementia outcomes and were qualitatively described. Fifteen trials encompassing 6480 participants were eligible for meta-analysis. Compared to control, intervention improved performance on measures of global cognition (SMD = 0.14, 95% CI 0.01-0.27, P = .05, I2 76%), executive function (SMD = 0.11, 95% CI 0.04-0.18, P = .003, I2 0%), and processing speed (SMD = 0.12, 95% CI 0.05-0.19, P = .001, I2 0%). There was no effect of intervention on delayed memory (SMD = 0.04, 95% CI -0.02 to 0.09, P = .18, I2 4%). Significant heterogeneity and funnel plot asymmetry were detected for global cognition, but removal of studies with high risk of bias did not change the pooled findings. Current evidence is limited but indicates that diverse interventions improve nonmemory cognitive functions during normal cognitive aging. Measures of executive function and processing speed should be considered as feasible end points in future dietary intervention trials.
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Affiliation(s)
- Claire T McEvoy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
| | - Yue Leng
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | | | - Allison R Kaup
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA; Departments of Neurology, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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26
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McEvoy CT, Hoang T, Sidney S, Steffen LM, Jacobs DR, Shikany JM, Wilkins JT, Yaffe K. Dietary patterns during adulthood and cognitive performance in midlife: The CARDIA study. Neurology 2019; 92:e1589-e1599. [PMID: 30842290 DOI: 10.1212/wnl.0000000000007243] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate whether dietary patterns (Mediterranean diet [MedDiet], Dietary Approaches to Stop Hypertension [DASH], and A Priori Diet Quality Score [APDQS]) during adulthood are associated with midlife cognitive performance. METHODS We studied 2,621 Coronary Artery Risk Development in Young Adults (CARDIA) participants; 45% were black, 57% were female, and mean age was 25 ± 3.5 years at baseline (year 0). Mean diet scores were calculated from diet history at baseline, year 7, and year 20 (mean age 25, 32, and 45 years, respectively). Cognitive function was assessed at years 25 and 30 (mean age 50 and 55 years, respectively). Linear models were used to examine association between tertiles of diet score and change in composite cognitive function and cognitive z scores (verbal memory [Rey Auditory Verbal Learning Test], processing speed [Digit Symbol Substitution Test], and executive function [Stroop Interference test]) and the Montreal Cognitive Assessment (MoCA) at year 30. RESULTS DASH was not associated with change in cognitive performance. Higher MedDiet and APDQS scores were associated with less decline in cognitive function (MedDiet: low -0.04, middle 0.03, high 0.03, p = 0.03; APDQS: low -0.04, middle -0.00, high 0.06, p < 0.01) and Stroop Interference (MedDiet: low 0.09, middle -0.06, high -0.03; APDQS: low 0.10, middle 0.01, high -0.09, both p < 0.01). Odds ratios (95% confidence interval) for poor global cognitive function (≥1 SD below mean MoCA score) comparing extreme tertiles of diet scores were 0.54 (0.39-0.74) for MedDiet, 0.48 (0.33-0.69) for APDQS, and 0.89 (0.68-1.17) for DASH. CONCLUSION Greater adherence to MedDiet and APDQS dietary patterns during adulthood was associated with better midlife cognitive performance. Additional studies are needed to define the combination of foods and nutrients for optimal brain health across the life course.
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Affiliation(s)
- Claire T McEvoy
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
| | - Tina Hoang
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Stephen Sidney
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Lyn M Steffen
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - David R Jacobs
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - James M Shikany
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - John T Wilkins
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Centre for Public Health (C.T.M.), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Global Brain Health Institute (C.T.M., K.Y.), Department of Neurology (K.Y.), and Department of Epidemiology and Biostatistics (K.Y.), University of California, San Francisco; Trinity College Dublin (C.T.M.), Ireland; Northern California Institute for Research and Education (T.H.), San Francisco; Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; Division of Epidemiology and Community Health (L.M.S., D.R.J.), School of Public Health, University of Minnesota, Minneapolis; Division of Preventive Medicine (J.M.S.), School of Medicine, University of Alabama at Birmingham; Department of Preventive Medicine and Medicine (Cardiology) (J.T.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
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McEvoy CT, Moore SE, Appleton KM, Cupples ME, Erwin C, Kee F, Prior L, Young IS, McKinley MC, Woodside JV. Development of a peer support intervention to encourage dietary behaviour change towards a Mediterranean diet in adults at high cardiovascular risk. BMC Public Health 2018; 18:1194. [PMID: 30348137 PMCID: PMC6198381 DOI: 10.1186/s12889-018-6108-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/09/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mediterranean diet (MD) interventions are demonstrated to significantly reduce cardiovascular disease (CVD) risk but are typically resource intensive and delivered by health professionals. There is considerable interest to develop interventions that target sustained dietary behaviour change and that are feasible to scale-up for wider public health benefit. The aim of this paper is to describe the process used to develop a peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. METHODS The Medical Research Council (MRC) and Behaviour Change Wheel (BCW) frameworks and the COM-B (Capability, Opportunity, Motivation, Behaviour) theoretical model were used to guide the intervention development process. We used a combination of evidence synthesis and qualitative research with the target population, health professionals, and community health personnel to develop the intervention over three main stages: (1) we identified the evidence base and selected dietary behaviours that needed to change, (2) we developed a theoretical basis for how the intervention might encourage behaviour change towards a MD and selected intervention functions that could drive the desired MD behaviour change, and (3) we defined the intervention content and modelled outcomes. RESULTS A theory-based, culturally tailored, peer support intervention was developed to specifically target behaviour change towards a MD in the target population. The intervention was a group-based program delivered by trained peer volunteers over 12-months, and incorporated strategies to enhance social support, self-efficacy, problem-solving, knowledge, and attitudes to address identified barriers to adopting a MD from the COM-B analysis. CONCLUSIONS The MRC and BCW frameworks provided a systematic and complementary process for development of a theory-based peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. The next step is to evaluate feasibility, acceptability, and diet behaviour change outcomes in response to the peer support intervention (change towards a MD and nutrient biomarkers) using a randomized controlled trial design.
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Affiliation(s)
- Claire T. McEvoy
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Sarah E. Moore
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Katherine M. Appleton
- Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Talbot Campus, Bournemouth, BH12 5BB UK
| | - Margaret E. Cupples
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Christina Erwin
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Lindsay Prior
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Ian S. Young
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Michelle C. McKinley
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Jayne V. Woodside
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queens University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
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Leung CW, Fung TT, McEvoy CT, Lin J, Epel ES. Diet Quality Indices and Leukocyte Telomere Length Among Healthy US Adults: Data From the National Health and Nutrition Examination Survey, 1999-2002. Am J Epidemiol 2018; 187:2192-2201. [PMID: 29912268 PMCID: PMC6166208 DOI: 10.1093/aje/kwy124] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 01/04/2023] Open
Abstract
Aging is the biggest risk factor for the development of chronic diseases. Telomere length may represent one important mechanism by which dietary intake influences risk of age-related diseases; however, it is unknown which diet pattern is most strongly related to telomere length. We compared the relationships between 4 evidence-based diet quality indices and leukocyte telomere length in a nationally representative sample of healthy adults, and the extent to which these associations differed between men and women. Data on 4,758 adults aged 20-65 years with no prior diagnosis of major chronic disease were obtained from the 1999-2002 cycles of the National Health and Nutrition Examination Survey. Diet was assessed using one 24-hour dietary recall. After adjustment for sociodemographic and health characteristics, comparison of the top and bottom quintiles showed that higher Healthy Eating Index 2010 scores (β = 0.065, 95% confidence interval (CI): 0.018, 0.112; P-trend = 0.007), Alternate Healthy Eating Index 2010 scores (β = 0.054, 95% CI: 0.010, 0.097; P-trend = 0.007), Mediterranean Diet scores (β = 0.058, 95% CI: 0.017, 0.098; P-trend = 0.008), and Dietary Approaches to Stop Hypertension (DASH) scores (β = 0.052, 95% CI: 0.014, 0.090; P-trend = 0.007) were each associated with longer telomere length in women. These results may provide insight into the complex associations between optimal nutrition and longevity. Further investigation is needed to understand why associations were not observed in men.
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Affiliation(s)
- Cindy W Leung
- Center for Health and Community, University of California, San Francisco, San Francisco, California
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Teresa T Fung
- Department of Nutrition, School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jue Lin
- Department of Biochemistry and Biophysics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Elissa S Epel
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California
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McEvoy CT, Hoang TD, Sidney S, Steffen LM, Jacobs DR, Shikany JM, Wilkins JT, Yaffe K. P2‐593: DIETARY PATTERNS DURING EARLY ADULTHOOD AND COGNITIVE PERFORMANCE IN MIDLIFE: THE CORONARY ARTERY RISK DEVELOPMENT IN YOUNG ADULTS (CARDIA) STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Claire T. McEvoy
- Queen's University BelfastBelfastUnited Kingdom
- Global Brain Health InstituteDublinIreland
| | | | | | | | | | | | | | - Kristine Yaffe
- University of California, San FranciscoSan FranciscoCAUSA
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30
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McGrattan AM, McEvoy CT, McGuinness B, McKinley MC, Woodside JV. P3‐613: ACCEPTABILITY OF A TAILORED MEDITERRANEAN LIFESTYLE EDUCATION RESOURCE AMONG PATIENTS WITH MILD COGNITIVE IMPAIRMENT: A QUALITATIVE STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Claire T. McEvoy
- Queen's University BelfastBelfastUnited Kingdom
- University of California, San FranciscoSan FranciscoCAUSA
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31
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McGrattan AM, McEvoy CT, McGuinness B, McKinley MC, Woodside JV. P4‐176: THE EFFECT OF DIETARY INTERVENTIONS IN MILD COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Claire T. McEvoy
- Queen's University BelfastBelfastUnited Kingdom
- University of California, San FranciscoSan FranciscoCAUSA
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32
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McEvoy CT, Moore SE, Appleton KM, Cupples ME, Erwin CM, Hunter SJ, Kee F, McCance D, Patterson CC, Young IS, McKinley MC, Woodside JV. Trial to Encourage Adoption and Maintenance of a Mediterranean Diet (TEAM-MED): Protocol for a Randomised Feasibility Trial of a Peer Support Intervention for Dietary Behaviour Change in Adults at High Cardiovascular Disease Risk. Int J Environ Res Public Health 2018; 15:E1130. [PMID: 30720783 PMCID: PMC6025132 DOI: 10.3390/ijerph15061130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/27/2018] [Accepted: 05/29/2018] [Indexed: 12/22/2022]
Abstract
Adoption of a Mediterranean diet (MD) reduces cardiovascular disease (CVD) risk. However, interventions to achieve dietary behaviour change are typically resource intensive. Peer support offers a potentially low-cost approach to encourage dietary change. The primary objective of this randomised controlled trial is to explore the feasibility of peer support versus a previously tested dietetic-led intervention to encourage MD behaviour change, and to test recruitment strategies, retention and attrition in order to inform the design of a definitive trial. A total of 75 overweight adults at high CVD risk who do not follow a MD (Mediterranean Diet Score (MDS ≤ 3)) will be randomly assigned to either: a minimal intervention (written materials), a proven intervention (dietetic support, written materials and key MD foods), or a peer support intervention (group-based community programme delivered by lay peers) for 12 months. The primary end-point is change in MDS from baseline to 6 months (adoption of MD). Secondary end-points include: change in MDS from 6 to 12 months (maintenance of MD), effects on nutritional biomarkers and CVD risk factors, fidelity of implementation, acceptability and feasibility of the peer support intervention. This study will generate important data regarding the feasibility of peer support for ease of adoption of MD in an 'at risk' Northern European population. Data will be used to direct a larger scale trial, where the clinical efficacy and cost-effectiveness of peer support will be tested.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Sarah E Moore
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Katherine M Appleton
- Department of Psychology, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Talbot Campus, Bournemouth BH12 5BB, UK.
| | - Margaret E Cupples
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Christina M Erwin
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Steven J Hunter
- Belfast Health and Social Care Trust, Diabetes and Endocrinology, Grosvenor Road, Belfast BT12 6BA, UK.
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - David McCance
- Belfast Health and Social Care Trust, Diabetes and Endocrinology, Grosvenor Road, Belfast BT12 6BA, UK.
| | - Christopher C Patterson
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Michelle C McKinley
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
- UK Clinical Research Collaboration, Centre of Excellence for Public Health, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK.
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Erwin CM, McEvoy CT, Moore SE, Prior L, Lawton J, Kee F, Cupples ME, Young IS, Appleton K, McKinley MC, Woodside JV. A qualitative analysis exploring preferred methods of peer support to encourage adherence to a Mediterranean diet in a Northern European population at high risk of cardiovascular disease. BMC Public Health 2018; 18:213. [PMID: 29402256 PMCID: PMC5800279 DOI: 10.1186/s12889-018-5078-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/19/2017] [Accepted: 01/12/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Epidemiological and randomised controlled trial evidence demonstrates that adherence to a Mediterranean diet (MD) can reduce cardiovascular disease (CVD) risk. However, methods used to support dietary change have been intensive and expensive. Peer support has been suggested as a possible cost-effective method to encourage adherence to a MD in at risk populations, although development of such a programme has not been explored. The purpose of this study was to use mixed-methods to determine the preferred peer support approach to encourage adherence to a MD. METHODS Qualitative (focus groups) and quantitative methods (questionnaire and preference scoring sheet) were used to determine preferred methods of peer support. Sixty-seven high CVD risk participants took part in 12 focus groups (60% female, mean age 64 years) and completed a questionnaire and preference scoring sheet. Focus group data were transcribed and thematically analysed. RESULTS The mean preference score (1 being most preferred and 5 being least preferred) for group support was 1.5, compared to 3.4 for peer mentorship, 4.0 for telephone peer support and 4.0 for internet peer support. Three key themes were identified from the transcripts: 1. Components of an effective peer support group: discussions around group peer support were predominantly positive. It was suggested that an effective group develops from people who consider themselves similar to each other meeting face-to-face, leading to the development of a group identity that embraces trust and honesty. 2. Catalysing Motivation: participants discussed that a group peer support model could facilitate interpersonal motivations including encouragement, competitiveness and accountability. 3. Stepping Stones of Change: participants conceptualised change as a process, and discussed that, throughout the process, different models of peer support might be more or less useful. CONCLUSION A group-based approach was the preferred method of peer support to encourage a population at high risk of CVD to adhere to a MD. This finding should be recognised in the development of interventions to encourage adoption of a MD in a Northern European population.
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Affiliation(s)
- Christina M. Erwin
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Claire T. McEvoy
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Sarah E. Moore
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Lindsay Prior
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Margaret E. Cupples
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Ian S. Young
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Katherine Appleton
- Department of Psychology, Bournemouth University, Fern Barrow, Talbot Campus, Poole, Dorset, Bournemouth, BH12 5BB UK
| | - Michelle C. McKinley
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Jayne V. Woodside
- Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
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34
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Neville CE, Montgomery S, Silvestri G, McGowan A, Moore E, Silvestri V, Cardwell C, McEvoy CT, Maxwell AP, Woodside JV, McKay GJ. Dietary Patterns and Retinal Vessel Caliber in the Irish Nun Eye Study. J Nutr Health Aging 2018; 22:751-758. [PMID: 30080215 PMCID: PMC6061240 DOI: 10.1007/s12603-017-0992-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/04/2017] [Accepted: 10/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Retinal vessel abnormalities are associated with cardiovascular disease risk. Widening of retinal venules is associated with increased risk of stroke while narrowing of retinal arterioles independently predicts incident hypertension, coronary heart disease and diabetes. Dietary factors are known to play an important role in cardiovascular health. However, few studies have examined the association between dietary patterns (DPs) and retinal microvascular health. OBJECTIVE To examine the association between 'a posteriori'-derived DPs and retinal vascular caliber (RVC) in older women with a restricted lifestyle. METHODS This was a cross-sectional study of 1233 participants (mean age: 76.3 years) from the Irish Nun Eye Study (INES). Computer-assisted software was used to measure RVC from digital eye images using standardized protocols. Dietary intake was assessed using a food frequency questionnaire (FFQ). DP analysis was performed using principal component analysis from completed FFQs. Regression models were used to assess associations between DPs and retinal vessel diameters, adjusting for age, body mass index, refraction, hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular accident and fellow eye RVC. RESULTS Two DPs were identified: a 'healthy' pattern with high factor loadings for fruit, vegetables, wholegrains and oily fish and an 'unhealthy' pattern with high factor loadings for sugar and sweets, chips, high fat dairy products and French fries. Adjusted linear regression analysis revealed that those who adhered most closely to the unhealthy DP had wider central retinal venular equivalent (CRVE) (p=0.03) and narrower central retinal arteriolar equivalent (CRAE) (p=0.01) compared to the least unhealthy DP. No independent relationship was observed between the healthy DP and RVC. CONCLUSION In this cohort of older women with a restricted lifestyle, an unhealthy DP was independently associated with an unfavorable retinal profile, namely a widening of retinal venules and narrowing of retinal arterioles.
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Affiliation(s)
- C E Neville
- Charlotte E. Neville, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom,
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35
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Moore SE, McEvoy CT, Prior L, Lawton J, Patterson CC, Kee F, Cupples M, Young IS, Appleton K, McKinley MC, Woodside JV. Barriers to adopting a Mediterranean diet in Northern European adults at high risk of developing cardiovascular disease. J Hum Nutr Diet 2017; 31:451-462. [PMID: 29159932 DOI: 10.1111/jhn.12523] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Strong evidence links the consumption of a Mediterranean diet (MD) with a reduced cardiovascular disease (CVD) risk; however, there is uncertainty as to whether non-Mediterranean regions will adopt this diet. The present qualitative research aimed to investigate attitudes towards a MD in individuals at high CVD risk in a Northern European population. This information is needed to inform development of MD interventions in non-Mediterranean high-risk populations. METHODS Focus groups (n = 12) were held with individuals at high CVD risk from Northern Europe (≥2 CVD risk factors, aged ≥50 years, no established CVD/type 2 diabetes). Attitudes to dietary change towards a MD were explored. Data were analysed using inductive thematic analysis. RESULTS Sixty-seven adults participated (60% female, mean age 64 years). There was some awareness of the term MD but limited knowledge of its composition. Barriers to general dietary change were evident, including perception of expense, concern over availability, expectation of time commitment, limited knowledge, lack of cooking skills, amount and conflicting nature of media information on diets, changing established eating habits and resistance to dietary change. Barriers specific to MD adoption were also identified, including perceived difficulty living in a colder climate, perceived impact on body weight, acceptability of a MD and cultural differences. CONCLUSIONS Knowledge of a MD was limited in this Northern European sample at high CVD risk. In addition to general barriers to dietary change, barriers specific to a MD were identified. These findings have implications for the development of interventions aiming to promote MD adoption in non-Mediterranean populations.
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Affiliation(s)
- S E Moore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - C T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - L Prior
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - J Lawton
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - F Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - M Cupples
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - I S Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - K Appleton
- Department of Psychology, Bournemouth University, Bournemouth, UK
| | - M C McKinley
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - J V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
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36
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Leng Y, McEvoy CT, Allen IE, Yaffe K. Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA Neurol 2017; 74:1237-1245. [PMID: 28846764 PMCID: PMC5710301 DOI: 10.1001/jamaneurol.2017.2180] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/15/2017] [Indexed: 11/14/2022]
Abstract
Importance Growing evidence suggests an association between sleep-disordered breathing (SDB) and cognitive decline in elderly persons. However, results from population-based studies have been conflicting, possibly owing to different methods to assess SDB or cognitive domains, making it difficult to draw conclusions on this association. Objective To provide a quantitative synthesis of population-based studies on the relationship between SDB and risk of cognitive impairment. Data Sources PubMed, EMBASE, and PsychINFO were systematically searched to identify peer-reviewed articles published in English before January 2017 that reported on the association between SDB and cognitive function. Study Selection We included cross-sectional and prospective studies with at least 200 participants with a mean participant age of 40 years or older. Data Extraction and Synthesis Data were extracted independently by 2 investigators. We extracted and pooled adjusted risk ratios from prospective studies and standard mean differences from cross-sectional studies, using random-effect models. This meta-analysis followed the PRISMA guidelines and also adhered to the MOOSE guidelines. Main Outcomes and Measures Cognitive outcomes were based on standard tests or diagnosis of cognitive impairment. Sleep-disordered breathing was ascertained by apnea-hypopnea index or clinical diagnosis. Results We included 14 studies, 6 of which were prospective, covering a total of 4 288 419 men and women. Pooled analysis of the 6 prospective studies indicated that those with SDB were 26% (risk ratio, 1.26; 95% CI, 1.05-1.50) more likely to develop cognitive impairment, with no evidence of publication bias but significant heterogeneity between studies. After removing 1 study that introduced significant heterogeneity, the pooled risk ratio was 1.35 (95% CI, 1.11-1.65). Pooled analysis of the 7 cross-sectional studies suggested that those with SDB had slightly worse executive function (standard mean difference, -0.05; 95% CI, -0.09 to 0.00), with no evidence of heterogeneity or publication bias. Sleep-disordered breathing was not associated with global cognition or memory. Conclusions and Relevance Sleep-disordered breathing is associated with an increased risk of cognitive impairment and a small worsening in executive function. Further studies are required to determine the mechanisms linking these common conditions and whether treatment of SDB might reduce risk of cognitive impairment.
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Affiliation(s)
- Yue Leng
- Department of Psychiatry, University of California,
San Francisco
| | - Claire T. McEvoy
- Department of Psychiatry, University of California,
San Francisco
- School of Medicine, Dentistry, and Biomedical
Sciences, Queen’s University, Belfast, United Kingdom
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics,
University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry, University of California,
San Francisco
- Department of Neurology, University of California, San
Francisco
- Department of Epidemiology, University of California,
San Francisco
- San Francisco VA Medical Center, San Francisco,
California
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Leng Y, McEvoy CT, Allen IE, Yaffe K. 0468 SLEEP-DISORDERED BREATHING, COGNITIVE FUNCTION AND RISK OF COGNITIVE DECLINE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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McEvoy CT, Guyer H, Langa KM, Yaffe K. Neuroprotective Diets Are Associated with Better Cognitive Function: The Health and Retirement Study. J Am Geriatr Soc 2017; 65:1857-1862. [PMID: 28440854 DOI: 10.1111/jgs.14922] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the association between the Mediterranean diet (MedDiet) and the Mediterranean-DASH diet Intervention for Neurodegeneration Delay (MIND diet) and cognition in a nationally representative population of older U.S. adults. DESIGN Population-based cross-sectional study. SETTING Health and Retirement Study. PARTICIPANTS Community-dwelling older adults (N = 5,907; mean age 67.8 ± 10.8). MEASUREMENTS Adherence to dietary patterns was determined from food frequency questionnaires using criteria determined a priori to generate diet scores for the MedDiet (range 0-55) and MIND diet (range 0-15). Cognitive performance was measured using a composite test score of global cognitive function (range 0-27). Linear regression was used to compare cognitive performance according to tertiles of dietary pattern. Logistic regression was used to examine the association between dietary patterns and clinically significant cognitive impairment. Models were adjusted for age, sex, race, educational attainment, and other health and lifestyle covariates. RESULTS Participants with mid (odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.71-1.02, P = .08) and high (OR 0.65, 95% CI = 0.52-0.81, P < .001) MedDiet scores were less likely to have poor cognitive performance than those with low scores in fully adjusted models. Results for the MIND diet were similar. Higher scores in each dietary pattern were independently associated with significantly better cognitive function (P < .001) in a dose-response manner (P trend < .001). CONCLUSION In a large nationally representative population of older adults, greater adherence to the MedDiet and MIND diet was independently associated with better cognitive function and lower risk of cognitive impairment. Clinical trials are required to elucidate the role of dietary patterns in cognitive aging.
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Affiliation(s)
- Claire T McEvoy
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Centre for Public Health, Queen's University Belfast, Northern Ireland, United Kingdom.,Global Brain Health Institute, University of California, San Francisco, San Francisco, California
| | - Heidi Guyer
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Kenneth M Langa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Division of General Medicine, Veterans Affairs Center for Practice Management and Outcomes Research, Institute of Gerontology, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Global Brain Health Institute, University of California, San Francisco, San Francisco, California.,Departments of Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
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39
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Wallace IR, McKinley MC, McEvoy CT, Hamill LL, Ennis CN, McGinty A, Bell PM, Patterson CC, Woodside JV, Young IS, Hunter SJ. Serum 25-hydroxyvitamin D and insulin resistance in people at high risk of cardiovascular disease: a euglycaemic hyperinsulinaemic clamp study. Clin Endocrinol (Oxf) 2016; 85:386-92. [PMID: 27175553 DOI: 10.1111/cen.13100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT In observational studies, low serum 25-hydroxyvitamin D (25-OHD) concentration is associated with an increased risk of type 2 diabetes mellitus (DM). Increasing serum 25-OHD may have beneficial effects on insulin resistance or beta-cell function. Cross-sectional studies utilizing suboptimal methods for assessment of insulin sensitivity and serum 25-OHD concentration provide conflicting results. OBJECTIVE This study examined the relationship between serum 25-OHD concentration and insulin resistance in healthy overweight individuals at increased risk of cardiovascular disease, using optimal assessment techniques. METHODS A total of 92 subjects (mean age 56·0, SD 6·0 years), who were healthy but overweight (mean body mass index 30·9, SD 2·3 kg/m(2) ), underwent assessments of insulin sensitivity (two-step euglycaemic hyperinsulinaemic clamp, HOMA2-IR), beta-cell function (HOMA2%B), serum 25-OHD concentration and body composition (DEXA). RESULTS Mean total 25-OHD concentration was 32·2, range 21·8-46·6 nmol/l. No association was demonstrated between serum 25-OHD concentration and insulin resistance. CONCLUSIONS In this study using optimal assessment techniques to measure 25-OHD concentration, insulin sensitivity and body composition, there was no association between serum 25-OHD concentration and insulin resistance in healthy, overweight individuals at high risk of developing cardiovascular disease. This study suggests the documented inverse association between serum 25-OHD concentration and risk of type 2 DM is not mediated by a relationship between serum 25-OHD concentration and insulin resistance.
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Affiliation(s)
- I R Wallace
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - M C McKinley
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - C T McEvoy
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - L L Hamill
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - C N Ennis
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - A McGinty
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - P M Bell
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - J V Woodside
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - I S Young
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK
| | - S J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
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McEvoy CT, Wallace IR, Hamill LL, Neville CE, Hunter SJ, Patterson CC, Woodside JV, Chakravarthy U, Young IS, McKinley MC. Increasing fruit and vegetable intake has no effect on retinal vessel caliber in adults at high risk of developing cardiovascular disease. Nutr Metab Cardiovasc Dis 2016; 26:318-325. [PMID: 27004617 DOI: 10.1016/j.numecd.2015.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Retinal vessel abnormalities are associated with cardiovascular disease (CVD) risk. To date, there are no trials investigating the effect of dietary factors on the retinal microvasculature. This study examined the dose response effect of fruit and vegetable (FV) intake on retinal vessel caliber in overweight adults at high CVD risk. METHODS AND RESULTS Following a 4 week washout period, participants were randomized to consume either 2 or 4 or 7 portions of FV daily for 12 weeks. Retinal vessel caliber was measured at baseline and post-intervention. A total of 62 participants completed the study. Self-reported FV intake indicated good compliance with the intervention, with serum concentrations of zeaxanthin and lutein increasing significantly across the groups in a dose-dependent manner (P for trend < 0.05). There were no significant changes in body composition, 24-h ambulatory blood pressure or fasting blood lipid profiles in response to the FV intervention. Increasing age was a significant determinant of wider retinal venules (P = 0.004) whereas baseline systolic blood pressure was a significant determinant of narrower retinal arterioles (P = 0.03). Overall, there was no evidence of any short-term dose-response effect of FV intake on retinal vessel caliber (CRAE (P = 0.92) or CRVE (P = 0.42)). CONCLUSIONS This study demonstrated no effect of increasing FV intake on retinal vessel caliber in overweight adults at high risk of developing primary CVD. CLINICAL TRIAL REGISTRATION NCT00874341.
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Affiliation(s)
- C T McEvoy
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - I R Wallace
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - L L Hamill
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - C E Neville
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - S J Hunter
- Regional Centre for Endocrinology & Diabetes, Belfast Health and Social Care Trust, Northern Ireland, UK
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - J V Woodside
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - U Chakravarthy
- Centre for Experimental Medicine, Queen's University Belfast, Northern Ireland, UK
| | - I S Young
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK
| | - M C McKinley
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.
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McEvoy CT, Wallace IR, Hamill LL, Hunter SJ, Neville CE, Patterson CC, Woodside JV, Young IS, McKinley MC. Increasing Fruit and Vegetable Intake Has No Dose-Response Effect on Conventional Cardiovascular Risk Factors in Overweight Adults at High Risk of Developing Cardiovascular Disease. J Nutr 2015; 145:1464-71. [PMID: 25972532 DOI: 10.3945/jn.115.213090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 03/03/2015] [Accepted: 04/21/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Improving diet and lifestyle is important for prevention of cardiovascular disease (CVD). Observational evidence suggests that increasing fruit and vegetable (FV) consumption may lower CVD risk, largely through modulation of established risk factors, but intervention data are required to fully elucidate the mechanisms by which FVs exert benefits on vascular health. OBJECTIVE The aim of this study was to examine the dose-response effect of FV intake on cardiovascular risk factors in adults at high CVD risk. METHODS This was a randomized controlled parallel group study involving overweight adults (BMI: >27 and ≤35 kg/m(2)) with a habitually low FV intake (≤160 g/d) and a high total risk of developing CVD (estimated ≥20% over 10 y). After a 4-wk run-in period where FV intake was limited to <2 portions/d (<160 g/d), 92 eligible participants were randomly assigned to 1 of 3 groups: to consume either 2, 4, or 7 portions (equivalent to 160 g, 320 g, or 560 g, respectively) of FVs daily for 12 consecutive weeks. Fasting venous blood samples were collected at baseline (week 4) and post-intervention (week 16) for analysis of lipid fractions and high-sensitivity C-reactive protein (hsCRP) concentrations. Compliance with the FV intervention was determined with use of self-reported FV intake and biomarkers of micronutrient status. Ambulatory blood pressure and body composition were also measured pre- and post-intervention. RESULTS A total of 89 participants completed the study and body composition remained stable throughout the intervention period. Despite good compliance with the intervention, no significant difference was found between the FV groups for change in measures of ambulatory blood pressure, plasma lipids, or hsCRP concentrations. CONCLUSIONS There was no evidence of a dose-response effect of FV intake on conventional CVD risk factors measured in overweight adults at high CVD risk. This trial was registered at clinicaltrials.gov as NCT00874341.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; and
| | - Ian R Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Lesley L Hamill
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; and
| | - Steven J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Charlotte E Neville
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; and
| | | | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; and
| | - Ian S Young
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; and
| | - Michelle C McKinley
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland; and
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McEvoy CT, Cardwell CR, Woodside JV, Young IS, Hunter SJ, McKinley MC. A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and meta-analysis. J Acad Nutr Diet 2014; 114:1759-75.e4. [PMID: 25001435 DOI: 10.1016/j.jand.2014.05.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 05/01/2014] [Indexed: 11/18/2022]
Abstract
Our review and meta-analysis examined the association between a posteriori-derived dietary patterns (DPs) and risk of type 2 diabetes mellitus. MEDLINE and EMBASE were searched for articles published up to July 2012 and data were extracted by two independent reviewers. Overall, 19 cross-sectional, 12 prospective cohort, and two nested case-control studies were eligible for inclusion. Results from cross-sectional studies reported an inconsistent association between DPs and measures of insulin resistance and/or glucose abnormalities, or prevalence of type 2 diabetes. A meta-analysis was carried out on nine prospective cohort studies that had examined DPs derived by principle component/factor analysis and incidence of type 2 diabetes risk (totaling 309,430 participants and 16,644 incident cases). Multivariate-adjusted odds ratios were combined using a random-effects meta-analysis. Two broad DPs (Healthy/Prudent and Unhealthy/Western) were identified based on food factor loadings published in original studies. Pooled results indicated a 15% lower type 2 diabetes risk for those in the highest category of Healthy/Prudent pattern compared with those in the lowest category (95% CI 0.80 to 0.91; P<0.0001). Compared with the lowest category of Unhealthy/Western DP, those in the highest category had a 41% increased risk of type 2 diabetes (95% CI 1.32 to 1.52; P<0.0001). These results provide evidence that DPs are consistently associated with risk of type 2 diabetes even when other lifestyle factors are controlled for. Thus, greater adherence to a DP characterized by high intakes of fruit, vegetables, and complex carbohydrate and low intakes of refined carbohydrate, processed meat, and fried food may be one strategy that could have a positive influence on the global public health burden of type 2 diabetes.
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McEvoy CT, Lawton J, Kee F, Young IS, Woodside JV, McBratney J, McKinley MC. Adolescents' views about a proposed rewards intervention to promote healthy food choice in secondary school canteens. Health Educ Res 2014; 29:799-811. [PMID: 24851865 DOI: 10.1093/her/cyu025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Using rewards may be an effective method to positively influence adolescent eating behaviour, but evidence regarding this approach is limited. The aim of this study was to explore young adolescent views about a proposed reward intervention associated with food choice in school canteens. Focus groups were held in 10 schools located in lower socioeconomic areas within Northern Ireland and involved 90 pupils aged 11-12 years (54 girls, 36 boys). Our findings indicated a high degree of acceptability for a reward scheme but there was major diversity in the type of rewards valued by pupils, largely defined by geographical area and socio-cultural differences. Pupils from rural areas tended to emphasize group-based and longer-term rewards, whereas pupils from urban-city schools tended to suggest individualistic and immediate rewards. The major factors influencing food choice were food price, value for money, taste and visual appearance. Pupils felt that factors outside of their control, such as being assigned to the second lunch sitting placed considerable constraints on their food choice. This research not only indicated a high degree of acceptability for a rewards-based intervention but also highlighted a number of socio-cultural and environmental factors that should be considered by researchers when developing such an intervention.
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Affiliation(s)
- C T McEvoy
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
| | - J Lawton
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
| | - F Kee
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
| | - I S Young
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
| | - J V Woodside
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
| | - J McBratney
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
| | - M C McKinley
- Centre for Public Health, Institute of Clinical Science B, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ, UK, Public Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK and Public Health Agency for Northern Ireland, Linenhall Street, Belfast BT2 8BS, UK
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Wallace IR, McEvoy CT, Hunter SJ, Hamill LL, Ennis CN, Bell PM, Patterson CC, Woodside JV, Young IS, McKinley MC. Dose-response effect of fruit and vegetables on insulin resistance in people at high risk of cardiovascular disease: a randomized controlled trial. Diabetes Care 2013; 36:3888-96. [PMID: 24130354 PMCID: PMC3836143 DOI: 10.2337/dc13-0718] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this randomized controlled trial was to investigate the dose-response effect of fruit and vegetable (F&V) intake on insulin resistance (IR) in people who are overweight and at high risk of cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS A total of 105 participants (mean age 56 years) followed a 4-week washout diet (one to two portions of F&Vs per day). Ninety-two participants completed the washout and were randomized to receive one to two, four, or seven portions of F&Vs per day for 12 weeks. IR was assessed at the start and end of this 12-week period by the two-step euglycemic-hyperinsulinemic clamp. Compliance was monitored using a combination of 4-day food diaries and plasma biomarkers of F&V intake. RESULTS A total of 89 participants completed the study. Participants attained self-reported F&V intakes of 1.8, 3.8, and 7.0 portions per day (P < 0.001) per group. There was a significant linear increase in serum lutein status across the groups, indicating good compliance (P < 0.001), and body weight was maintained (P = 0.77). No significant difference was found between groups in terms of a change in measures of whole-body, peripheral, or hepatic IR or adiponectin multimers. CONCLUSIONS Increased consumption of F&Vs, as advocated in public-health advice, has no effect on IR in overweight individuals who are at high risk of CVD when body weight is maintained. Recent evidence from systematic reviews indicates that particular classes or types of F&Vs may have particular antidiabetic properties; hence, it is possible that benefits may only be observed in response to a more specific fruit or vegetable intervention.
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McEvoy CT, Cardwell CR, Chakravarthy U, Hogg RE, McKinley MC, Young IS, Fletcher AE, Woodside JV. A Posteriori–Derived Dietary Patterns and Retinal Vessel Caliber in an Elderly Population. ACTA ACUST UNITED AC 2013; 54:1337-44. [DOI: 10.1167/iovs.12-11065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Usha Chakravarthy
- Centre for Vision and Vascular Science, Queen's University Belfast, Belfast, United Kingdom; and the
| | - Ruth E. Hogg
- Centre for Vision and Vascular Science, Queen's University Belfast, Belfast, United Kingdom; and the
| | | | | | - Astrid E. Fletcher
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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McEvoy CT, Temple N, Woodside JV. Vegetarian diets, low-meat diets and health: a review. Public Health Nutr 2012; 15:2287-94. [PMID: 22717188 PMCID: PMC10271837 DOI: 10.1017/s1368980012000936] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 12/05/2011] [Accepted: 02/17/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review the epidemiological evidence for vegetarian diets, low-meat dietary patterns and their association with health status in adults. DESIGN Published literature review focusing primarily on prospective studies and meta-analyses examining the association between vegetarian diets and health outcomes. RESULTS Both vegetarian diets and prudent diets allowing small amounts of red meat are associated with reduced risk of diseases, particularly CHD and type 2 diabetes. There is limited evidence of an association between vegetarian diets and cancer prevention. Evidence linking red meat intake, particularly processed meat, and increased risk of CHD, cancer and type 2 diabetes is convincing and provides indirect support for consumption of a plant-based diet. CONCLUSIONS The health benefits of vegetarian diets are not unique. Prudent plant-based dietary patterns which also allow small intakes of red meat, fish and dairy products have demonstrated significant improvements in health status as well. At this time an optimal dietary intake for health status is unknown. Plant-based diets contain a host of food and nutrients known to have independent health benefits. While vegetarian diets have not shown any adverse effects on health, restrictive and monotonous vegetarian diets may result in nutrient deficiencies with deleterious effects on health. For this reason, appropriate advice is important to ensure a vegetarian diet is nutritionally adequate especially for vulnerable groups.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science B, Belfast, UK.
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McEvoy CT, Cran GW, Cooke SR, Young IS. Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: comparison of prediction equations with indirect calorimetry values. Clin Nutr 2009; 28:526-32. [PMID: 19423202 DOI: 10.1016/j.clnu.2009.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Little is known about energy requirements in brain injured (TBI) patients, despite evidence suggesting adequate nutritional support can improve clinical outcomes. The study aim was to compare predicted energy requirements with measured resting energy expenditure (REE) values, in patients recovering from TBI. METHODS Indirect calorimetry (IC) was used to measure REE in 45 patients with TBI. Predicted energy requirements were determined using FAO/WHO/UNU and Harris-Benedict (HB) equations. Bland-Altman and regression analysis were used for analysis. RESULTS One-hundred and sixty-seven successful measurements were recorded in patients with TBI. At an individual level, both equations predicted REE poorly. The mean of the differences of standardised areas of measured REE and FAO/WHO/UNU was near zero (-9 kcal) but the variation in both directions was substantial (range -591 to +573 kcal). Similarly, the differences of areas of measured REE and HB demonstrated a mean of 1.9 kcal and range -568 to +571 kcal. Glasgow coma score, patient status, weight and body temperature were significant predictors of measured REE (p<0.001; R(2)=0.47). CONCLUSIONS Clinical equations are poor predictors of measured REE in patients with TBI. The variability in REE is substantial. Clinicians should be aware of the limitations of prediction equations when estimating energy requirements in TBI patients.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queens University Belfast, BT12 6BJ, Northern Ireland, UK.
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