Behnaz Shakersain

Prudent diet may attenuate the adverse effects of Western diet on cognitive decline

The influence of mixed dietary patterns on cognitive changes is unknown.

Sociodemographic determinants of diet quality of the EU elderly: a comparative analysis in four countries

OBJECTIVE To investigate the sociodemographic determinants of diet quality of the elderly in four EU countries. DESIGN Cross-sectional study. For each country, a regression was performed of a multidimensional index of dietary quality v. sociodemographic variables. SETTING In Finland, Finnish Household Budget Survey (1998 and 2006); in Sweden, SNAC-K (2001-2004); in the UK, Expenditure & Food Survey (2006-07); in Italy, Multi-purpose Survey of Daily Life (2009). SUBJECTS One- and two-person households of over-50s (Finland, n 2994; UK, n 4749); over-50 s living alone or in two-person households (Italy, n 7564); over-60 s (Sweden, n 2023). RESULTS Diet quality among the EU elderly is both low on average and heterogeneous across individuals. The regression models explained a small but significant part of the observed heterogeneity in diet quality. Resource availability was associated with diet quality either negatively (Finland and UK) or in a non-linear or non-statistically significant manner (Italy and Sweden), as was the preference for food parameter. Education, not living alone and female gender were characteristics positively associated with diet quality with consistency across the four countries, unlike socio-professional status, age and seasonality. Regional differences within countries persisted even after controlling for the other sociodemographic variables. CONCLUSIONS Poor dietary choices among the EU elderly were not caused by insufficient resources and informational measures could be successful in promoting healthy eating for healthy ageing. On the other hand, food habits appeared largely set in the latter part of life, with age and retirement having little influence on the healthiness of dietary choices.

Impact of living alone on institutionalization and mortality: a population-based longitudinal study

BACKGROUND Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people. METHODS Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged ≥66 years and living at home (n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders. RESULTS Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk. CONCLUSIONS Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

Nutritional status and survival among old adults: an 11-year population-based longitudinal study

Background/Objectives:The impact of nutritional status on survival among community-dwelling older adults is unclear. We aimed to investigate the prevalence and association of poor nutritional status, including malnutrition and risk for malnutrition defined by the Mini-Nutritional Assessment-Short Form (MNA-SF) with survival, and to explore the role of relevant biomarkers (hemoglobin, albumin and C-reactive protein) in this association.Subjects/Methods:This study included 3041 participants aged ⩾60 in the Swedish National study on Aging and Care-Kungsholmen. On the basis of the total score in MNA-SF, nutritional status for each participant was assessed as normal (score 12–14), risk for malnutrition (8–11) or malnutrition (<8). Over an 11-year follow-up, survival status was observed. Data were analysed using logistic regression, flexible parametric survival and Laplace models.Results:Of all the participants, 51 (1.7%) had malnutrition and 751 (24.7%) were at risk for malnutrition. The multi-adjusted hazard ratio (95% confidence interval) of mortality was 2.40 (1.56−3.67; P<0.001) for malnutrition and 1.49 (1.29−1.71; P<0.001) for risk for malnutrition. The median ages at death of participants with malnutrition and risk for malnutrition were ~3 and 1.5 years shorter than those with normal nutritional status, respectively, whereas malnutrition or risk for malnutrition together with abnormal biomarker (hemoglobin and albumin) levels was related to 1 year more shortened survival.Conclusions:Malnutrition and risk for malnutrition are highly prevalent and significantly associated with a shorter survival. Poor nutritional status in combination with abnormalities in the biomarkers is associated with even more shortened survival.

The Nordic Prudent Diet Reduces Risk of Cognitive Decline in the Swedish Older Adults: A Population-Based Cohort Study

Appropriate dietary pattern for preserving cognitive function in northern Europe remains unknown. We aimed to identify a Nordic dietary pattern index associated with slower cognitive decline compared to the Mediterranean-DASH Intervention for Neurodegenerative Delay, Mediterranean Diet, Dietary Approaches to Stop Hypertension, and Baltic Sea Diet indices. A total of 2223 dementia-free adults aged ≥60 were followed for 6 years. Mini-Mental State Examination was administrated at baseline and follow-ups. Dietary intake was assessed by 98-item food frequency questionnaire, and the Nordic Prudent Dietary Pattern (NPDP) was identified. Data were analysed using mixed-effects and parametric survival models and receiver operating characteristic curves with adjustment for potential confounders. Moderate (β = 0.139, 95% CI 0.077−0.201) and high adherence (β = 0.238, 95% CI 0.175−0.300) to NPDP were associated with less cognitive decline compared to other four indices. High adherence to NPDP was also associated with the lowest risk of MMSE decline to ≤24 (HR = 0.176, 95% CI 0.080−0.386) and had the greatest ability to predict such decline (area under the curve = 0.70). Moderate-to-high adherence to the NPDP may predict a better-preserved cognitive function among older adults in Nordic countries. Regional dietary habits should be considered in developing dietary guidelines for the prevention of cognitive impairment and dementia.

Adherence to prudent diet attenuates the adverse effect of western diet on cognitive decline

Background:The purpose of this 3 year-longitudinal observational study was to investigate the effects of inequalities in socioeconomic status (SES) on cognitive impairment in a total of 136,217 elderly with normal cognition. Methods: SES was subdivided in to two groups based on the type of health care services provided by the Korean government; the lower SES for “Medical Aid” services, the higher SES for “National Health Insurance” services. Cognitive function was measured by the Korean version of Mini-Mental Status Examination. The Kaplan-Meier method was used to estimate overall time of development for cognitive impairment. The Coxproportional hazard model was used to explore the significant risk factors for incidence of cognitive impairment and to calculate the hazard ratio for incidence of cognitive impairment between lower and higher SES. Results: Our results showed that those from the lower SES group were older, less educated and had a higher percentage of cardiovascular risk factors and showed less health-related behaviors at the baseline. The cumulative incidence rate (CIR) for cognitive impairment in lower SES was 8.65% whereas the CIR in higher SES was 4.08% (p<0.001). The lower SES group had a 1.66 times higher risk of developing cognitive impairment compared to the higher SES (HR 1.62, 95% CI 1.491.77) even after all the different risk factors at the baseline were adjusted. Conclusions:From our study, we found that SES inequalities in the elderly may contribute to disparities in the incidence of cognitive impairment. Efforts to reduce this gap could be an important goal to determine public health policy for the elderly.

An Active Lifestyle Reinforces the Effect of a Healthy Diet on Cognitive Function: A Population-Based Longitudinal Study

The joint effect of diet and leisure activity on cognitive function remains unknown. We aimed to verify the hypothesis that an active lifestyle reinforces the effect of the Nordic Prudent Dietary Pattern (NPDP) on cognitive function. A total of 2223 dementia-free Swedish adults aged ≥60 with Mini-Mental State Examination (MMSE) scores ≥27 were followed for an average of 6 years. MMSE was tested during follow-ups. Diet was assessed by food frequency questionnaire. The NPDP index was calculated and tertiled (low, moderate, and high adherence). Participation in physical, mental and social activities was trichotomised (low, moderate, and intense). An active lifestyle was defined based on the participation in each activity. Data were analyzed using mixed-effects models. Moderate-to-high adherence to NPDP was associated with a reduced decline in the MMSE score (β: 0.19, 95% Confidence Interval (CI): 0.14–0.24). This association became stronger when combined with moderate-to-intense physical (β: 0.34, 95% CI: 0.2–0.45), mental (β: 0.29, 95% CI: 0.21–0.37), or social (β: 0.27, 95% CI: 0.19–0.34) activities. An active lifestyle strengthened the effect of NPDP on cognitive function by two times, and further lowered risk of MMSE decline by 30%. Thus, an active lifestyle reinforces the effect of a healthy diet on preserved cognitive function, and further decreases the risk of cognitive decline.

WHICH DIETARY INDEX MAY PREDICT PRESERVED COGNITIVE FUNCTION IN NORDIC OLDER ADULTS

measures using a talk aloud approach. A subset of interviews was conducted with dementia care practitioners (N1⁄4 55). Findings were analyzed using a thematic approach assisted by Atlas.ti. Results:The internal and external physical environment as a specific source of stress was less understood by participants, carers and practitioners. While dyads often made adjustments to mediate the strain caused by perceptual challenges these were largely ‘trial and error’ attempts rather than in response to research informed advice normally available for other stressors associated with dementia. Additionally, the strain associated with the physical environment was layered with strain that originated in the psychosocial environment and these interacted with one another in a complex manner. Conclusions: The SPM provided a helpful, but sometimes limited, understanding of the illness and caring experience by highlighting the nature of various psychosocial stressors and adaptations over time to minimize their impact. While physical environmental interventions would seem to logically function as a mediator to prevent stress proliferation, the nature of them, their timing and how they are delivered remains unknown. Additionally, the SPM does not adequately capture the intersection between stressors and strains within a dyad or family and how these systems navigate the illness experience over time.