C.P.G.M. de Groot

Effect of fish oil on cognitive performance in older subjects A randomized, controlled trial

Background: High intake of n-3 polyunsaturated fatty acids may protect against age-related cognitive decline. However, results from epidemiologic studies are inconclusive, and results from randomized trials in elderly subjects without dementia are lacking. Objective: To investigate the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on cognitive performance. Methods: Double-blind, placebo-controlled trial involving 302 cognitively healthy (Mini-Mental State Examination score > 21) individuals aged 65 years or older. Participants were randomly assigned to 1,800 mg/d EPA–DHA, 400 mg/d EPA–DHA, or placebo capsules for 26 weeks. Cognitive performance was assessed using an extensive neuropsychological test battery that included the cognitive domains of attention, sensorimotor speed, memory, and executive function. Results: The mean age of the participants was 70 years, and 55% were male. Plasma concentrations of EPA–DHA increased by 238% in the high-dose and 51% in the low-dose fish oil group compared with placebo, reflecting excellent compliance. Baseline scores on the cognitive tests were comparable in the three groups. Overall, there were no significant differential changes in any of the cognitive domains for either low-dose or high-dose fish oil supplementation compared with placebo. Conclusions: In this randomized, double-blind, placebo-controlled trial, we observed no overall effect of 26 weeks of eicosapentaenoic acid and docosahexaenoic acid supplementation on cognitive performance.

Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project.

Objective:To investigate and compare the associations between dietary patterns and mortality using different European indexes of overall dietary quality.Design, Setting and Participants:The HALE (Healthy Ageing: a Longitudinal study in Europe) population includes 2068 men and 1049 women, aged between 70 and 90 years of 10 European countries. Subjects were followed for 10 years. This cohort study was conducted between 1988 and 2000.Results:During the follow-up period, 1382 people died. The Mediterranean Diet Score (MDS) (HR: 0.82 with 95% CI: 0.75–0.91), the Mediterranean Adequacy Index (MDI) (HR: 0.83 with 95% CI: 0.75–0.92) and the Healthy Diet Indicator (HDI)(HR: 0.89 with 95% CI: 0.81–0.98) were inversely associated with all-causes mortality. Adjustments were made for age, gender, alcohol consumption, physical activity, smoking, number of years of education, body mass index, chronic diseases at baseline and study centre.Conclusions:The MDS, the MDI and the HDI were significantly inversely related with mortality.Sponsorship:This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000–00211) to D Kromhout.

Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients.

Objectives: To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight, plasma nutrients and activities of daily life.Design: Double-blind, placebo-controlled 12-week intervention study.Setting: Two nursing homes in Boxtel, The Netherlands.Subjects: Forty-two (body mass index (BMI) <23 kg/m2 for men or <25 kg/m2 for women) psycho-geriatric nursing home patients aged 60 y or over.Interventions: Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ (135 kcal) or placebo twice daily during daytime between main meals. Study parameters were assessed at 0, 6 and 12 weeks.Main Outcome for Measures: Weight, Barthel index of daily activities, several plasma values (albumin, C-reactive protein (CRP), homocysteine, thiamine, thiamine diphosphate (TDF), vitamin B6, vitamin B12, folic acid, vitamin D), bowel function.Results: The supplement was well accepted. Thirty-five patients completed the intervention period (16 control group; 19 supplement group). Baseline daily nutrient intake was low. A statistically significant improvement was observed for body weight (difference between groups 2.2 kg, P=0.03), and homocysteine, vitamin B1, TDF, vitamin B6, vitamin B12, folate and vitamin D in the supplement group compared to the placebo group. No significant difference was observed in the Barthel index (mean difference −0.3±1.1 for both groups). No difference in occurrence of diarrhoea was observed.Conclusions: The study shows that nutritional supplementation is well accepted and can improve the nutritional status of psycho-geriatric nursing home patients.Sponsorship: Numico Research BV.

ENERGY INTAKE AND MICRONUTRIENT INTAKE IN ELDERLY EUROPEANS : SEEKING THE MINIMUM REQUIREMENT IN THE SENECA STUDY

OBJECTIVE To examine energy intake of elderly people participating in the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA) study in relation to the adequacy of micronutrient intake. DESIGN Data from eight countries on 486 men and 519 women who were 74-79 years old. Dietary intakes of energy, iron, thiamine, riboflavin and pyridoxine were calculated. RESULTS There was inadequate intake of one or more nutrients in 23.9% of men and 46.8% of women. The prevalence of inadequate intakes decreased gradually with higher energy intakes. Of all people with energy intakes exceeding 1500 kcal, 19% of men and 26% of women still had an inadequate intake of at least one micronutrient. CONCLUSION We found no single criterion ensuring level of energy intake with an adequate micronutrient supply. The prevalence of an inadequate intake of micronutrients was high at all energy intake levels, especially in women.

Dietary intake and status of folate and vitamin B12 and their association with homocysteine and cardiovascular disease in European populations

Background/Objectives:Folate and vitamin B12 have been suggested to play a role in chronic diseases like cardiovascular diseases. The objectives are to give an overview of the actual intake and status of folate and vitamin B12 in general populations in Europe, and to evaluate these in view of the current vitamin recommendations and the homocysteine concentration.Methods:Searches in Medline with ‘folic acid’, ‘folate’ and ‘vitamin B12’, ‘B12’ or ‘cobalamin’ as key words were combined with the names of the European countries. Populations between 18 and 65 years were included.Results:Sixty-three articles reporting on studies from 15 European countries were selected. Low folate intakes were observed in Norway, Sweden, Denmark and the Netherlands. Low intakes of vitamin B12 were not common and only seen in one small Greek study. In the countries with a low intake of folate, the recommended levels were generally not achieved, which was also reflected in the folate status. Vitamin B12 intake was not strongly associated with the vitamin B12 status, which can explain why in the Netherlands and Germany the vitamin B12 status was inadequate, despite sufficient intake levels. In countries with a low folate intake in particular, the Hcy concentration was higher than ideal.Conclusions:Populations from the Nordic countries, the Netherlands, Germany and Greece may need to improve their intakes of folic acid, B12 or both to either meet the recommendations or to optimize their statuses. This could be achieved via a food-based approach, food fortification or supplements.

Genetic factors as predictors of weight gain in young adult Dutch men and women

OBJECTIVE: To investigate the association between DNA polymorphisms in several candidate genes for obesity and weight gain. Polymorphisms in these genes may contribute to weight gain through effects on energy intake, energy expenditure or adipogenesis.DESIGN AND METHODS: From two large cohorts in the Netherlands (total 17 500 adult men and women), we compared 286 subjects aged 20–40 y who gained an average of 12.8 kg (range 5.5–47 kg) during a mean follow-up of 6.8 y with 296 subjects who remained relatively constant over the same period with respect to occurrence of several polymorphisms in candidate genes of obesity and some lifestyle factors. Subjects who were dieting, were high alcohol consumers, were pregnant, changed their smoking status recently, or those who suffered from serious illnesses were excluded. Polymorphisms were determined in the LEPR-gene (LEPR Lys109Arg, LEPR Gln223Arg, LEPR Lys656Asn), in the UCP1 gene (A–G mutation at position-3826 5′region), in the UCP2 gene (Ala55Val, 45 bp Ins/Del), in the PPARG2 gene (Prol2Ala) and in the ADRB2 gene (Gly16Arg and Gln27Glu).RESULTS: With the exception of the Gly16Arg polymorphism in the ADRB2 gene in men (P=0.04) and women (P=0.05), and the Lys109Arg polymorphism in the LEPR gene in women, no statistically significant differences in the genotype and allele frequencies were observed between weight gainers and non-weight gainers. Weight gainers differed in some aspects of dietary habits and physical activity patterns: weight gainers consumed relatively more savory snacks and were less active during leisure time compared with non-weight gainers.CONCLUSION: Only variations in the ADRB2 gene and LEPR gene, may contribute to susceptibility to weight gain. None of the other studied genetic markers were clearly associated with weight gain. Further research is necessary to establish the role of lifestyle factors, or interactions between genes or between genes and lifestyle factors on weight gain with age.

Dietary supplements and physical exercise affecting bone and body composition in frail elderly persons.

OBJECTIVES This study determined the effect of enriched foods and all-around physical exercise on bone and body composition in frail elderly persons. METHODS A 17-week randomized, controlled intervention trial, following a 2 x 2 factorial design--(1) enriched foods, (2) exercise, (3) both, or (4) neither--was performed in 143 frail elderly persons (aged 78.6 +/- 5.6 years). Foods were enriched with multiple micronutrients; exercises focused on skill training, including strength, endurance, coordination, and flexibility. Main outcome parameters were bone and body composition. RESULTS Exercise preserved lean mass (mean difference between exercisers and non-exercisers: 0.5 kg +/- 1.2 kg; P < .02). Groups receiving enriched food had slightly increased bone mineral density (+0.4%), bone mass (+0.6%), and bone calcium (+0.6%) compared with groups receiving non-enriched foods, in whom small decreases of 0.1%, 0.2%, and 0.4%, respectively, were found. These groups differed in bone mineral density (0.006 +/- 0.020 g/cm2; P = .08), total bone mass (19 +/- g; P = .04), and bone calcium (8 +/- 21 g; P = .03). CONCLUSIONS Foods containing a physiologic dose of micronutrients slightly increased bone density, mass, and calcium, whereas moderately intense exercise preserved lean body mass in frail elderly persons.

On-Line Detection of Antioxidative Activity in High-Performance Liquid Chromatography Eluates by Chemiluminescence

Luminol chemiluminescence (CL) was employed for the on-line detection of radical scavengers in HPLC eluates. Optimization of CL reagents and instrumental setup resulted in a steady postcolumn luminol photochemical reaction in the presence of microperoxidase and hydrogen peroxide at pH 10. Quenching of the CL signal was utilized to detect radical scavenging activity of both natural and synthetic antioxidants at the nanogram level. The detection system can be used with isocratic or gradient elution. Several antioxidative compounds were detected in thyme and sage acetone extracts. Quantitative results can be obtained when antioxidants are analyzed at certain concentrations. The method is suitable for rapid screening of antioxidants in crude extracts.

Undernutrition in the European SENECA studies.

The SENECA study, which sampled a cohort of community-dwelling persons born between 1913 and 1918 in 12 European countries in baseline (1988), follow up (1993), and final (1999) surveys, found a relatively high risk of malnutrition despite a low prevalence of actual malnourishment. The results point out the importance of monitoring nutritional status in healthy elderly adults.

Vitamin B12, Folate, Homocysteine, and Bone Health in Adults and Elderly People: A Systematic Review with Meta-Analyses

Elevated homocysteine levels and low vitamin B12 and folate levels have been associated with deteriorated bone health. This systematic literature review with dose-response meta-analyses summarizes the available scientific evidence on associations of vitamin B12, folate, and homocysteine status with fractures and bone mineral density (BMD). Twenty-seven eligible cross-sectional (n = 14) and prospective (n = 13) observational studies and one RCT were identified. Meta-analysis on four prospective studies including 7475 people showed a modest decrease in fracture risk of 4% per 50 pmol/L increase in vitamin B12 levels, which was borderline significant (RR = 0.96, 95% CI = 0.92 to 1.00). Meta-analysis of eight studies including 11511 people showed an increased fracture risk of 4% per μmol/L increase in homocysteine concentration (RR = 1.04, 95% CI = 1.02 to 1.07). We could not draw a conclusion regarding folate levels and fracture risk, as too few studies investigated this association. Meta-analyses regarding vitamin B12, folate and homocysteine levels, and BMD were possible in female populations only and showed no associations. Results from studies regarding BMD that could not be included in the meta-analyses were not univocal.