Consumption of dietary nuts in midlife and risk of cognitive impairment in late-life: the Singapore Chinese Health Study

Abstract Background evidence from prospective studies investigating the association between consumption of nuts in midlife and risk of cognitive impairment in late life is limited. Methods this study analysed data from 16,737 participants in a population-based cohort, the Singapore Chinese Health Study. Intake of nuts was assessed using a validated food-frequency questionnaire at baseline (1993–1998), when participants were 45–74 years old (mean age = 53.5 years). Cognitive function was tested using the Singapore modified Mini-Mental State Examination during the third follow-up visit (2014–2016), when participants were 61–96 years old (mean age = 73.2 years). Cognitive impairment was defined using education-specific cut-off points. Logistic regression models were used to estimate the odds ratio (OR) and the 95% confidence interval (CI) for the association between intake and risk of cognitive impairment. Results cognitive impairment was identified in 2,397 (14.3%) participants. Compared with those who consumed <1 serving/month of nuts, participants who consumed 1–3 servings/month, 1 serving/week and ≥2 servings/week had 12% (95% CI 2–20%), 19% (95% CI 4–31%) and 21% (2–36%) lower risk of cognitive impairment, respectively (P-trend = 0.01). Further adjustment for intake of unsaturated fatty acids attenuated the association to non-significance. Mediation analysis showed that the 50.8% of the association between nuts and risk of cognitive impairment was mediated by the intake of total unsaturated fatty acids (P < 0.001). Conclusion higher intake of nuts in midlife was related to a lower risk of cognitive impairment in late life, which was partly mediated by unsaturated fatty acids.

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Dietary Intakes of Fatty Acids in Midlife and Risk of Cognitive Impairment in Late Life: The Singapore Chinese Health Study (P01-009-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz028.p01-009-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Yiwen Jiang ◽

Liting Sheng ◽

Jian-Min Yuan ◽

Woon-Puay Koh ◽

An Pan

Keyword(s):

Fatty Acids ◽

Cognitive Impairment ◽

Lower Risk ◽

Health Study ◽

Fat Intake ◽

Dietary Intakes ◽

Chinese Adults ◽

Total Carbohydrate ◽

Singapore Chinese

Abstract Objectives We aimed to examine the association between dietary intakes of fat and risk of cognitive impairment in Chinese adults, which has rarely been evaluated. Methods The Singapore Chinese Health Study is an ongoing cohort among Chinese adults living in Singapore. Dietary information was assessed by a validated food-frequency questionnaire at baseline (1993–1998) when the participants were aged 45–74 years old. Cognitive impairment was identified using modified Singapore version of Mini-Mental State Examination at the 3rd follow-up interviews (2014–2016). After a mean follow-up of 19.7 years, 16,948 surviving participants was included in the final analysis. Multivariable logistic regression models were used to calculate odds ratio (OR) and 95% confidence interval (CI) with adjustment for potential confounders. Results Cognitive impairment was presented in 2443 participants. Compared to total carbohydrate, dietary fat intake was inversely related to cognitive impairment (OR comparing extreme quartiles = 0.82; 95% CI 0.69–0.97; P-trend = 0.008). The OR (95% CI) comparing extreme quartiles of specific dietary fats was 1.08 (0.89–1.31) for saturated fatty acids (SFAs; P-trend = 0.50), 0.81 (0.65–1.00) for monounsaturated fatty acids (MUFAs; P-trend = 0.03), 0.83 (0.71–0.97) for polyunsaturated fatty acids (PUFAs; P-trend < 0.001), 0.92 (0.77–1.10) for n-3 PUFAs (P-trend = 0.49), and 0.83 (0.71–0.99) for n-6 PUFAs (P-trend = 0.01). Plant-based fat showed an inverse association with cognitive impairment (OR 0.84; 95% CI 0.72–0.98; P-trend = 0.02), whereas no significant association was found for animal fat (P-trend = 0.97). When compared to SFAs, inverse associations remained similar for MUFAs (P-trend = 0.03) and PUFAs (P-trend < 0.001). Conclusions In this large population-based cohort in Chinese adults, we found that substitution of total carbohydrate or SFAs with MUFAs and PUFAs, mainly n-6 PUFAs, was related to a lower risk of cognitive impairment. Furthermore, plant-based fat intake was associated with a lower risk. Our results indicate the importance of considering the quality of fat intake in preventing cognitive impairment. Funding Sources National Medical Research Council, Singapore; National Institutes of Health; National Key Research and Development Program of China. Supporting Tables, Images and/or Graphs

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Relation of cigarette smoking and alcohol drinking in midlife with risk of cognitive impairment in late life: the Singapore Chinese Health Study

Age and Ageing ◽

10.1093/ageing/afy166 ◽

2018 ◽

Vol 48 (1) ◽

pp. 101-107 ◽

Cited By ~ 2

Author(s):

Jing Wu ◽

Wenhong Dong ◽

Xiong-Fei Pan ◽

Lei Feng ◽

Jian-Min Yuan ◽

...

Keyword(s):

Cognitive Impairment ◽

Cigarette Smoking ◽

Alcohol Drinking ◽

Late Life ◽

Health Study ◽

Singapore Chinese

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The relation between dietary phytochemical index and metabolic syndrome and its components in a large sample of Iranian adults: A population-based study

10.21203/rs.3.rs-37118/v1 ◽

2020 ◽

Author(s):

Aazam ahmadi Vasmehjani ◽

Zahra Darabi ◽

azadeh Nadjarzadeh ◽

masoud Mirzaei ◽

Mahdieh Hosseinzadeh

Keyword(s):

Metabolic Syndrome ◽

Energy Intake ◽

Lower Risk ◽

Binary Logistic Regression ◽

Population Based ◽

Protective Role ◽

Food Sources ◽

Health Study ◽

Plant Foods ◽

Logistic Regression Models

Abstract Background: Phytochemicals are natural non-nutritive bioactive compounds in plant foods. There is growing agreement that plant foods-based phytochemicals have a protective role against chronic diseases. The purpose of current study was to appraise Dietary Phytochemical Index (DPI) with the risk of metabolic syndrome (MetS) and its components.Methods: This study was conducted on 2326 participants (1097 men and 1220 women), aged 20-70 years of the recruitment phase of Yazd Health Study (YaHS), a population-based cohort study on Iranian adults. Dietary intake was prepared using a validated and reliable food frequency questionnaire. DPI is calculated based on dietary energy derived from phytochemical-rich food sources (kcal)/ total daily energy intake (kcal). The odds ratio of MetS and its components were assessed across DPI quartiles by binary logistic regression models.Results: After adjustment for all potential confounders, the risk of MetS (OR=0.63, 95% CI=0.41-0.96, P=0.03) and elevated blood pressure (OR=0.62, 95% CI=0.40-0.96, P=0.03) in second category of DPI compared to the first significantly decreased. After full adjustment for confounders, women in the highest quartile of DPI compared with the lowest, had 59% lower risk of MetS (OR=0.41, 95% CI=0.22-0.76, P=0.005). In second quartiles of DPI, the risk of MetS decreased by 62% (OR=0.38, 95% CI=0.16-0.90, P=0.02) in participants with normal BMI and 29% in subjects with high BMI (OR=0.71, 95% CI=0.52-0.99, P=0.04), and also 57% in men (OR=0.43, 95%CI=0.23-0.83, P=0.01). Independent of variables including age, sex and total energy intake, subjects in second and fourth quartiles of DPI had 30% and 25% lower risk of abdominal obesity, respectively.Conclusions: Greater adherence to phytochemical-rich diet could reduce odds of MetS and some components especially in women. Further studies with intervention approaches are required to discover causal relations and relevant underlying mechanisms.

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Association Between Dietary Intakes of B Vitamins in Midlife and Cognitive Impairment in Late-Life: The Singapore Chinese Health Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glz125 ◽

2019 ◽

Vol 75 (6) ◽

pp. 1222-1227

Author(s):

Li-Ting Sheng ◽

Yi-Wen Jiang ◽

Xiong-Fei Pan ◽

Lei Feng ◽

Jian-Min Yuan ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Chinese Population ◽

Late Life ◽

Epidemiological Studies ◽

B Vitamins ◽

Health Study ◽

Dependent Manner ◽

Dietary Intakes ◽

Singapore Chinese

Abstract Background Dietary intakes of B vitamins (eg, folate) are related to cognitive function according to epidemiological studies in western countries. But prospective studies in Asian populations are scarce. This study evaluated the relationships of dietary intakes of six B vitamins in midlife with cognitive impairment in old age in a Chinese population living in Singapore. Methods This study included 16,948 participants from the Singapore Chinese Health Study, a population-based prospective cohort. Baseline dietary intakes of B vitamins were assessed using a validated 165-item food frequency questionnaire when the participants were aged 45–74 years (1993–1998). After an average follow-up of 20 years, cognitive function was examined using a Singapore-modified version of Mini-Mental State Examination scale in 2014–2016, and cognitive impairment was defined using education-specific cutoffs. Logistic regression models were applied to estimate the association between B vitamins and cognitive impairment. All the six B vitamins were mutually adjusted in the final model. Results In the 2014–2016 interview, 2,443 participants were defined as cognitive impairment. Riboflavin and folate were significantly and independently associated with cognitive impairment in a dose-dependent manner: the odds ratio (95% confidence interval) comparing the highest with the lowest quartile was 0.82 (0.69, 0.97) for riboflavin and 0.83 (0.70, 0.98) for folate (both p-trend <.05). Dietary intakes of thiamine, niacin, vitamin B-6, and B-12 were not significantly associated with risk of cognitive impairment. Conclusions Higher dietary intakes of riboflavin and folate in midlife were associated with a lower risk of cognitive impairment in late-life in the Chinese population.

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Factors Associated With Social Isolation Among Older Adults: The Singapore Chinese Health Study

Innovation in Aging ◽

10.1093/geroni/igaa057.543 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Jon Barrenetxea ◽

Yang Yi ◽

Woon Puay Koh ◽

Feng Qiushi

Keyword(s):

Social Support ◽

Older Adults ◽

Cognitive Impairment ◽

Social Isolation ◽

Well Being ◽

Population Based ◽

Living Alone ◽

Health Study ◽

Factors Associated ◽

Singapore Chinese

Abstract Social isolation is a determinant of mortality and well-being among older people. Factors associated with isolation could be different in societies where older adults live mainly with family, as individuals might feel isolated despite living with others. We studied the factors associated with isolation among 16,948 older adults from follow-up 3 of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age of 73, range: 61-96 years). We defined social isolation as having “zero hour per week” of participation in social activities involving 3 or more people and scoring the lowest decile on the Duke Social Support Scale of perceived social support. We used multivariable logistic regressions to compute odds ratio (OR) and 95% confidence interval (CI) for factors associated with likelihood of social isolation. Although only 14.4% of isolated participants lived alone, living alone remained a significant factor associated with isolation (OR 1.93, 95% CI 1.58-2.35), together with cognitive impairment (OR 1.73, 95% CI 1.46-2.04) and depression (OR 2.44, 95% CI 2.12-2.80). Higher education level was inversely associated with isolation (p for trend<0.001). In stratified analysis, among those living alone, compared to women, men had higher odds of social isolation (OR 2.18, 95% CI 1.43-3.32) than among those not living alone (OR 0.99, 95% CI 0.84-1.17) (p for interaction<0.001). Our results showed that living alone, cognitive impairment and depression were indicators of isolation among older Singaporeans. In addition, among those living alone, men were more likely to experience social isolation than women.

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Midlife Plasma Aβ and Late-Life Risk of Cognitive Impairment: The Atherosclerosis Risk in Communities Study

Innovation in Aging ◽

10.1093/geroni/igaa057.810 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 251-252

Author(s):

Kevin Sullivan ◽

Chad Blackshear ◽

A Richey Sharrett ◽

Rebecca Gottesman ◽

David Knopman ◽

...

Keyword(s):

Cognitive Impairment ◽

Standard Deviation ◽

Sex Education ◽

Lower Risk ◽

Late Life ◽

Cognitive Status ◽

Cognitive Outcomes ◽

Effective Population ◽

Standard Deviation Increase ◽

Cerebral Amyloidosis

Abstract Plasma-based biomarkers of amyloid beta (Aβ), a neuropathological hallmark of Alzheimer’s disease, show promise in predicting cognitive impairment and mapping onto cerebral amyloidosis, but little is known about how midlife plasma Aβ associates with late-life cognitive outcomes. Midlife plasma variants Aβ42 and Aβ40 were measured using a fluorimetric bead-based immunoassay in a subsample of visit 3 ARIC participants (1993-95; n=2585, mean age=59.4±5.2, 57% female, 23% African American). We investigated the relationship between midlife plasma Aβ and late-life mild cognitive impairment (MCI; n=923) and dementia (n=628) diagnosed from 2011-19. Multinomial logistic regressions estimated relative risk ratios (RRR) of MCI, dementia, and death vs normal cognitive status as a function of:(1) Aβ42:Aβ40 ratio, (2) Aβ42 and Aβ40 included as separate terms, and (3) Protected Aβ group (participants with Aβ42≥46 pg/ml and Aβ40 <233 pg/ml). Adjusters included age, sex, education, site-race, and APOE4. Every doubling of midlife plasma Aβ42:Aβ40 up to a threshold of 0.20 was associated with 41% lower risk of developing MCI/dementia in comparison to cognitively normal (RRR=0.59 [95% CI:0.42, 0.82]), with no association for ratio values ≥0.20. Every standard deviation increase in plasma Aβ42 was associated with 17% lower risk of dementia (RRR=0.83 [0.70, 0.99]), whereas every standard deviation increase in plasma Aβ40 was associated with 16% higher risk of MCI (RRR=1.16 [1.02, 1.31]). The protected midlife plasma Aβ group had 86% lower risk of late-life dementia vs all others (RRR=0.14 [0.04, 0.47]). Early measurement of plasma Aβ may prove an accessible and effective population screener for future cognitive impairment.

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The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab157 ◽

2021 ◽

Author(s):

Joshua R Ehrlich ◽

Bonnielin K Swenor ◽

Yunshu Zhou ◽

Kenneth M Langa

Keyword(s):

Visual Acuity ◽

Logistic Regression ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Vision Impairment ◽

Logistic Regression Models ◽

Cox Proportional Hazards Models ◽

Longitudinal Association

Abstract Background Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. Methods We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. Results There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Conclusions Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

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Age-Dependent Association Between Elevated Homocysteine and Cognitive Impairment in a Post-stroke Population: A Prospective Study

Frontiers in Nutrition ◽

10.3389/fnut.2021.691837 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shengnan Zhou ◽

Jiahao Chen ◽

Lin Cheng ◽

Kaili Fan ◽

Minjie Xu ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Multivariate Regression Analysis ◽

Logistic Regression Models ◽

Post Stroke ◽

Stroke Population ◽

Age Dependent ◽

Independent Association ◽

A Prospective Study ◽

State Examination

Background and Purpose: The results regarding the independent association between homocysteine (Hcy) levels and post-stroke cognitive impairment (PSCI) were inconsistent. The effect of age on this association has yet to be explored. This study aims to determine the relationship between Hcy levels, age, and cognitive impairment in a post-stroke population.Methods: A total of 592 patients with acute ischemic stroke (AIS) completed follow-up. Serum Hcy levels were measured enzymatically by spectrophotometry within 24 h of admission. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) 1 month after stroke, and the scores ≤ 24 were considered as cognitive impairment. Our study was dichotomized into two groups by a cut-off of 65 years. Multivariate logistic regression models were used to determine the association between baseline Hcy levels and cognitive impairment.Results: According to the MMSE score, 317 (53.5%) patients had cognitive impairment. Patients with higher levels of Hcy were more prone to have cognitive impairment 1 month after stroke than patients with lower levels of Hcy (p < 0.001). The optimal cut-off points of Hcy level (μmol/L) were (T1) ≤ 8, (T2) 8–12, and (T3) ≥ 12. After adjusting for confounding factors, the multivariate regression analysis showed that the third Hcy tertile was independently associated with cognitive impairment [odds ratio (OR) = 2.057, 95% confidence interval (CI) = 1.133–3.735, p = 0.018). A stronger association [T2 (OR = 2.266, 95% CI = 1.042–4.926, p = 0.039); T3 (OR =3.583, 95% CI = 1.456–8.818, p = 0.005)] was found in the younger group. However, the independent association was not confirmed in the older group.Conclusions: Elevated Hcy levels in the acute phase of ischemic stroke were independently associated with cognitive impairment in a post-stroke population. Furthermore, the association was age-dependent and more meaningful in a younger population aged below 65. So, Hcy levels in patients with stroke should be well-monitored, especially in younger patients.

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Midlife Dietary Intakes of Monounsaturated Acids, n–6 Polyunsaturated Acids, and Plant-Based Fat Are Inversely Associated with Risk of Cognitive Impairment in Older Singapore Chinese Adults

Journal of Nutrition ◽

10.1093/jn/nxz325 ◽

2019 ◽

Vol 150 (4) ◽

pp. 901-909 ◽

Cited By ~ 1

Author(s):

Yi-Wen Jiang ◽

Li-Ting Sheng ◽

Xiong-Fei Pan ◽

Lei Feng ◽

Jian-Min Yuan ◽

...

Keyword(s):

Cognitive Impairment ◽

Dietary Fat ◽

Cohort Analysis ◽

The Elderly ◽

Health Study ◽

Inverse Association ◽

Fat Intake ◽

Total Carbohydrate ◽

Dietary Fat Intake ◽

Singapore Chinese

ABSTRACT Background Previous studies have shown inconsistent results for the relation between dietary fat intake and cognitive function in the elderly. Furthermore, prospective studies on this topic among the Chinese population are scarce. Objectives We aimed to examine the association between midlife dietary fat intake and risk of cognitive impairment in the elderly. Methods Prospective cohort analysis was conducted among 16,736 participants from the Singapore Chinese Health Study. Dietary information was assessed by a validated FFQ at baseline (1993–1998) when participants aged 45–74 y (mean: 53.5; SD: 6.22). Cognitive impairment was identified using the Singapore modified Mini-Mental State Examination at the third follow-up visit (2014–2016) when participants aged 61–96 y (mean: 73.2; SD: 6.41). Multivariable logistic regression models were used to calculate ORs and 95% CIs. Results Cognitive impairment was presented in 2397 participants. When substituted for total carbohydrate, dietary fat intake was inversely related to cognitive impairment (OR comparing extreme quartiles: 0.80; 95% CI: 0.67, 0.94; P-trend = 0.003). The OR (95% CI) comparing extreme quartiles of specific dietary fats was 1.08 (0.89, 1.31; P-trend = 0.51) for SFAs, 0.80 (0.64, 0.99; P-trend = 0.02) for MUFAs, 0.84 (0.72, 0.99; P-trend = 0.02) for PUFAs, 0.92 (0.77, 1.09; P-trend = 0.49) for n–3 PUFAs, and 0.83 (0.70, 0.98; P-trend = 0.01) for n–6 PUFAs. An inverse association was found for plant-based fat (OR: 0.84; 95% CI: 0.72, 0.98; P-trend = 0.02), but not for animal-based fat (OR: 0.96; 95% CI: 0.81, 1.15; P-trend = 0.76). When substituted for SFAs, the OR (95% CI) was 0.77 (0.61, 0.97; P-trend = 0.02) for MUFAs and 0.82 (0.70, 0.95; P-trend = 0.003) for PUFAs. Conclusions We found that substitution of total carbohydrate or SFAs with MUFAs and PUFAs, particularly n–6 PUFAs, was related to a lower risk of cognitive impairment in elderly Chinese participants. In addition, an inverse association with cognitive impairment was found for plant-based fat.

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Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study)

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000400016 ◽

2008 ◽

Vol 66 (3a) ◽

pp. 524-528 ◽

Cited By ~ 44

Author(s):

Érico Castro-Costa ◽

Cíntia Fuzikawa ◽

Elizabeth Uchoa ◽

Josélia Oliveira Araújo Firmo ◽

Maria Fernanda Lima-Costa

Keyword(s):

Cognitive Impairment ◽

Mental State ◽

Mini Mental State Examination ◽

Population Based ◽

Score Distribution ◽

Study Results ◽

Health Aging ◽

Aging Study ◽

Study Population ◽

State Examination

OBJECTIVE: To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. METHOD: A total of 1558 subjects aged >60 years (89.4% of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. RESULTS: The estimated prevalences of cognitive impairment varied from 13.2% to 27.0% depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cut-off point 13/14 corresponded to the 5th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. CONCLUSION: In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.

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