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Life expectancy has increased leading to a concomitant increase in the population of older people. Malnutrition, a major problem in this age group, deteriorates their health and quality of life. The association between risk of malnutrition and dietary intake has not been investigated sufficiently. The aim of this study was to examine potential associations between risk of malnutrition and dietary intake in a representative cohort of adults ≥ 65 years old.
Materials and methods
1,831 older people (mean age 73.1 ± 5.9 years old) from the HELIAD study were included in the analyses. Risk of malnutrition was assessed with the “Determine your Nutritional Health” checklist. Total score of the questionnaire ranges from 1–21, with 0–2 indicating good nutritional status, 3–5 moderate nutritional risk and ≥ 6 high nutritional risk. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, validated for the Greek population, from which consumption of specific food groups (non-refined cereals, fruits, vegetables, legumes, fish, red meat, poultry, fish, dairy products, alcohol and sweets in servings/day) was estimated, as well as adherence to the Mediterranean diet, using a relevant a priori score.
35.8% of the participants were well-nourished, 34.8% were at moderate nutritional risk and 29.4% were at high nutritional risk. Total energy intake did not differ between the groups (1,984 ± 500 kcal/day for those well-nourished, 1,995 ± 537 kcal/day for those at moderate nutritional risk and 1,934 ± 566 kcal/day for those at high nutritional risk, p = 0.140). Well-nourished older people consumed per day more portions of vegetables, fruits, legumes, poultry, sweets and fewer portions of alcohol compared to those at moderate and high risk (all p < 0.05). Furthermore, adherence to the Mediterranean diet differed significantly between the groups, i.e. those well-nourished had greater adherence to the Mediterranean Diet compared to the other groups (p < 0.001).
Although energy intake did not differ between the groups, there were significant differences in quality of their diet, as this was depicted in specific food group intake and adherence to a healthy dietary pattern. Thus, health experts should also consider diet quality when screening malnutrition in this vulnerable age group.
Cumulative findings have recently highlighted the role of gut microbiota as a novel environmental factor in the fight against obesity and related comorbidities. We aimed to investigate (1) the gut microbiome characteristics of a Greek adult population in terms of adiposity prevalence and (2) to further elucidate the potential effect of physical activity level and adherence to a-priori (Mediterranean Diet) and a-posteriori dietary patterns in gut microbiota profiling after accounting for sex, age and obesity status.
Materials and Methods
Adult participants (n = 125) underwent clinical, anthropometric, dietary, physical activity and lifestyle evaluation. Obesity status [normal-weight (NW), overweight (OW), obesity (OB)] was defined based on body weight and height measurements, Body Mass Index calculation and the World Health Organization criteria. Levels of physical activity (low/medium/high) were estimated according to International Physical Activity Questionnaire (IPAQ) scoring. Dietary intake was evaluated through a food frequency questionnaire. Adherence to the Mediterranean diet was based on the MedDietScore and Principal Component Analysis (PCA) was applied for dietary patterns analysis. Gut microbial community characteristics (diversity, richness and proportions at phylum level) were calculated based on 16S rRNA gene sequencing.
A total of 122 subjects (58 females; mean age 42.4 ± 13.1 years) completed the study. OB was characterized by lower proportions of Verrucomicrobia compared to NW state (p = 0.034 for univariate), unidentified bacteria (p = 0.014) and the Archaea Euryarchaeota (p = 0.003) compared to OW status, and the phylum Candidatus Saccharibacteria compared to NW (p = 0.027) and OW (p = 0.039) after sex and age adjustments. Regarding lifestyle parameters, our data proposed no significant effect of total physical activity levels on gut microbiome; notably, a ‘fruit and vegetables’ dietary pattern and adherence to Mediterranean diet were both characterized by lower microbial diversity and proportions of Actinobacteria but higher proportions of Cyanobacteria/Chloroplast and Lentisphaerae, respectively. Furthermore, a Western-type dietary pattern (high in full fat dairy products, potatoes, refined cereals, red meat, snacks and junkfood) was characterized by lower gut microbial richness (Chao1 index), whereas a healthy dietary pattern (high in low fat dairy and wholegrain cereals and low in snack and junk food) was characterized by higher proportion of Firmicutes.
Our data proposed variable connections of metabolic health and dietary patterns with features of gut microbiota; design of gut microbiome studies is advisable to account for host- and lifestyle-related potential confounders.
To investigate the association between parity and the risk of incident dementia in women.
We pooled baseline and follow-up data for community-dwelling women aged 60 or older from six population-based, prospective cohort studies from four European and two Asian countries. We investigated the association between parity and incident dementia using Cox proportional hazards regression models adjusted for age, educational level, hypertension, diabetes mellitus and cohort, with additional analysis by dementia subtype (Alzheimer dementia (AD) and non-Alzheimer dementia (NAD)).
Of 9756 women dementia-free at baseline, 7010 completed one or more follow-up assessments. The mean follow-up duration was 5.4 ± 3.1 years and dementia developed in 550 participants. The number of parities was associated with the risk of incident dementia (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02–1.13). Grand multiparity (five or more parities) increased the risk of dementia by 30% compared to 1–4 parities (HR = 1.30, 95% CI = 1.02–1.67). The risk of NAD increased by 12% for every parity (HR = 1.12, 95% CI = 1.02–1.23) and by 60% for grand multiparity (HR = 1.60, 95% CI = 1.00–2.55), but the risk of AD was not significantly associated with parity.
Grand multiparity is a significant risk factor for dementia in women. This may have particularly important implications for women in low and middle-income countries where the fertility rate and prevalence of grand multiparity are high.
Instrumental activities of daily living (IADL) have been operationalized as exhibiting a greater level of complexity than basic ADL. In the same way, incorporating more advanced ADLs may increase the sensitivity of functional measures to identify cognitive changes that may precede IADL impairment. Towards this direction, the IADL-extended scale (IADL-x) consists of four IADL tasks and five advanced ADLs (leisure time activities).
Retrospective, cross-sectional study.
Athens and Larissa, Greece.
1,864 community-dwelling men and women aged over 64.
We employed both the IADL-x and IADL scales to assess functional status among all the participants. Diagnoses were assigned dividing the population of our study into three groups: cognitively normal (CN), mild cognitive impairment (MCI) and dementia patients. Neuropsychological evaluation was stratified in five cognitive domains: memory, language, attention-speed, executive functioning and visuospatial perception. Z scores for each cognitive domain as well as a composite z score were constructed. Models were controlled for age, sex, education and depression.
In both IADL-x and IADL scales dementia patients reported the most functional difficulties and CN participants the fewest, with MCI placed in between. When we restricted the analyses to the CN population, lower IADL-x score was associated with worse cognitive performance. This association was not observed when using the original IADL scale.
There is strong evidence that the endorsement of more advanced IADLs in functional scales may be useful in detecting cognitive differences within the normal spectrum.
The present study aimed to explore the associations between social life and adherence to a healthy dietary pattern, the Mediterranean diet (MD), in a population-representative cohort of older people.
Cross-sectional study. Adherence to the MD was evaluated by an a priori score; tertiles of the score, indicating low, medium and high adherence, were used in the analyses. Social life was assessed by a questionnaire evaluating participation in leisure-time activities and the number of social contacts; primary occupation was also recorded and job characteristics were further explored.
Community-dwelling older adults.
Adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study (n 1933; age range 65–99 years).
Each unit increase in the number of social contacts/month and in the frequency score of intellectual, social and physical activities was associated with a 1·6, 6·8, 4·8 and 13·7 % increase in the likelihood of a participant being in the high MD adherence group, respectively. The analysis by age group revealed that younger elderly participants had a 1·4, 8·4 and 11·3 % higher likelihood to be in the high adherence group for each unit increase in the number of social contacts/month and in the frequency score of engagement in intellectual and physical activities, respectively. Similar associations were found for older elderly participants with high compared with low MD adherence, except for the intellectual activities.
The present results suggest that high MD adherence is associated with good social life, suggesting a clustering of health-promoting lifestyle factors in older adults.