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Uma Pala

Uma Rakshita Pala

Research trainee

Role of Vitamin D on cognitive performance among healthy volunteers of SANSCOG cohort.

Published on: August 21, 2024

Original author: Abhishek Menesgere, et al. (2022) (DOI: 10.1016/j.nutos.2022.05.006)

Dementia is a chronic, progressive neurological condition which has already affected 3 million people in India, and it is projected to quadruple by 2050. Studying cognitive changes in the normal aging brain helps us to know the pathogenesis of dementia. Several factors such as hypertension, diabetes mellitus, dyslipidemia, obesity and stroke, geriatric depression, social engagement, physical inactivity and diet can influence cognitive decline among elderly individuals. Vitamin D is known to influence cognition in both healthy individuals and cognitively impaired individuals. A meta-analysis in 2017 using 26 observational and 3 randomized control trials (RCT) found that both cross-sectional and longitudinal observational studies showed that low vitamin D levels were associated with cognitive decline. However, RCTs demonstrated that there was not much improvement in cognitive performance when vitamin D supplements were given. Usually vitamin D production is dependent on the geographical location of an individual, persons living in an area with low exposure to sunlight are at more risk of having vitamin D deficiency when compared to a person living in a tropical area. According to the guidelines of the Institute of Medicine (USA), a healthy adult should have serum vitamin D levels above 30 ng/dl, serum vitamin D levels between 20-30 ng/dl is considered as insufficient and less than 20 ng/dl is considered as deficiency. Methodology: 1. Study design and participants: The study sample was taken from Srinivaspura Aging Neurosenescence and Cognition (SANSCOG) study, which is an ongoing large-scale, prospective, population-based cohort study of adults aged 45 years and above in a rural site in the southern region of India. This investigation included only cognitively healthy volunteers as indicated by a Clinical Dementia Rating score of 0 and all of whom had vitamin D data available for analysis. 2. Measures: (a) Serum 25(OH) D measurement: In SANSCOG, blood samples collected between 2018 and 2020 were analyzed. The samples obtained were divided into three categories as per the Endocrinology Society of America - the sufficient group with serum 25 hydroxy vitamin D above 30 ng/dl, the insufficient group with serum vitamin D levels between 20 and 30 ng/dL and the deficient group with below 20 ng/dL serum 25(OH) D. (b) Assessment of cognitive performance: Hindi Mental Status Examination (HMSE), an Indian adaptation of the Mini Mental Status Examination (MMSE) and Computerized Assessment of Information Processing (COGNITO) are the two measures of cognition which were used in this study. (c) Assessment of covariates: Age, sex, education level, depression (as measured by the Geriatric Depression Scale), smoking habits, heavy alcohol use, presence of hypertension, and presence of type II diabetes are the covariates assessed in this study along with the assessment of cognition and blood investigations. (d) Statistical analyses: All statistical analyses were done using Statistical Packages for Social Sciences, IBM version 26. Results: A total sample size of 1346 was included in the study. Of these 1346 volunteers, not all of them had undergone all the cognitive assessments and hence there were varying sample sizes for each cognitive test. The obtained sample was unevenly distributed into three groups; the insufficient group comprising the largest proportion of the sample (N=516, 38.3 %); the sufficient group which is the smallest (N=487, 25%) proportion of the sample, and the deficient group (N=343, 36.2%). The mean age for the three groups were comparable; the sufficient and deficient groups had a mean age of 56 years while the insufficient group had a mean age of 58 years. The mean years of education for sufficient, insufficient and the deficient groups were found to be 5.3, 4.7 and 4.7 years respectively. There were significant group differences in gender distribution with the number of men steadily declining with decreasing vitamin D levels. Depression (GDS) scores also showed significant variation across the three vitamin D groups with higher mean GDS scores being prevalent in lower vitamin D groups and vice versa. Similar trends were observed with respect to the prevalence of Type 2 diabetes; increased prevalence in lower vitamin D groups. Conclusion: This study showed that the effect of vitamin D on cognitive performance did not have any meaningful significance in the study sample, and also in this study a large portion of subjects had vitamin D deficiency, which affects their mental health and glucose metabolism. These findings warrant large scale public health measures with a focus on primary and secondary prevention measures. Impact of the research: This study reported the need to maintain sufficient vitamin D levels, which helps to have good mental health and glucose metabolism.

Lower adherence to a Mediterranean diet is associated with high adiposity in community-dwelling older adults: Results from the longevity check-up (lookup) 7+ project.

Published on: June 19, 2024

Original author: Cacciatore, S., et al. (2023) (DOI: 10.3390/nu15234892)

Excessive fat accumulation is associated with negative health outcomes, which is a major public health concern at all life stages. According to the World Obesity Federation, more than half of the global population will be overweight or obese in the next 12 years. Body mass index (BMI) is the most used metric to assess adiposity in the general population. However, recent evidence suggests that BMI may not possess sufficient sensitivity for identifying excess fat at the individual level, so novel whole-body fat estimators based on anthropometric measures have been proposed and validated. Among them, relative fat mass (RFM) was proved to be more accurate than BMI for estimating whole-body adiposity and reducing obesity misclassification in adults of different ethnicities, especially among older individuals. In the general population, a high RFM has been associated with incidental cardiovascular disease and diabetes as well as mortality. Physical inactivity and unhealthy dietary habits are the main modifiable contributors to excess adiposity. The Mediterranean diet (Medi-Diet) is considered a healthy dietary model, and several studies have also highlighted a possible role for Medi-Diet as a suitable strategy for preventing and/or managing obesity. Methodology: The data used in this study was collected within the Longevity Check-up 7+ (Lookup 7+) project. Inclusion criteria: ● Participants who are 65 years of age or older Exclusion criteria: ● Self-reported pregnancy, refusal to perform capillary blood testing for the measurement of total cholesterol and glycemia, and unwillingness or inability to provide a written informed consent. Participants were recruited in public places and events, as well as during health prevention campaigns. To ensure consistency, all assessments were conducted in a standardized sequence: lifestyle interview, measurement of blood pressure, measurement of body weight and height, capillary blood testing for total cholesterol and glycemia, physical performance tests. Anthropometry and Lifestyle Habits: A questionnaire on dietary and other lifestyle habits was prepared by trained personnel to collect information on personal characteristics and modifiable risk factors for chronic diseases. Other parameters such as weight, height, BMI, and regular physical activity were also estimated. Relative Fat Mass: ● Woolcott and Bergman’s equation was used to estimate RFM, as follows: RFM=64−(20×height (cm) / waist circumference (cm))+(12×sex), Where sex = 0 for men and 1 for women. High adiposity was operationalized as having RFM values ≥40% in women and ≥30% in men. ● Adherence to a Mediterranean Diet and Daily Energy Intake: Nutritional data were obtained using a simplified food frequency questionnaire (FFQ). Adherence to a Medi-Diet was determined through a modified version of the Medi-Lite scoring system. ● Statistical analysis: Statistical methods used in the study were ANOVA, chi-square test, logistic regression to determine the relationship between adherence to the Mediterranean diet and high adiposity. Results: A total of 2092 participants were included in the study. The mean age of the study population was 73.1 ± 5.9 years and 1117 (53.4%) were women. Adherence to a Medi-Diet was low in 346 (19.7%) participants, moderate in 1198 (57.3%), and high in 481 (23.0%). Individuals with a low Medi-Diet adherence were predominantly women and were more frequently active smokers than in the other two groups. Daily energy intake was higher in participants with high Medi-Diet adherence than in those with moderate or low adherence. BMI values and waist circumference were lower in participants with a high Medi-Diet adherence. Mean RFM was 39.6 ± 5.1% in women and 29.0 ± 3.6% in men and was significantly lower in individuals with a high Medi-Diet adherence. A high adiposity was found in 971 (46.4%) participants and was more frequent in those with a low or moderate Medi-Diet adherence than in the high-adherence group. Conclusion: This study shows that there is a significant correlation between a higher Medi-Diet adherence and reduced levels of body adiposity in a large and relatively unselected sample of older adults residing in the community. Impact of the research: This study suggests the need and importance of dietary modifications in our daily life in order to reduce adiposity, which is a major risk factor for health conditions such as obesity, cardiovascular disease, hypertension, and diabetes.

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