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Warren A. The relationship between gender differences in dietary habits, neuroinflammation, and Alzheimer's disease. Front Aging Neurosci 2024; 16:1395825. [PMID: 38694261 PMCID: PMC11061392 DOI: 10.3389/fnagi.2024.1395825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/03/2024] [Indexed: 05/04/2024] Open
Abstract
Neurocognitive decline is one of the foremost dire issues in medicine today. The mechanisms by which dementia pathogenesis ensues are complicated and multifactorial, particularly in the case of Alzheimer's disease (AD). One irrefutable, yet unexplained factor is the gender disparity in AD, in which women are disproportionately affected by AD, both in the rate and severity of the disease. Examining the multifaceted contributing causes along with unique gender dynamics in modifiable risk factors, such as diet, may lend some insight into why this disparity exists and potential paths forward. The aim of this brief narrative review is to summarize the current literature of gender differences in dietary habits and how they may relate to neuroinflammatory states that contribute to AD pathogenesis. As such, the interplay between diet, hormones, and inflammation will be discussed, along with potential interventions to inform care practices.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Ge S, Dong F, Tian C, Yang CH, Liu M, Wei J. Serum soluble alpha-klotho klotho and cognitive functioning in older adults aged 60 and 79: an analysis of cross-sectional data of the National Health and Nutrition Examination Survey 2011 to 2014. BMC Geriatr 2024; 24:245. [PMID: 38468203 DOI: 10.1186/s12877-024-04661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/03/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES Klotho, consisting of membrane klotho and soluble alpha-klotho, is found to be associated with better cognitive outcomes in small samples of the aged population. We aimed to examine the association of serum soluble alpha-klotho with cognitive functioning among older adults using a nationally representative sample of U.S. older adults. METHOD A total of 2,173 U.S. older adults aged 60-79 years in the National Health and Nutrition Examination Survey from 2011 to 2014 were included in this cross-sectional analysis. Serum soluble alpha-klotho was measured in the laboratory and analyzed with an ELISA kit. Cognitive function was measured using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) immediate and delayed memory, the Animal fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated based on sample means and standard deviations. Multivariable linear regression models were applied to examine the association of quartiles and continuous value of serum soluble alpha-klotho with test-specific and global cognition z-scores. Subgroup analysis was conducted by sex. The following covariates were included in the analysis- age, sex, race/ethnicity, education, depressive symptoms, smoking status, body mass index (BMI), physical activity, stroke, prevalent coronary heart disease, total cholesterol, and systolic blood pressure. All the information was self-reported or obtained from health exams. RESULTS Serum soluble alpha-klotho level in the lowest quartile was associated with lower z-scores for DSST (beta [β] =-0.13, 95% confidence interval [CI]: -0.25, -0.01). For subgroup analysis, serum soluble alpha-klotho level in the lowest quartile was associated with lower z-scores for DSST (β=-0.16, 95% CI: -0.32, -0.003) and global cognition (β=-0.14, 95% CI: -0.28, -0.01) among female participants. No association was found between continuous serum soluble alpha-klotho and cognitive functioning among the participants. CONCLUSIONS Lower serum soluble alpha-klotho quartile was associated with poorer cognitive functioning among older women. Future studies are expected to examine the longitudinal association between klotho levels and cognitive outcomes.
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Affiliation(s)
- Song Ge
- College of Sciences and Technology, University of Houston-Downtown, Houston, TX, US
| | - Fanghong Dong
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missiouri, United States of America
| | - Chong Tian
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Chih-Hsiang Yang
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
| | - Minhui Liu
- School of Nursing, Ningxia Medical University, No. 1160, Shengli Street, Xingqing District, 410013, Yinchuan, Ningxia, China.
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, US
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Alam MT, Vásquez E, Etnier JL, Echeverria S. Dietary Adherence and Cognitive Performance in Older Adults by Nativity Status: Results from the National Health and Nutrition Examination Survey (NHANES), 2011-2014. Geriatrics (Basel) 2024; 9:25. [PMID: 38525742 PMCID: PMC10961773 DOI: 10.3390/geriatrics9020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Although adherence to dietary guidelines is associated with better cognitive performance, there may be differences by nativity status. This study aimed to investigate the association between adherence to the healthy eating index (HEI) and cognitive performance (CP) among United States (US)-born and foreign-born older adults (60+ years). Data were obtained from the 2011-2014 NHANES (n = 3065). Dietary adherence was assessed with HEI quintiles. CP (adequate vs. low) was examined using word listing (CERAD), animal naming (AFT), and the digit symbol substitution test (DSST). Weighted multivariable logistic regressions were used to examine associations. The US-born participants in higher dietary quintiles had adequate CP when compared to foreign-born participants. In adjusted models, the US-born participants in the highest HEI quintile had increased odds of adequate DSST scores (odds ratio: 1.95, 95% confidence interval: 1.15-3.28) compared with those in the lowest quintile. Patterns of association were generally reversed for foreign-born participants and were non-statistically significant. Future research should consider the influence of diets in delaying or preventing decline in cognition and evaluate nutritional factors that contribute to cognitive outcomes for the foreign-born population.
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Affiliation(s)
- Md Towfiqul Alam
- Department of Health Sciences, James Madison University, Harrisonburg, VA 22807, USA
| | - Elizabeth Vásquez
- Department of Epidemiology & Biostatistics, University at Albany, Albany, NY 12144, USA
| | - Jennifer L Etnier
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
| | - Sandra Echeverria
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
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Gui J, Wang L, Han Z, Ding R, Yang X, Yang J, Luo H, Huang D, Liu J, Jiang L. Association between the Healthy Eating Index-2015 and Developmental Disabilities in Children: A Cross-Sectional Analysis. Brain Sci 2023; 13:1353. [PMID: 37759954 PMCID: PMC10526872 DOI: 10.3390/brainsci13091353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/31/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Few studies have examined the association between dietary quality and the risk of developmental disabilities (DDs). This study aimed to investigate the association between dietary quality and the risk of DDs in US children aged 5 to 15. We employed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. Multivariable logistic regression was used to evaluate the association between HEI-2015 score, HEI component score, and the likelihood of DDs. Restricted cubic splines (RCS) were utilized to investigate nonlinear links between HEI-2015 score and the likelihood of DDs. Interaction analysis was utilized to explore differences between subgroups. HEI-2015 score was negatively linked with the risk of DDs after adjusting covariates [odds ratio (OR) = 0.99; 95% confidence interval (CI) = (0.98, 1.00)]. HEI-2015 score was separated by quartile into Q1, Q2, Q3, and Q4. Q1 represents the lowest HEI scores, while Q4 represents the highest HEI scores. Children in the fourth quartile of the HEI-2015 exhibited a decreased prevalence of DDs compared to those in the first quartile [(OR = 0.69; 95% CI = (0.53, 0.89)]. The association between HEI-2015 score and the risk of DDs was modified by race/ethnicity. The higher HEI-2015 score was associated with a lower risk of DDs, suggesting that better dietary quality may reduce the risk of DDs in children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Li Jiang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China (J.Y.); (H.L.)
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Song G, Yang C, Qu Z, Lin X, Liu M, Wang Y. Association between seropositivity for toxocariasis and cognitive functioning in older adults: an analysis of cross-sectional data from the US National Health and Nutrition Examination Survey (NHANES), 2011-2014. BMJ Open 2023; 13:e068974. [PMID: 36858467 PMCID: PMC9980365 DOI: 10.1136/bmjopen-2022-068974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES This study sought to examine the relationship between seropositivity for toxocariasis and cognitive functioning in a nationally representative sample of US older adults. DESIGN A cross-sectional study. SETTING National Health and Nutrition Examination Survey (NHANES) data collection took place in the US at participants' homes and mobile examination centres with specialised equipment. PARTICIPANTS The study population consisted of 3188 community-dwelling US older adults aged 60 and above from the NHANES 2011 to 2014. OUTCOME MEASURES IgG antibody against Toxocara spp was tested by a Luminex assay using recombinant rTc-CTL-1 antigen. A value >23.1 mean fluorescence intensity (MFI) indicated positive for toxocariasis and a value ≤23.1 MFI as negative for toxocariasis. The Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest immediate and delayed memory, the Animal Fluency test and the Digit Symbol Substitution Test (DSST) were used to assess cognitive functioning. Cognitive test-specific and global cognitive z scores were computed using sample means and SD. RESULTS The study population consisted of 3188 participants who represented a total of 111 896 309 civilian citizens in the USA. The mean age of the participants was 69.6 years (standard deviation 6.8). The prevalence of toxocariasis in this population was 7.3% (95% confidence interval [CI] 6.1% to 8.5%). The survey-weighted linear regression model showed that compared with participants who were toxocariasis seronegative, those who were seropositive had lower DSST z score (beta [β] = -0.12, 95% CI -0.22 to -0.01) and global cognition z score (β=-0.11, 95% CI -0.22 to -0.01), after controlling for age, sex, race/ethnicity, education, depressive symptoms, smoking status, body mass index, prevalent coronary heart disease, prevalent stroke, and systolic blood pressure, physical activity, and total cholesterol. CONCLUSIONS In our study, seropositive toxocariasis was independently and significantly associated with worse working memory, sustained attention, processing speed and global cognition in older adults. If this association is causal, public health measures to prevent human toxocariasis might help protect older adults' cognitive function.
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Affiliation(s)
- Ge Song
- Department of Natural Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Chao Yang
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhe Qu
- School of Nursing, Xu Zhou Medical College, Xuzhou, Jiangsu, China
| | - Xuechun Lin
- Department of Nutrition and Food hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minhui Liu
- Central South University Xiangya School of Nursing, Changsha, Hunan Sheng, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
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A Healthful Plant-Based Diet Is Associated with Lower Odds of Nonalcoholic Fatty Liver Disease. Nutrients 2022; 14:nu14194099. [PMID: 36235752 PMCID: PMC9572274 DOI: 10.3390/nu14194099] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
There is little evidence for the associations of the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI) with the odds of nonalcoholic fatty liver disease (NAFLD). We present a nationwide cross-sectional study among US adults aged 18 years or older. Diet was assessed by 24-h recalls. Overall PDI, hPDI, and uPDI were constructed based on 18 food groups. NAFLD was defined based on controlled attenuation parameter derived via transient elastography (TE) in the absence of other causes of chronic liver disease. Among 3900 participants with eligible TE examination, 1686 were diagnosed with NAFLD. The overall PDI was not associated with NAFLD prevalence (comparing extreme tertiles of PDI score OR = 1.03, 95% CI 0.76, 1.38, ptrend = 0.609). However, hPDI was inversely (OR = 0.50, 95% CI 0.35, 0.72, ptrend < 0.001), while uPDI was positively associated with odds of NAFLD (OR = 1.37, 95% CI 0.93, 2.02, ptrend = 0.009) in the multivariable-adjusted models without body mass index (BMI). After further adjustment for BMI, only the association of hPDI with NAFLD remained statistically significant (OR = 0.64, 95% CI 0.46, 0.87, ptrend = 0.006). Such inverse association appeared stronger in non-Hispanic whites, but not in other racial/ethnic groups (pinteraction = 0.009). Our findings suggest that a plant-based diet rich in healthy plant foods might be associated with lower odds of NAFLD, particularly among US non-Hispanic whites. Clinical trials and cohort studies to validate our findings are needed.
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Tao M, Liu J, Cervantes D. Association between magnesium intake and cognition in US older adults: National Health and Nutrition Examination Survey (NHANES) 2011 to 2014. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12250. [PMID: 35128033 PMCID: PMC8804621 DOI: 10.1002/trc2.12250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/28/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Identifying nutrition- and modifiable lifestyle-based risk factors for cognitive decline and dementia may contribute future primary prevention strategies. This study aimed to evaluate the associations between magnesium intake and cognition in older adults in the United States. METHODS Based on the National Health and Nutrition Survey (NHANES) between 2011 and 2014, the study included 2508 participants aged 60 years and older. Linear regression models were used to examine the association of total magnesium intake with cognition. RESULTS After adjusted demographic and other confounding factors, intakes of energy and total calcium, and serum vitamin D level, higher intake of total magnesium was independently associated with 0.15 higher global cognitive z-score (95% confidence interval, 0.02 to 0.28 for highest vs. lowest quartile, P trend = .037). The positive association of total magnesium intake with global cognition was primarily presented among women, non-Hispanic Whites, and those with sufficient serum vitamin D levels (≥50 nmol/L), although interactions were not significant. There were no clear linear associations for global cognition with serum vitamin D level. DISCUSSIONS Our findings suggest that high magnesium intake alone may improve cognition in older adults, particularly among non-Hispanic Whites and subjects with sufficient levels of serum vitamin D. Further studies are needed to confirm the findings.
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Affiliation(s)
- Meng‐Hua Tao
- Department of Biostatistics and EpidemiologyUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Jialiang Liu
- Department of Epidemiology and BiostatisticsCollege of Public HealthTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Diana Cervantes
- Department of Biostatistics and EpidemiologyUniversity of North Texas Health Science CenterFort WorthTexasUSA
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Beydoun MA, Weiss J, Beydoun HA, Fanelli‐Kuczmarski MT, Hossain S, El‐Hajj ZW, Evans MK, Zonderman AB. Pathways explaining racial/ethnic disparities in incident all‐cause and Alzheimer's disease dementia among older US men and women. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12275. [PMID: 35317081 PMCID: PMC8924949 DOI: 10.1002/trc2.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 12/23/2021] [Accepted: 01/23/2022] [Indexed: 11/14/2022]
Abstract
Introduction Racial disparities in Alzheimer's disease (AD) and all‐cause dementia (DEMENTIA) incidence may exist differentially among men and women, with unknown mechanisms. Methods A retrospective cohort study examining all‐cause and AD dementia incidence was conducted linking Third National Health and Nutrition Examination Survey (NHANES III) to Centers for Medicare & Medicaid Services Medicare data over ≤26 years of follow‐up (1988 to 2014). Cox regression and generalized structural equation models (GSEMs) were constructed among men and women ≥60 years of age at baseline (N = 4592). Outcomes included onset ages of all‐cause and AD dementia, whereas the main exposures were race/ethnicity contrasts (RACE_ETHN). Potential mediators) included socio‐economic status (SES), lifestyle factors (dietary quality [DIET] nutritional biomarkers [NUTR], physical activity [PA], social support [SS], alcohol [ALCOHOL], poor health [or HEALTH], poor cognitive performance [or COGN]. In addition to RACE_ETHN, the following were exogenous covariates in the GSEM and potential confounders in Cox models: age, sex, urban‐rural, household size, and marital status. Results Non‐Hispanic Black (NHB) women had a higher risk of DEMENTIA versus non‐Hispanic White (NHW) women in GSEM, consistent with Cox models (age‐adjusted model: hazard ratio [HR] = 1.34, 95% confidence interval [CI]: 1.10 to 1.61). The total effect of this RACE_ETHN contrast in women was explained by four main pathways: (1) RACE_ETHN→ poor cognitive performance (COGN, +) → DEMENTIA (+); (2) RACE_ETHN → SES (−) → COGN (−) → DEMENTIA (+); (3) RACE_ETHN → SES (−) → physical activity (PA, +) → COGN (−) → DEMENTIA (+); and (4) RACE_ETHN → SES (−) → DIET (+) → COGN (−) → DEMENTIA (+). A reduced AD risk in Mexican American (MA) women versus NHW women upon adjustment for SES and downstream factors (HR = 0.53, 95% CI: 0.35 to 0.80). For the non‐White versus NHW contrast in incident DEMENTIA, pathways involved lower SES, directly increasing cognitive deficits (or indirectly through lifestyle factors), which then directly increases DEMENTIA . Discussion Socioeconomic and lifestyle factors explaining disparities between NHB and NHW in dementia onset among women are important to consider for future observational and intervention studies.
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Affiliation(s)
- May A. Beydoun
- Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA/NIH/IRP Baltimore Maryland USA
| | - Jordan Weiss
- Department of Demography University of California‐Berkeley Berkeley California USA
| | - Hind A. Beydoun
- Department of Research Programs Fort Belvoir Community Hospital Fort Belvoir Virginia USA
| | - Marie T. Fanelli‐Kuczmarski
- Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA/NIH/IRP Baltimore Maryland USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA/NIH/IRP Baltimore Maryland USA
| | | | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA/NIH/IRP Baltimore Maryland USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences National Institute on Aging, NIA/NIH/IRP Baltimore Maryland USA
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Fan Y, Zhang Y, Li J, Liu Y, Chang H, Jiang Y, Tuo X, Zhou L, Yu Y. Association between healthy eating index-2015 and various cognitive domains in US adults aged 60 years or older: the National Health and Nutrition Examination Survey (NHANES) 2011-2014. BMC Public Health 2021; 21:1862. [PMID: 34654401 PMCID: PMC8520277 DOI: 10.1186/s12889-021-11914-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diet, as a modifiable factor, plays an important role in cognitive function. However, the association between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), measured by Healthy Eating Index (HEI)-2015, and cognitive function remains unclear. This study aims to explore whether HEI-2015 is associated with various cognitive domains and whether such association is modified by age, gender, or ethnicity in the US adults aged 60 years or older using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. METHODS HEI-2015 scores were calculated from 24-h dietary recall interviews. Cognitive function was evaluated by Digit Symbol Substitution Test (DSST, a measure of processing speed), Animal Fluency Test (AFT, a measure of executive function), a subtest from Consortium to Establish a Registry for Alzheimer's disease (CERAD, a measure of memory), and a composite-z score calculated by summing z scores of individual tests. The associations between HEI-2015 scores and cognitive performance were explored using multiple linear regression models. RESULTS A total of 2450 participants aged 60 years or older were included. Participants with higher HEI-2015 scores were more likely to have higher DSST, AFT as well as composite-z scores (P<0.05). Significant interaction effects were identified between HEI-2015 and ethnicity in specific cognitive domains (Pinteraction<0.05). Among HEI-2015 components, higher intakes of whole fruits and seafood and plant protein were associated with better cognitive performance (P<0.05). CONCLUSION Higher adherence to DGA is associated with better cognitive performance, especially regarding processing speed and executive function among the US adults aged 60 years or older.
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Affiliation(s)
- Yameng Fan
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yinyin Zhang
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Jiaqiao Li
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yamei Liu
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Huan Chang
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yude Jiang
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xingxia Tuo
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Long Zhou
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yan Yu
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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