The nutritional status of older people with and without dementia living in an urban setting in Central Africa: the EDAC study

The association between BMI and cognition in India: data from the Longitudinal Aging Study in India (LASI)

BACKGROUND

High body-mass index (BMI) is an established risk factor for late-life cognitive impairment and dementia, but most evidence comes from high-income contexts. Existing evidence from cross-sectional data in low- and middle-income settings is inconsistent, and many studies do not adequately address potential sources of bias.

METHODS

We used data from Wave 1 of the Longitudinal Aging Study in India (LASI) (analytic N = 56,753) to estimate the association between BMI categories and cognitive functioning among older adults aged 45 + years using survey-weighted linear regression models stratified by gender and controlling for potential confounders including demographic factors, socio-economic status (SES) characteristics, and health-related behaviors. To probe potential sources of bias, including residual confounding and reverse causation, we used weighting and trimming methods, sample restriction, and explored effect modification.

RESULTS

In fully adjusted models, relative to normal BMI underweight BMI was associated with lower cognitive scores (Men: -0.16 SD difference, 95% CI -0.18, -0.13; Women: -0.12 SD, -0.15, -0.10). Overweight and obesity were associated with higher cognitive scores in both men (overweight: 0.09; 0.07, 0.12, obese: 0.10; 0.05, 0.15) and women (overweight: 0.09; 0.07-0.12, obese: 0.12; 0.08-0.15). Estimates were similar after weighting and trimming but were attenuated after excluding those with low cognition (≥1 SD below the mean relative to those with similar demographic characteristics). Positive associations between overweight and obese BMI and cognition were attenuated or null in those living in urban settings and those with higher levels of educational attainment.

CONCLUSIONS

Underweight BMI is a risk factor for poor cognitive outcomes in adults 45 years and older and may be indicative of poor nutritional status and life-course disadvantage in India. In tandem with existing literature, supplemental analyses and effect modification results indicate that unmeasured confounding and reverse causation may explain the observed positive associations between overweight and obese BMI and cognitive functioning from cross-sectional studies in low- and middle-income settings. Future data with longitudinal follow-up will be helpful to further disentangle biases.

Association Between Cognitive Performance and Nutritional Status: Analysis From LASI-DAD

Malnutrition in low- and middle-income countries causes cognitive decline and other health problems. Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI DAD) is an extensive study on late-life cognition and dementia. This study examines the link between nutrition and cognitive abilities in older adults using data from the LASI DAD. We conducted descriptive statistics on nutritional parameters (body-mass index, waist-hip ratio, and Mini-Nutritional Assessment), cognitive functions, and socio-demographic variables in 2,892 adults aged ≥60 years. Cognitive domains assessed included delayed recall, orientation, language, executive function, abstract reasoning, and attention. Cognitive impairment was defined as impaired performance in two or more domains. Mean age was 69.3 ± 7.1 years, 52.9% were female, and 57.5% were illiterate. Low body-mass index (adjusted OR: 1.88, p < .001), at risk of malnutrition (adjusted OR: 1.89, p < .001) and malnourished (adjusted OR: 2.86, p < .001) on Mini-Nutritional Assessment were associated with the presence of cognitive impairment. Better cognitive performance was associated with increased body mass index (adjusted OR: 0.74, p-.03), hemoglobin (adjusted OR: 0.91, p-.006), and serum albumin (adjusted OR: 0.38, p < .001). This study shows that nutritional status assessed by anthropometric measures and blood markers is strongly linked to cognitive performance in older adults.

Prevalence of malnutrition among old people in Africa: systematic review and meta-analysis

OBJECTIVE

To summarise available evidence and estimate the pooled prevalence of malnutrition among old people in Africa.

DESIGN

Systematic review and meta-analysis.

SETTING

Any healthcare or community research reporting the prevalence or incidence of malnutrition in Africa from January 2000 to October 2021.

PARTICIPANTS

Old people, aged above 60 years.

OUTCOME MEASURES

Malnutrition, either undernutrition or overnutrition.

RESULTS

A total of 1442 studies were retrieved based on the search strategy, where only 36 studies (n=15 266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2% to 77.3% across the continent. Overall, the pooled prevalence rates of undernutrition and overnutrition were 18% (95% CI: 15% to 22%; I²=98.1; p<0.001) and 33% (95% CI: 22% to 44%; p<0. 001), respectively.

CONCLUSION

The prevalence of malnutrition in old African people is high and differs by setting, assessment tool and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable and simple screening tool should be thought of.

Prevalence of malnutrition among old age people in Africa

Background: Improved health care and rising life expectancy are creating a growing pool of old age people all over the world, including Africa. Malnutrition in the old age people is associated with both short- and long-term negative health outcomes. However, the reported burdens of malnutrition are fragmented and inconsistent, where more compiled evidence is warranted to aid decision-makers. Hence, this paper is aimed to estimate the pooled prevalence of malnutrition among old age people in Africa. Methods: A systematic search for research reporting the prevalence of malnutrition among old age people (aged above 60 years) was conducted from HINARI/PubMed and Google Scholar databases using combination keywords. Published articles in English language starting from January 2000 to October 2021 were screened. We presented the results based on the standard for reporting systematic review and meta-analysis of observational studies. A random-effect meta-analysis was done to estimate the prevalence of malnutrition along with the 95% confidence intervals. The publication bias was assessed using the funnel plot. Results: A total of 1,442 studies were retrieved based on the search strategy, where only 36 studies (n = 15,266 participants) reported from 11 African countries were included for meta-analysis. The reported prevalence of malnutrition ranges from 2.2 to 77.3% across Africa. Overall, the pooled prevalence of malnutrition was 18% (95% CI: 15-22; I2 = 98.1; p < 0.001). The prevalence is higher in the Central Africa (3.8%; 95% CI: 3.2-4.4), in the community (3.1%; 95% CI: 2.7-3.7), and among advanced age (3.5%; 95% CI: 2.3-5.4). Conclusion: The prevalence of malnutrition in African old age people is high and differs by setting, assessment tool, and country of residence. Hence, due attention to geriatric nutrition is mandatory, and the need for a valid, reliable, and simple screening tool should be thought of.

Nutritional status and associated factors of older persons in sub-Saharan Africa: a scoping review

BACKGROUND

The older person population is rapidly increasing globally, including sub-Saharan Africa (SSA). Concurrently, malnutrition is also increasing among older persons in SSA, with a dearth of empirical evidence on nutritional status and associated factors among the older persons in the region to inform effective interventions to promote healthy ageing.

AIM/OBJECTIVE

This review assessed the nutritional status and associated factors among older persons in SSA.

METHOD

PubMed, Google Scholar, and Cochrane Library electronic databases were searched for published articles from 2010 to 2021 using keywords and Boolean logic. Also, we carried out a free web-based search to retrieve other relevant evidence that assesses the older persons' nutritional status. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart was used to appraise the research articles that responded to the study's research questions.

FINDINGS

Twenty studies met the inclusion criteria, from which data were extracted as findings. The malnutrition prevalence was between 6 to 54% among older persons in SSA. We found that the prevalence of malnutrition vary and could be as high as 28.4% in a low socio-economic status area. Of these studies, twelve (12) provided data on undernutrition with prevalence ranging from 2.9 to 41%;10 provided data on overweight (8.1-54.1%) and 5 on obesity (2.7-44.7%). Seventeen of the studies evaluated factors associated with malnutrition; 4 studies revealed the association between socioeconomic status and malnutrition, 7 studies reported a significant association between dietary habits and malnutrition. Four studies showed an association between educational status and malnutrition. Disease conditions associated with malnutrition were reported in four of the studies.

CONCLUSION

This review shows that malnutrition is a problem among older persons in SSA coupled with many risk factors which should be given critical attention. We recommend nutrition education for older persons as well as the development of nutrition interventions for this vulnerable group.

Depressive and anxiety symptoms in early childhood education teachers: Relations to professional well-being and absenteeism

This study investigated how early childhood education teachers' (N = 444) depressive and anxiety symptoms predicted their professional well-being outcomes and absenteeism over the course of one school year in Ghana. Higher anxiety and depressive symptoms predicted lower job motivation and job satisfaction and higher levels of emotional exhaustion at the end of the school year. Increased depressive symptoms were further associated with more days absent over the course of the school year. Findings point to the importance of considering teachers' mental health for early educational quality. Implications for policy and practice are discussed.

Predictors of anxiety and depressive symptoms among teachers in Ghana: Evidence from a randomized controlled trial

RATIONALE

While teachers are heralded as key drivers of student learning outcomes, little attention has been paid to teachers' mental health, especially in less-developed countries such as Ghana. Professional background, workplace environment, and personal life stressors may threaten teachers' mental health and subsequent effectiveness in the classroom.

OBJECTIVES

The objectives of this study were to investigate 1) whether and how professional background, workplace environment, and personal life stressors predicted teachers' anxiety and depressive symptoms, and 2) whether participation in a professional development intervention predicted change in teachers' symptoms over the course of one school year in Ghana.

METHOD

We used multilevel models to examine predictors of depressive and anxiety symptoms among 444 kindergarten teachers (98% female; age range: 18-69) who participated in the Quality Preschool for Ghana (QP4G) Study. QP4G was a school-randomized control trial (n = 108 public schools; n = 132 private schools) evaluating a one-year teacher professional development intervention program implemented with and without parental-awareness meetings. Teacher depressive and anxiety symptoms were assessed at baseline before the intervention and at the end of the school year.

RESULTS

Poor workplace environment was associated with increased anxiety and depressive symptoms. Social support also predicted symptoms, with lack of support from students' parents and being new to the local community associated with more anxiety symptoms. Within teachers' personal lives, household food insecurity predicted more depressive symptoms. Finally, anxiety and depressive symptoms increased for all teachers over the school year. However, randomization to either intervention was linked to a significantly smaller increase in symptoms over the school year.

CONCLUSIONS

Results suggest that teachers' personal and professional lives are consequential for their mental health, and that professional development interventions that provide training and in-class coaching and parent engagement may benefit teachers' mental health.

Predictive formulas for estimation of height in sub-Saharan African older people: A new formula (EPIDEMCA study)

OBJECTIVES

Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population.

METHODS

Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877).

RESULTS

The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed: height (cm) = 72.75 + (1.86 × KHt [cm]) - (0.13 × age [y]) + 3.41 × sex (0: women; 1: men). This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula.

CONCLUSION

Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.

Risk of malnutrition and associated factors in institutionalized elderly persons

Abstract Objective : to evaluate the risk of malnutrition and associated factors in institutionalized elderly persons. Method : a cross-sectional study was carried out with elderly persons living in long-term care facilities in the municipal regions of Passo Fundo (Rio Grande do Sul) and Carazinho (Rio Grande do Sul) in 2017. A standardized, pre-codified questionnaire with sociodemographic variables was used, along with anthropometric data and the Mini Nutritional Assessment. Cognitive decline and non-intentional weight loss were also evaluated. The qualitative variables were presented in terms of univariate frequencies and the quantitative variables were described through measures of central tendency and dispersion. In order to verify the association between the categorical variables, the Pearson’s correlation coefficient, Chi-Squared test and the Fisher Exact test were applied, and in the crude and adjusted analysis the Poisson regression was used with robust variance. The level of significance was 5%. Results : a total of 399 elderly people were included, of whom 69.9% were female, 54.5% were aged 80 years or older and 88.4% were white. Of these elderly people, 61.7% lived in non-profit facilities. In the evaluation of nutritional status, 26.6% of the elderly were found to be malnourished, 48.1% were at risk of malnutrition and 25.3% had normal nutritional status. The highest prevalence ratio of at risk of malnutrition/malnutrition was with cognitive decline and unintentional weight loss (p<0.001). Conclusion : through the results, identifying nutritional status and the characteristics associated with the risk of malnutrition contribute to effective evaluation and nutritional monitoring, assisting in the prevention of diseases related to this condition.

The nutritional care of people living with dementia at home: A scoping review

There are an increasing number of people with dementia living in their own home for longer, often supported by a family member. The symptoms of dementia can affect an individual's nutritional status, which can lead to a reduced quality of life for the person with dementia and their family members. A scoping review was conducted from July 2016 until September 2016, using a recognised framework, to explore what is currently known, and identify any gaps in the research regarding the nutritional care of people living with dementia at home. This included any interventions that may have been trialled or implemented, and the views of those living with dementia, carers and clinicians. Six electronic databases were searched from inception to July 2016. A review team was involved in screening and data extraction for selected articles. Published qualitative and quantitative studies were included that explored the nutritional care of people living with dementia at home. Methods included data extraction and conventional content analysis. Stakeholders were involved in the development of final categories. Following screening, 61 studies reported in 63 articles were included. Most studies were cross-sectional (n = 24), cohort (n = 15) or qualitative (n = 9). Only three were randomised controlled trials. Three overarching categories represented the results: Timely identification of nutritional risk and subsequent regular monitoring of nutritional status, multi-component tailored interventions and the influence of the care-giving dyad on nutritional status. Many studies identify people living at home with dementia as a vulnerable group prone to malnutrition; however, a lack of interventions exists to address the increased risk. There is a lack of research exploring the role of home care providers and healthcare professionals in the provision of nutritional care. Further research is required to explore how the emotional aspect of the care-giving dyad influences nutritional care.

Functional determinants of dietary intake in community-dwelling older adults: a DEDIPAC (DEterminants of DIet and Physical ACtivity) systematic literature review

Objective

The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults.

Design

A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant.

Setting

Community.

Subjects

Older adults at least 65 years old without acute or specific chronic diseases.

Results

From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived.

Conclusions

Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.

Undernutrition and obesity among elderly people living in two cities of developing countries: Prevalence and associated factors in the EDAC study

BACKGROUND

Nutritional status among elderly people living in Sub-Saharan Africa is poorly studied, even though undernutrition and obesity are known to cause many complications and are risk factors for progression and death in several diseases. The aims of this study were to assess the nutritional status of the elderly in Central Africa and to study the factors associated with nutritional disorders (undernutrition and obesity).

METHODS

Two cross-sectional population-based studies were carried out in the capitals of Central African Republic (CAR) and Republic of Congo (ROC) between 2008 and 2009. Participants were aged ≥65 years old and underwent nutritional assessment including the following measurements: weight, height, body mass index (BMI), waist circumference (WC). Diet was also investigated. Nutritional status was defined according to the WHO BMI classification (<18.5 = undernutrition; ≥30 = obesity). Multinomial regression analysis was performed in order to identify factors associated with nutritional status.

RESULTS

990 elderly people underwent nutritional assessment (482 in CAR and 508 in ROC). Mean BMI was 22.7 ± 4.8 kg/m². The prevalence of undernutrition was 19.2% and was lower in ROC than in CAR (9.5% vs. 29.5%; p < 0.0001). The prevalence of obesity was 8.8% and was higher in ROC than in CAR (14.6% vs. 2.7%; p < 0.0001). The mean WC was 85.3 ± 28.4 cm. Adjusted on study site, increasing age (OR = 1.6 [95% CI: 1.1-2.3] for 75-84 years, OR = 2.6 [95% CI: 1.4-4.8] for 85+ years), occupation as farmer/breeder (OR = 2.2 [95% CI: 1.1-4.2]), smoking (OR = 1.71 [95% CI: 1.14-2.56]) and low sugar consumption (OR = 1.7 [95% CI: 1.1-2.7]) were positively associated with undernutrition whereas only female sex was positively associated with obesity (OR = 5.0 [95% CI: 2.2-11.0]).

CONCLUSIONS

The prevalence of undernutrition is high in the elderly population of these countries, in contrast to obesity. Undernutrition and obesity are associated with different socio-economic factors and food consumption. Simple nutritional advice could contribute to improving the nutritional status of elderly people in Central Africa.

Validity of equations using knee height to predict overall height among older people in Benin

OBJECTIVES

Chumlea's formulas are a validated means of predicting overall height from knee height (KH) among people >60 y of age, but, to our knowledge, no formula is validated for use in African countries, including Benin. The aim of this study was to compare height provided by predictive formulas using KH to measured height in an elderly population in Benin.

METHODS

Individuals >60 y of age in Benin underwent nutritional assessment with determination of weight, body mass index (BMI), height, and KH. A Bland-Altman analysis was carried out by sex and age. The percentage of predictions accurate to ±5 cm compared with the measured height was calculated. The tested formulas were Chumlea's formulas for non-Hispanic Black people (CBP) and two formulas for use among Caucasians.

RESULTS

Data from 396 individuals (81.1% male) were analyzed. The three formulas achieved 98% accuracy, but with 4.6% risk for error (±2 SD: -6 to +9 cm), which appeared to make them unfit for the whole population. Nevertheless, if a level of prediction ±5 cm is considered acceptable in clinical practice, the CBP formula achieved 83.1% accuracy. Moreover, there was no significant difference in BMI calculated with the measured and the predicted height, and the nutritional status based on BMI did not differ.

CONCLUSION

CBP formulas seem applicable in 83% of cases (±5 cm) to assess the height with KH of older people in Benin and do not overestimate the prevalence of malnutrition.

Exploring the health status of older persons in Sub-Saharan Africa

Sub-Saharan Africa (SSA) has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation, SSA is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases (NCD). The aim of this review is to highlight available research on the health status of older persons in SSA, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in SSA on older persons (aged 50 years and older) related to health indicators including nutritional status, NCD and HIV burden. While it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.

Primary Sarcopenia in Older People with Normal Nutrition

OBJECTIVE

The aim of this study was to investigate the presence of primary sarcopenia in older patients with normal nutrition and to assess the relationships between the primary sarcopenia with anthropometric measurements.

DESIGN AND METHODS

In this prospective clinical cross-sectional study, six-hundred patients who applied to Polyclinic of Geriatrics between dates 2010 and 2011 have been evaluated. The 386 patients who were supposed to have potential secondary sarcopenia were excluded from the study. Age, gender, weight, height, BMI, calf and waist circumference, ongoing medications, additional diseases of the 214 patients included in the study have been surveyed. The sarcopenia criteria of EWSGOP have been applied.

RESULTS

Two hundred fourteen cases included in the study were composed of 148 female and 66 male subjects. Mean age was 71.8 ± 2.1 years. Sarcopenia was detected in 105 (49%) subjects while 109 (51%) were normal. Sixty-four female (61%) and 41 (39%) male subjects were sarcopenic. Normal group included 84 female (77%) and 25 male (23%) subjects. Incidence of sarcopenia was found higher in the female patients (p<0.001). No statistically significant difference was detected between sarcopenic and normal groups with respect to age, height, weight, calf circumference and evaluation tests. Waist circumference was higher in the sarcopenic group than the normal group (p=0.02). When both groups were analyzed for BMI; 53 (51%) of the 105 sarcopenic patients had BMI over 30 kg/m2 while 29 (27%) and 23 (22%) patients had BMI of 25-30 kg/m2 and below 25 kg/m2, respectively. Incidence of sarcopenia was significantly higher in the group with BMI over 30 kg/m2 when compared with the groups with BMI of 25-30 kg/m2 and below 25 kg/m2 (p=0.01).

CONCLUSION

Sarcopenia that makes older people physically dependent and decreases their quality of life that receive sufficient nutritional support and are also obese should be comprehensively investigated with respect to presence of sarcopenia.

Energy and Protein Intake, Anthropometrics, and Disease Burden in Elderly Home-care Receivers--A Cross-sectional Study in Germany (ErnSIPP Study)

OBJECTIVE

To date, no study has examined the nutritional status and disease burden of elderly home-care receivers living in Germany. Aim of this cross-sectional study was, first, to assess disease burden and nutritional status, denoted in anthropometrics, and, second, to investigate associations between anthropometrics and disease burden.

DESIGN

Cross-sectional multi-centre study.

SETTING

Home-care receivers living in three urban areas of Germany in 2010.

PARTICIPANTS

353 elderly (>64 years) in home care (128 males aged 79.1 ±7.8 years, 225 females aged 82.0 ±7.5 years).

MEASUREMENTS

Nutritional status was assessed by body mass index (BMI), mid upper arm circumference (MUAC) and calf circumference (CC). Medical conditions were assessed in personal interviews. A 3-day prospective nutrition diary was kept. Metric data are reported as mean±SD or median (interquartile range), p<0.05 was considered significant.

RESULTS

Most participants were substantially (59%), and 11% severest in need of care. The seniors suffered from 5 (4-7) chronic diseases; dementia, depression, stroke, and respiratory illness were most prevalent (each 20-40%). More than one-third of participants had only moderate or poor appetite, nearly half were unable to eat independently. Chewing problems were reported for 52% of study participants, and more than one quarter of elderly had swallowing problems. Daily mean energy intake was 2017±528 kcal in men (n=123) and 1731±451 kcal in women (n=216; p<0.001). Mean protein intake amounted to 1.0 g/kg body weight. Mean BMI was 28.2±6.2 kg/m² (n=341), 14% of seniors had a BMI <22 kg/m² (including 4% with BMI <20 kg/m²). Critical MUAC (<22 cm) was indicated in 6% of subjects; and CC <31 cm in 11% of men, 21% of women (p<0.05). After adjusting for sex and age, BMI, MUAC and CC were negatively associated with high care level, hospitalization in the previous year, nausea/vomiting, prevalence of dementia, poor appetite, and eating difficulties like dependency, chewing and swallowing problems.

CONCLUSION

We recommend to pay special attention to the nutritional status of elderly persons in home-care exhibiting named disease burden.

Improving food intake in persons living with dementia

Persons living with dementia have many health concerns, including poor nutritional states. This narrative review provides an overview of the literature on nutritional status in persons diagnosed with a dementing illness or condition. Poor food intake is a primary mechanism for malnutrition, and there are many reasons why poor food intake occurs, especially in the middle and later stages of the dementing illness. Research suggests a variety of interventions to improve food intake, and thus nutritional status and quality of life, in persons with dementia. For family care partners, education programs have been the focus, while a range of intervention activities have been the focus in residential care, from tableware changes to retraining of self-feeding. It is likely that complex interventions are required to more fully address the issue of poor food intake, and future research needs to focus on diverse components. Specifically, modifying the psychosocial aspects of mealtimes is proposed as a means of improving food intake and quality of life and, to date, is a neglected area of intervention development and research.

Association of Grip Strength, Upper Arm Circumference, and Waist Circumference with Dementia in Older Adults of the WiSE Study: A Cross-Sectional Analysis

OBJECTIVE

We examined the associations of handgrip strength, upper arm circumference, and waist circumference with dementia among Singapore older adults.

DESIGN

Cross-sectional epidemiological study.

SETTING

Residential homes, day care centres, nursing homes and institutions.

PARTICIPANTS

2,565 men and women aged 60 years and above who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013.

MEASUREMENTS

Socio-demographic correlates, dietary habits, health behaviours, grip strength, upper arm circumference, and waist circumference were collected. Grip strength was measured using a hand dynamometer with the dominant hand. Upper arm circumference was measured using a measuring tape around the thickest part of the upper arm while waist circumference measured in centimetres was measured at the narrowest part of the body between the chest and hips for women, and measured at the level of the umbilicus for men. Dementia was diagnosed using the 10/66 dementia diagnostic criteria.

RESULTS

Mean grip strength was 13.07 kg (SE=0.60) for people with dementia and 21.98 kg (SE=0.26) for people without dementia. After adjusting for all factors, grip strength remained significantly associated with dementia (p <0.0001). Upper arm circumference was associated with dementia (p <0.0001) but this association was only significant in the univariate analysis. Waist circumference was not significantly associated with dementia.

CONCLUSIONS

Lower grip strength was independently associated with dementia in the older adult population in Singapore. Further research needs to be done to ascertain whether this association exists for specific types of dementia and look into the relationship of other anthropometric measurements with dementia in Singapore.

Diet, Alcohol Consumption and Cognitive Disorders in Central Africa: A Study from the EPIDEMCA Program

Western research into dementia has focused on finding effective means of prevention, particularly through nutrition. To date, however, little is known about the relationship between diet and cognitive disorders in Africa, where the number of people with dementia is expected to increase most over the coming decades. The objective of the study was to investigate the relationship between diet and alcohol intake and cognitive disorders among elderly people in Central Africa. Between 2011 and 2012, a cross-sectional multicentre population-based study was carried out in rural and urban areas of the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 years were interviewed using the Community Screening Interview for Dementia (CSI-D). Elderly people who performed poorly (COGSCORE≤24.5/30) were clinically assessed by neurologists and underwent further psychometric testing. DSM-IV and Petersen criteria were required for a diagnosis of dementia or mild cognitive impairment (MCI), respectively. A food frequency questionnaire assessed the intakes of dairy products, fruit, vegetables, starches, legumes, oleaginous foods, meat or fish, eggs and sweet foods over the previous three days. We also collected data on alcohol intake. Sociodemographic, vascular, and psychological factors were documented. Multivariate multinomial logistic regression models were used to estimate the associations. In fully adjusted models, a lower consumption of oleaginous foods was associated with MCI (OR=3.7 [1.4-9.9]) and dementia (OR=2.8 [1.0-7.7]) in a rural area of CAR. Alcohol consumption was associated with reduced probability of dementia in CAR (OR=0.3 [0.1-0.8]). In ROC, food groups and alcohol intake were not associated with MCI or dementia. In conclusion, our study provides new data about the association between diet and cognitive disorders in Africa. Further studies should investigate the relationship between diet and cognitive disorders at the level of specific foods rather than food groups.