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Christidi F, Drouka A, Brikou D, Mamalaki E, Ntanasi E, Karavasilis E, Velonakis G, Angelopoulou G, Tsapanou A, Gu Y, Yannakoulia M, Scarmeas N. The Association between Individual Food Groups, Limbic System White Matter Tracts, and Episodic Memory: Initial Data from the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration (ALBION) Study. Nutrients 2024; 16:2766. [PMID: 39203902 PMCID: PMC11357525 DOI: 10.3390/nu16162766] [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: 07/22/2024] [Revised: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Many studies link food intake with clinical cognitive outcomes, but evidence for brain biomarkers, such as memory-related limbic white matter (WM) tracts, is limited. We examined the association between food groups, limbic WM tracts integrity, and memory performance in community-dwelling individuals. (2) Methods: We included 117 non-demented individuals (ALBION study). Verbal and visual episodic memory tests were administered, and a composite z-score was calculated. Diffusion tensor imaging tractography was applied for limbic WM tracts (fornix-FX, cingulum bundle-CB, uncinate fasciculus-UF, hippocampal perforant pathway zone-hPPZ). Food intake was evaluated through four 24-h recalls. We applied linear regression models adjusted for demographics and energy intake. (3) Results: We found significant associations between (a) higher low-to-moderate alcohol intake and higher FX fractional anisotropy (FA), (b) higher full-fat dairy intake and lower hPPZ FA, and (c) higher red meat and cold cuts intake and lower hPPZ FA. None of the food groups was associated with memory performance. (4) Conclusions: Despite non-significant associations between food groups and memory, possibly due to participants' cognitive profile and/or compensatory mechanisms, the study documented a possible beneficial role of low-to-moderate alcohol and a harmful role of full-fat dairy and red meat and cold cuts on limbic WM tracts.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece (G.A.)
- Computational Neuroimaging Group (CNG), School of Medicine, Trinity College Dublin, D08 NHY1 Dublin, Ireland
| | - Archontoula Drouka
- Department of Nutrition and Dietetics, Harokopio University, 17671 Athens, Greece
| | - Dora Brikou
- Department of Nutrition and Dietetics, Harokopio University, 17671 Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, Harokopio University, 17671 Athens, Greece
| | - Eva Ntanasi
- First Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece (G.A.)
| | - Efstratios Karavasilis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- School of Medicine, Democritus University of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Georgia Angelopoulou
- First Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece (G.A.)
| | - Angeliki Tsapanou
- First Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece (G.A.)
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA;
| | - Yian Gu
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA;
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, 17671 Athens, Greece
| | - Nikolaos Scarmeas
- First Department of Neurology, Aiginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece (G.A.)
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA;
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Hepsomali P, Costabile A, Schoemaker M, Imakulata F, Allen P. Adherence to unhealthy diets is associated with altered frontal gamma-aminobutyric acid and glutamate concentrations and grey matter volume: preliminary findings. Nutr Neurosci 2024:1-13. [PMID: 38794782 DOI: 10.1080/1028415x.2024.2355603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
OBJECTIVES Common mental disorders (CMD) are associated with impaired frontal excitatory/inhibitory (E/I) balance and reduced grey matter volume (GMV). Larger GMV (in the areas that are implicated in CMD-pathology) and improved CMD-symptomatology have been observed in individuals who adhere to high quality diets. Moreover, preclinical studies have shown altered neurometabolites (primarily gamma-aminobutyric acid: GABA and glutamate: GLU) in relation to diet quality. However, neurochemical correlates of diet quality and how these neurobiological changes are associated with CMD and with its transdiagnostic factor, rumination, is unknown in humans. Therefore, in this study, we examined the associations between diet quality and frontal cortex neuro-chemistry and structure, as well as CMD and rumination in humans. METHODS Thirty adults were classified into high and low diet quality groups and underwent 1H-MRS to measure medial prefrontal cortex (mPFC) metabolite concentrations and volumetric imaging to measure GMV. RESULTS Low (vs High) diet quality group had reduced mPFC-GABA and elevated mPFC-GLU concentrations, as well as reduced right precentral gyrus (rPCG) GMV. However, CMD and rumination were not associated with diet quality. Notably, we observed a significant negative correlation between rumination and rPCG-GMV and a marginally significant association between rumination and mPFC-GLU concentrations. There was also a marginally significant association between mPFC-GLU concentrations and rPCG-GMV. DISCUSSION Adhering to unhealthy dietary patterns may be associated with compromised E/I balance, and this could affect GMV, and subsequently, rumination.
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Affiliation(s)
- Piril Hepsomali
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Adele Costabile
- School of Life and Health Sciences, University of Roehampton, London, UK
| | | | | | - Paul Allen
- Department of Neuroimaging, Kings College London, Institute of Psychology and Neuroscience, London, UK
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3
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Zwilling CE, Wu J, Barbey AK. Investigating nutrient biomarkers of healthy brain aging: a multimodal brain imaging study. NPJ AGING 2024; 10:27. [PMID: 38773079 PMCID: PMC11109270 DOI: 10.1038/s41514-024-00150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/15/2024] [Indexed: 05/23/2024]
Abstract
The emerging field of Nutritional Cognitive Neuroscience aims to uncover specific foods and nutrients that promote healthy brain aging. Central to this effort is the discovery of nutrient profiles that can be targeted in nutritional interventions designed to promote brain health with respect to multimodal neuroimaging measures of brain structure, function, and metabolism. The present study therefore conducted one of the largest and most comprehensive nutrient biomarker studies examining multimodal neuroimaging measures of brain health within a sample of 100 older adults. To assess brain health, a comprehensive battery of well-established cognitive and brain imaging measures was administered, along with 13 blood-based biomarkers of diet and nutrition. The findings of this study revealed distinct patterns of aging, categorized into two phenotypes of brain health based on hierarchical clustering. One phenotype demonstrated an accelerated rate of aging, while the other exhibited slower-than-expected aging. A t-test analysis of dietary biomarkers that distinguished these phenotypes revealed a nutrient profile with higher concentrations of specific fatty acids, antioxidants, and vitamins. Study participants with this nutrient profile demonstrated better cognitive scores and delayed brain aging, as determined by a t-test of the means. Notably, participant characteristics such as demographics, fitness levels, and anthropometrics did not account for the observed differences in brain aging. Therefore, the nutrient pattern identified by the present study motivates the design of neuroscience-guided dietary interventions to promote healthy brain aging.
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Affiliation(s)
- Christopher E Zwilling
- Department of Psychology, University of Illinois, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, USA
| | - Jisheng Wu
- Decision Neuroscience Laboratory, University of Nebraska-Lincoln, Lincoln, NE, USA
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Aron K Barbey
- Department of Psychology, University of Illinois, Urbana, IL, USA.
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL, USA.
- Decision Neuroscience Laboratory, University of Nebraska-Lincoln, Lincoln, NE, USA.
- Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NE, USA.
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.
- Department of Bioengineering, University of Illinois, Urbana, IL, USA.
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4
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Cui F, Li H, Cao Y, Wang W, Zhang D. The Association between Dietary Protein Intake and Sources and the Rate of Longitudinal Changes in Brain Structure. Nutrients 2024; 16:1284. [PMID: 38732531 PMCID: PMC11085529 DOI: 10.3390/nu16091284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Few studies have examined dietary protein intake and sources, in combination with longitudinal changes in brain structure markers. Our study aimed to examine the association between dietary protein intake and different sources of dietary protein, with the longitudinal rate of change in brain structural markers. A total of 2723 and 2679 participants from the UK Biobank were separately included in the analysis. The relative and absolute amounts of dietary protein intake were calculated using a 24 h dietary recall questionnaire. The longitudinal change rates of brain structural biomarkers were computed using two waves of brain imaging data. The average interval between the assessments was three years. We utilized multiple linear regression to examine the association between dietary protein and different sources and the longitudinal changes in brain structural biomarkers. Restrictive cubic splines were used to explore nonlinear relationships, and stratified and sensitivity analyses were conducted. Increasing the proportion of animal protein in dietary protein intake was associated with a slower reduction in the total hippocampus volume (THV, β: 0.02524, p < 0.05), left hippocampus volume (LHV, β: 0.02435, p < 0.01) and right hippocampus volume (RHV, β: 0.02544, p < 0.05). A higher intake of animal protein relative to plant protein was linked to a lower atrophy rate in the THV (β: 0.01249, p < 0.05) and LHV (β: 0.01173, p < 0.05) and RHV (β: 0.01193, p < 0.05). Individuals with a higher intake of seafood exhibited a higher longitudinal rate of change in the HV compared to those that did not consume seafood (THV, β: 0.004514; p < 0.05; RHV, β: 0.005527, p < 0.05). In the subgroup and sensitivity analyses, there were no significant alterations. A moderate increase in an individual's intake and the proportion of animal protein in their diet, especially from seafood, is associated with a lower atrophy rate in the hippocampus volume.
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Affiliation(s)
- Fusheng Cui
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao 266021, China; (F.C.); (H.L.); (D.Z.)
| | - Huihui Li
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao 266021, China; (F.C.); (H.L.); (D.Z.)
| | - Yi Cao
- Biomedical Center, Qingdao University, Qingdao 266021, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao 266021, China; (F.C.); (H.L.); (D.Z.)
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao 266021, China; (F.C.); (H.L.); (D.Z.)
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5
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Wang Z, Xia K, Li J, Liu Y, Zhou Y, Zhang L, Tang L, Zeng X, Fan D, Yang Q. Essential Nutrients and White Matter Hyperintensities: A Two-Sample Mendelian Randomization Study. Biomedicines 2024; 12:810. [PMID: 38672165 PMCID: PMC11047968 DOI: 10.3390/biomedicines12040810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Stroke and dementia have been linked to the appearance of white matter hyperintensities (WMHs). Meanwhile, diffusion tensor imaging (DTI) might capture the microstructural change in white matter early. Specific dietary interventions may help to reduce the risk of WMHs. However, research on the relationship between specific nutrients and white matter changes is still lacking. We aimed to investigate the causal effects of essential nutrients (amino acids, fatty acids, mineral elements, and vitamins) on WMHs and DTI measures, including fraction anisotropy (FA) and mean diffusivity (MD), by a Mendelian randomization analysis. We selected single nucleotide polymorphisms (SNPs) associated with each nutrient as instrumental variables to assess the causal effects of nutrient-related exposures on WMHs, FA, and MD. The outcome was from a recently published large-scale European Genome Wide Association Studies pooled dataset, including WMHs (N = 18,381), FA (N = 17,663), and MD (N = 17,467) data. We used the inverse variance weighting (IVW) method as the primary method, and sensitivity analyses were conducted using the simple median, weighted median, and MR-Egger methods. Genetically predicted serum calcium level was positively associated with WMHs risk, with an 8.1% increase in WMHs risk per standard deviation unit increase in calcium concentration (OR = 1.081, 95% CI = 1.006-1.161, p = 0.035). The plasma linoleic acid level was negatively associated with FA (OR = 0.776, 95% CI = 0.616-0.978, p = 0.032). Our study demonstrated that genetically predicted calcium was a potential risk factor for WMHs, and linoleic acid may be negatively associated with FA, providing evidence for interventions from the perspective of gene-environment interactions.
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Affiliation(s)
- Zhengrui Wang
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
- Peking University Health Science Center, Beijing 100191, China
| | - Kailin Xia
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Jiayi Li
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
- Peking University Health Science Center, Beijing 100191, China
| | - Yanru Liu
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
- Peking University Health Science Center, Beijing 100191, China
| | - Yumou Zhou
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
- Peking University Health Science Center, Beijing 100191, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Xiangzhu Zeng
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing 100191, China
- Key Laboratory for Neuroscience, National Health Commission, Ministry of Education, Peking University, Beijing 100191, China
| | - Qiong Yang
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
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6
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Jensen DEA, Ebmeier KP, Suri S, Rushworth MFS, Klein-Flügge MC. Nuclei-specific hypothalamus networks predict a dimensional marker of stress in humans. Nat Commun 2024; 15:2426. [PMID: 38499548 PMCID: PMC10948785 DOI: 10.1038/s41467-024-46275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
The hypothalamus is part of the hypothalamic-pituitary-adrenal axis which activates stress responses through release of cortisol. It is a small but heterogeneous structure comprising multiple nuclei. In vivo human neuroimaging has rarely succeeded in recording signals from individual hypothalamus nuclei. Here we use human resting-state fMRI (n = 498) with high spatial resolution to examine relationships between the functional connectivity of specific hypothalamic nuclei and a dimensional marker of prolonged stress. First, we demonstrate that we can parcellate the human hypothalamus into seven nuclei in vivo. Using the functional connectivity between these nuclei and other subcortical structures including the amygdala, we significantly predict stress scores out-of-sample. Predictions use 0.0015% of all possible brain edges, are specific to stress, and improve when using nucleus-specific compared to whole-hypothalamus connectivity. Thus, stress relates to connectivity changes in precise and functionally meaningful subcortical networks, which may be exploited in future studies using interventions in stress disorders.
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Affiliation(s)
- Daria E A Jensen
- Department of Experimental Psychology, University of Oxford, Tinsley Building, Mansfield Road, Oxford, OX1 3TA, UK.
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB, University of Oxford, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
- Clinic of Cognitive Neurology, University Medical Center Leipzig and Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1a, 04103, Leipzig, Germany.
| | - Klaus P Ebmeier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK
| | - Sana Suri
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK
| | - Matthew F S Rushworth
- Department of Experimental Psychology, University of Oxford, Tinsley Building, Mansfield Road, Oxford, OX1 3TA, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB, University of Oxford, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Miriam C Klein-Flügge
- Department of Experimental Psychology, University of Oxford, Tinsley Building, Mansfield Road, Oxford, OX1 3TA, UK.
- Wellcome Centre for Integrative Neuroimaging (WIN), Centre for Functional MRI of the Brain (FMRIB, University of Oxford, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
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O'Dowd A, O'Connor DMA, Hirst RJ, Setti A, Kenny RA, Newell FN. Nutrition is associated with differences in multisensory integration in healthy older adults. Nutr Neurosci 2024:1-11. [PMID: 38386286 DOI: 10.1080/1028415x.2024.2316446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Diet can influence cognitive functioning in older adults and is a modifiable risk factor for cognitive decline. However, it is unknown if an association exists between diet and lower-level processes in the brain underpinning cognition, such as multisensory integration. We investigated whether temporal multisensory integration is associated with daily intake of fruit and vegetables (FV) or products high in fat/sugar/salt (FSS) in a large sample (N = 2,693) of older adults (mean age = 64.06 years, SD = 7.60; 56% female) from The Irish Longitudinal Study on Ageing (TILDA). Older adults completed a Food Frequency Questionnaire from which the total number of daily servings of FV and FSS items respectively was calculated. Older adults' susceptibility to the Sound Induced Flash Illusion (SIFI) measured the temporal precision of audio-visual integration, which included three audio-visual Stimulus Onset Asynchronies (SOAs): 70, 150 and 230 ms. Older adults who self-reported a higher daily consumption of FV were less susceptible to the SIFI at the longest versus shortest SOAs (i.e. increased temporal precision) compared to those reporting the lowest daily consumption (p = .013). In contrast, older adults reporting a higher daily consumption of FSS items were more susceptible to the SIFI at the longer versus shortest SOAs (i.e. reduced temporal precision) compared to those reporting the lowest daily consumption (p < .001). The temporal precision of multisensory integration is differentially associated with levels of daily consumption of FV versus products high in FSS, consistent with broader evidence that habitual diet is associated with brain health.
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Affiliation(s)
- Alan O'Dowd
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Deirdre M A O'Connor
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Mercer Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rebecca J Hirst
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Annalisa Setti
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Mercer Institute for Successful Ageing, St. James Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona N Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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Chen J, Li T, Zhao B, Chen H, Yuan C, Garden GA, Wu G, Zhu H. The interaction effects of age, APOE and common environmental risk factors on human brain structure. Cereb Cortex 2024; 34:bhad472. [PMID: 38112569 PMCID: PMC10793588 DOI: 10.1093/cercor/bhad472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023] Open
Abstract
Mounting evidence suggests considerable diversity in brain aging trajectories, primarily arising from the complex interplay between age, genetic, and environmental risk factors, leading to distinct patterns of micro- and macro-cerebral aging. The underlying mechanisms of such effects still remain unclear. We conducted a comprehensive association analysis between cerebral structural measures and prevalent risk factors, using data from 36,969 UK Biobank subjects aged 44-81. Participants were assessed for brain volume, white matter diffusivity, Apolipoprotein E (APOE) genotypes, polygenic risk scores, lifestyles, and socioeconomic status. We examined genetic and environmental effects and their interactions with age and sex, and identified 726 signals, with education, alcohol, and smoking affecting most brain regions. Our analysis revealed negative age-APOE-ε4 and positive age-APOE-ε2 interaction effects, respectively, especially in females on the volume of amygdala, positive age-sex-APOE-ε4 interaction on the cerebellar volume, positive age-excessive-alcohol interaction effect on the mean diffusivity of the splenium of the corpus callosum, positive age-healthy-diet interaction effect on the paracentral volume, and negative APOE-ε4-moderate-alcohol interaction effects on the axial diffusivity of the superior fronto-occipital fasciculus. These findings highlight the need of considering age, sex, genetic, and environmental joint effects in elucidating normal or abnormal brain aging.
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Affiliation(s)
- Jie Chen
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill NC 27514, United States
| | - Tengfei Li
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, United States
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, 125 Mason Farm Road, Chapel Hill, NC 27599, United States
| | - Bingxin Zhao
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, 265 South 37th Street, 3rd & 4th Floors, Philadelphia, PA 19104-1686, United States
| | - Hui Chen
- School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, China
- Department of Nutrition, Harvard T H Chan School of Public Health, 665 Huntington Avenue Boston, MA, 02115, United States
| | - Gwenn A Garden
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive Chapel Hill, NC 27599-7025, United States
| | - Guorong Wu
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27514, United States
- Departments of Statistics and Operations Research, University of North Carolina at Chapel Hill, 318 E Cameron Ave #3260, Chapel Hill, NC 27599, United States
- Departments of Computer Science, University of North Carolina at Chapel Hill, 201 South Columbia Street, Chapel Hill, NC 27599, United States
- UNC Neuroscience Center, University of North Carolina at Chapel Hill, 116 Manning Dr, Chapel Hill, NC 27599, United States
- Carolina Institute for Developmental Disabilities, 101 Renee Lynne Ct, Carrboro, NC 27510, United States
| | - Hongtu Zhu
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill NC 27514, United States
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, 125 Mason Farm Road, Chapel Hill, NC 27599, United States
- Departments of Statistics and Operations Research, University of North Carolina at Chapel Hill, 318 E Cameron Ave #3260, Chapel Hill, NC 27599, United States
- Departments of Computer Science, University of North Carolina at Chapel Hill, 201 South Columbia Street, Chapel Hill, NC 27599, United States
- Departments of Genetics, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC 27514, United States
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Chen X, Walton K, Brodaty H, Chalton K. Polyphenols and Diets as Current and Potential Nutrition Senotherapeutics in Alzheimer's Disease: Findings from Clinical Trials. J Alzheimers Dis 2024; 101:S479-S501. [PMID: 38875032 DOI: 10.3233/jad-231222] [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] [Indexed: 06/16/2024]
Abstract
Cellular senescence, a hallmark of aging, plays an important role in age-related conditions among older adults. Targeting senescent cells and its phenotype may provide a promising strategy to delay the onset or progression of Alzheimer's disease (AD). In this review article, we investigated efficacy and safety of nutrition senotherapy in AD, with a focus on the role of polyphenols as current and potential nutrition senotherapeutic agents, as well as relevant dietary patterns. Promising results with neuroprotective effects of senotherapeutic agents such as quercetin, resveratrol, Epigallocatechin-gallate, curcumin and fisetin were reported from preclinical studies. However, in-human trials remain limited, and findings were inconclusive. In future, nutrition senotherapeutic agents should be studied both individually and within dietary patterns, through the perspective of cellular senescence and AD. Further studies are warranted to investigate bioavailability, dosing regimen, long term effects of nutrition senotherapy and provide better understanding of the underlying mechanisms. Collaboration between researchers needs to be established, and methodological limitations of current studies should be addressed.
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Affiliation(s)
- Xi Chen
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Karen Walton
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Karen Chalton
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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10
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Jensen DE, Ebmeier KP, Akbaraly T, Jansen MG, Singh-Manoux A, Kivimäki M, Zsoldos E, Klein-Flügge MC, Suri S. The association of longitudinal diet and waist-to-hip ratio from midlife to old age with hippocampus connectivity and memory in old age: a cohort study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.12.570778. [PMID: 38168259 PMCID: PMC10760001 DOI: 10.1101/2023.12.12.570778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Epidemiological studies suggest lifestyle factors may reduce the risk of dementia. However, few studies have examined the association of diet and waist-to-hip ratio with hippocampus connectivity. In the Whitehall II Imaging Sub-study, we examined longitudinal changes in diet quality in 512 participants and waist-to-hip ratio in 665 participants. Diet quality was measured using the Alternative Health Eating Index-2010 assessed three times across 11 years between ages 48 and 60 years, and waist-to-hip ratio five times over 21 years between ages 48 and 68 years. Brain imaging and cognitive tests were performed at age 70±5 years. We measured white matter using diffusion tensor imaging and hippocampal functional connectivity using resting-state functional magnetic resonance imaging. In addition to associations of diet and waist-to-hip ratio with brain imaging measures, we tested whether associations between diet, waist-to-hip ratio and cognitive performance were mediated by brain connectivity. We found better diet quality in midlife and improvements in diet over mid-to-late life were associated with higher hippocampal functional connectivity to the occipital lobe and cerebellum, and better white matter integrity as measured by higher fractional anisotropy and lower diffusivity. Higher waist-to-hip ratio in midlife was associated with higher mean and radial diffusivity and lower fractional anisotropy in several tracts including the inferior longitudinal fasciculus and cingulum. Associations between midlife waist-to-hip ratio, working memory and executive function were partially mediated by radial diffusivity. All associations were independent of age, sex, education, and physical activity. Our findings highlight the importance of maintaining a good diet and a healthy waist-to-hip ratio in midlife to maintain brain health in later life. Future interventional studies for the improvement of dietary and metabolic health should target midlife for the prevention of cognitive decline in old age.
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11
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Gaudio S, Rukh G, Di Ciommo V, Berkins S, Wiemerslage L, Schiöth HB. Higher fresh fruit intake relates to larger grey matter volumes in areas involved in dementia and depression: A UK Biobank study. Neuroimage 2023; 283:120438. [PMID: 37918179 DOI: 10.1016/j.neuroimage.2023.120438] [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: 09/17/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023] Open
Abstract
The benefits of consuming fruits and vegetables are widely accepted. While previous studies suggest a protective role of fruits and vegetables against a variety of diseases such as dementia and depression, the biological mechanisms/effects remain unclear. Here we investigated the effect of fruit and vegetable consumption on brain structure. Particularly on grey matter (GM) and white matter (WM) volumes, regional GM volumes and subcortical volumes. Cross-sectional imaging data from UK Biobank cohort was used. A total of 9925 participants (Mean age 62.4 ± 7.5 years, 51.1 % men) were included in the present analysis. Measures included fruit and vegetable intake, other dietary patterns and a number of selected lifestyle factors and clinical data. Brain volumes were derived from structural brain magnetic resonance imaging. General linear model was used to study the associations between brain volumes and fruit/vegetable intakes. After adjusting for selected confounding factors, salad/raw vegetable intake showed a positive association with total white matter volume, fresh fruit intake showed a negative association with total grey matter (GM) volume. Regional GM analyses showed that higher fresh fruit intake was associated with larger GM volume in the left hippocampus, right temporal occipital fusiform cortex, left postcentral gyrus, right precentral gyrus, and right juxtapositional lobule cortex. We conclude that fruit and vegetable consumption seems to specifically modulate brain volumes. In particular, fresh fruit intake may have a protective role in specific cortical areas such as the hippocampus, areas robustly involved in the pathophysiology of dementia and depression.
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Affiliation(s)
- Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24, Uppsala, Sweden.
| | - Gull Rukh
- Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24, Uppsala, Sweden
| | - Vincenzo Di Ciommo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24, Uppsala, Sweden
| | - Samuel Berkins
- Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24, Uppsala, Sweden
| | - Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24, Uppsala, Sweden; Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
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12
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Mulder D, Aarts E, Arias Vasquez A, Bloemendaal M. A systematic review exploring the association between the human gut microbiota and brain connectivity in health and disease. Mol Psychiatry 2023; 28:5037-5061. [PMID: 37479779 PMCID: PMC11041764 DOI: 10.1038/s41380-023-02146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 07/23/2023]
Abstract
A body of pre-clinical evidence shows how the gut microbiota influence brain functioning, including brain connectivity. Linking measures of brain connectivity to the gut microbiota can provide important mechanistic insights into the bi-directional gut-brain communication. In this systematic review, we therefore synthesized the available literature assessing this association, evaluating the degree of consistency in microbiota-connectivity associations. Following the PRISMA guidelines, a PubMed search was conducted, including studies published up to September 1, 2022. We identified 16 studies that met the inclusion criteria. Several bacterial genera, including Prevotella, Bacteroides, Ruminococcus, Blautia, and Collinsella were most frequently reported in association with brain connectivity. Additionally, connectivity of the salience (specifically the insula and anterior cingulate cortex), default mode, and frontoparietal networks were most frequently associated with the gut microbiota, both in terms of microbial diversity and composition. There was no discernible pattern in the association between microbiota and brain connectivity. Altogether, based on our synthesis, there is evidence for an association between the gut microbiota and brain connectivity. However, many findings were poorly replicated across studies, and the specificity of the association is yet unclear. The current studies show substantial inter-study heterogeneity in methodology and reporting, limiting the robustness and reproducibility of the findings and emphasizing the need to harmonize methodological approaches. To enhance comparability and replicability, future research should focus on further standardizing processing pipelines and employing data-driven multivariate analysis strategies.
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Affiliation(s)
- Danique Mulder
- Department of Psychiatry, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Esther Aarts
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Alejandro Arias Vasquez
- Department of Psychiatry, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
| | - Mirjam Bloemendaal
- Department of Psychiatry, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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13
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Demnitz N, Hulme OJ, Siebner HR, Kjaer M, Ebmeier KP, Boraxbekk CJ, Gillan CM. Characterising the covariance pattern between lifestyle factors and structural brain measures: a multivariable replication study of two independent ageing cohorts. Neurobiol Aging 2023; 131:115-123. [PMID: 37619515 DOI: 10.1016/j.neurobiolaging.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
Modifiable lifestyle factors have been shown to promote healthy brain ageing. However, studies have typically focused on a single factor at a time. Given that lifestyle factors do not occur in isolation, multivariable analyses provide a more realistic model of the lifestyle-brain relationship. Here, canonical correlation analyses (CCA) examined the relationship between nine lifestyle factors and seven MRI-derived indices of brain structure. The resulting covariance pattern was further explored with Bayesian regressions. CCA analyses were first conducted on a Danish cohort of older adults (n = 251) and then replicated in a British cohort (n = 668). In both cohorts, the latent factors of lifestyle and brain structure were positively correlated (UK: r = .37, p < 0.001; Denmark: r = .27, p < 0.001). In the cross-validation study, the correlation between lifestyle-brain latent factors was r = .10, p = 0.008. However, the pattern of associations differed between datasets. These findings suggest that baseline characterisation and tailoring towards the study sample may be beneficial for achieving targeted lifestyle interventions.
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Affiliation(s)
- Naiara Demnitz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.
| | - Oliver J Hulme
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; London Mathematical Laboratory, London, UK; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus P Ebmeier
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Carl-Johan Boraxbekk
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Radiation Sciences, Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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14
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Alateeq K, Walsh EI, Cherbuin N. Dietary magnesium intake is related to larger brain volumes and lower white matter lesions with notable sex differences. Eur J Nutr 2023:10.1007/s00394-023-03123-x. [PMID: 36899275 DOI: 10.1007/s00394-023-03123-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/14/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE To examine the association between dietary magnesium (Mg) intake and brain volumes and white matter lesions (WMLs) in middle to early old age. METHODS Participants (aged 40-73 years) from UK Biobank (n = 6001) were included and stratified by sex. Dietary Mg was measured using an online computerised 24 h recall questionnaire to estimate daily Mg intake. Latent class analysis and hierarchical linear regression models were performed to investigate the association between baseline dietary Mg, Mg trajectories, and brain volumes and WMLs. Associations between baseline Mg, and baseline blood pressure (BP) measures, and baseline Mg, Mg trajectories and BP changes (between baseline and wave 2) were also investigated to assess whether BP mediates the link between Mg intake and brain health. All analyses controlled for health and socio-demographic covariates. Possible interactions between menopausal status and Mg trajectories in predicting brain volumes and WMLs were also investigated. RESULTS On average, higher baseline dietary Mg intake was associated with larger brain volumes (gray matter [GM]: 0.001% [SE = 0.0003]; left hippocampus [LHC]: 0.0013% [SE = 0.0006]; and right hippocampus [RHC]: 0.0023% [SE = 0.0006]) in both men and women. Latent class analysis of Mg intake revealed three classes: "high-decreasing" (men = 3.2%, women = 1.9%), "low-increasing" (men = 1.09%, women = 1.62%), and "stable normal" (men = 95.71%, women = 96.51%). In women, only the "high-decreasing" trajectory was significantly associated with larger brain volumes (GM: 1.17%, [SE = 0.58]; and RHC: 2.79% [SE = 1.11]) compared to the "normal-stable", the "low-increasing" trajectory was associated with smaller brain volumes (GM: - 1.67%, [SE = 0.30]; white matter [WM]: - 0.85% [SE = 0.42]; LHC: - 2.43% [SE = 0.59]; and RHC: - 1.50% [SE = 0.57]) and larger WMLs (1.6% [SE = 0.53]). Associations between Mg and BP measures were mostly non-significant. Furthermore, the observed neuroprotective effect of higher dietary Mg intake in the "high-decreasing" trajectory appears to be greater in post-menopausal than pre-menopausal women. CONCLUSIONS Higher dietary Mg intake is related to better brain health in the general population, and particularly in women.
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Affiliation(s)
- Khawlah Alateeq
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia. .,Radiological Science, College of Applied Medical Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Erin I Walsh
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia.,Population Health Exchange, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, 54 Mills Road, Canberra, ACT, 2601, Australia
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15
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Arnoldy L, Gauci S, Young LM, Marx W, Macpherson H, Pipingas A, Civier O, White DJ. The association of dietary and nutrient patterns on neurocognitive decline: A systematic review of MRI and PET studies. Ageing Res Rev 2023; 87:101892. [PMID: 36878405 DOI: 10.1016/j.arr.2023.101892] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND As the global population ages, there has been a growing incidence of neurodegenerative diseases such as Alzheimer's. More recently, studies exploring the relationship between dietary patterns and neuroimaging outcomes have received particular attention. This systematic literature review provides a structured overview of the association between dietary and nutrient patterns on neuroimaging outcomes and cognitive markers in middle-aged to older adults. A comprehensive literature search was conducted to find relevant articles published from 1999 to date using the following databases Ovid MEDLINE, Embase, PubMed, Scopus and Web of Science. The inclusion criteria for the articles comprised studies reporting on the association between dietary patterns and neuroimaging outcomes, which includes both specific pathological hallmarks of neurodegenerative diseases such as Aβ and tau and nonspecific markers such as structural MRI and glucose metabolism. The risk of bias was evaluated using the Quality Assessment tool from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The results were then organized into a summary of results table, collated based on synthesis without meta-analysis. After conducting the search, 6050 records were extracted and screened for eligibility, with 107 eligible for full-text screening and 42 articles ultimately being included in this review. The results of the systematic review indicate that there is some evidence suggesting that healthy dietary and nutrient patterns were associated with neuroimaging measures, indicative of a protective influence on neurodegeneration and brain ageing. Conversely, unhealthy dietary and nutrient patterns showed evidence pointing to decreased brain volumes, poorer cognition and increased Aβ deposition. Future research should focus on sensitive neuroimaging acquisition and analysis methods, to study early neurodegenerative changes and identify critical periods for interventions and prevention. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no, CRD42020194444).
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Affiliation(s)
- Lizanne Arnoldy
- Centre of Human Psychopharmacology, Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne Australia.
| | - Sarah Gauci
- Centre of Human Psychopharmacology, Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne Australia; IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Lauren M Young
- Centre of Human Psychopharmacology, Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne Australia; IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Wolfgang Marx
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Andrew Pipingas
- Centre of Human Psychopharmacology, Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne Australia
| | - Oren Civier
- Swinburne Neuroimaging, Swinburne University, Melbourne, Australia
| | - David J White
- Centre of Human Psychopharmacology, Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne Australia; Swinburne Neuroimaging, Swinburne University, Melbourne, Australia
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16
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Yassine HN, Self W, Kerman BE, Santoni G, Navalpur Shanmugam N, Abdullah L, Golden LR, Fonteh AN, Harrington MG, Gräff J, Gibson GE, Kalaria R, Luchsinger JA, Feldman HH, Swerdlow RH, Johnson LA, Albensi BC, Zlokovic BV, Tanzi R, Cunnane S, Samieri C, Scarmeas N, Bowman GL. Nutritional metabolism and cerebral bioenergetics in Alzheimer's disease and related dementias. Alzheimers Dement 2023; 19:1041-1066. [PMID: 36479795 PMCID: PMC10576546 DOI: 10.1002/alz.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022]
Abstract
Disturbances in the brain's capacity to meet its energy demand increase the risk of synaptic loss, neurodegeneration, and cognitive decline. Nutritional and metabolic interventions that target metabolic pathways combined with diagnostics to identify deficits in cerebral bioenergetics may therefore offer novel therapeutic potential for Alzheimer's disease (AD) prevention and management. Many diet-derived natural bioactive components can govern cellular energy metabolism but their effects on brain aging are not clear. This review examines how nutritional metabolism can regulate brain bioenergetics and mitigate AD risk. We focus on leading mechanisms of cerebral bioenergetic breakdown in the aging brain at the cellular level, as well as the putative causes and consequences of disturbed bioenergetics, particularly at the blood-brain barrier with implications for nutrient brain delivery and nutritional interventions. Novel therapeutic nutrition approaches including diet patterns are provided, integrating studies of the gut microbiome, neuroimaging, and other biomarkers to guide future personalized nutritional interventions.
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Affiliation(s)
- Hussein N Yassine
- Department of Medicine, Keck School of Medicine, University of Southern, California, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Wade Self
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bilal E Kerman
- Department of Medicine, Keck School of Medicine, University of Southern, California, Los Angeles, California, USA
| | - Giulia Santoni
- Laboratory of Neuroepigenetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale Lausanne (EPFL), Lausanne, Switzerland
| | - NandaKumar Navalpur Shanmugam
- Department of Neurology, Genetics and Aging Research Unit, McCance Center for Brain Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Lesley R Golden
- Department of Physiology, University of Kentucky, Lexington, Kentucky, USA
| | - Alfred N Fonteh
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Huntington Medical Research Institutes, Pasadena, California, USA
| | - Michael G Harrington
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Johannes Gräff
- Laboratory of Neuroepigenetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale Lausanne (EPFL), Lausanne, Switzerland
| | - Gary E Gibson
- Brain and Mind Research Institute, Weill Cornell Medicine, Burke Neurological Institute, White Plains, New York, USA
| | - Raj Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jose A Luchsinger
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Howard H Feldman
- Department of Neurosciences, University of California, San Diego, California, USA
| | - Russell H Swerdlow
- Department of Neurology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lance A Johnson
- Department of Physiology, University of Kentucky, Lexington, Kentucky, USA
| | - Benedict C Albensi
- Nova Southeastern Univ. College of Pharmacy, Davie, Florida, USA
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rudolph Tanzi
- Department of Neurology, Genetics and Aging Research Unit, McCance Center for Brain Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Cunnane
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Cécilia Samieri
- Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Department of Neurology, Columbia University, New York City, New York, USA
| | - Gene L Bowman
- Department of Neurology, Genetics and Aging Research Unit, McCance Center for Brain Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, USA
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17
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Abstract
Most societies witness an ever increasing prevalence of both obesity and dementia, a scenario related to often underestimated individual and public health burden. Overnutrition and weight gain have been linked with abnormal functionality of homoeostasis brain networks and changes in higher cognitive functions such as reward evaluation, executive functions and learning and memory. In parallel, evidence has accumulated that modifiable factors such as obesity and diet impact the gut-brain axis and modulate brain health and cognition through various pathways. Using neuroimaging data from epidemiological studies and randomised clinical trials, we aim to shed light on the underlying mechanisms and to determine both determinants and consequences of obesity and diet at the level of human brain structure and function. We analysed multimodal 3T MRI of about 2600 randomly selected adults (47 % female, 18-80 years of age, BMI 18-47 kg/m2) of the LIFE-Adult study, a deeply phenotyped population-based cohort. In addition, brain MRI data of controlled intervention studies on weight loss and healthy diets acquired in lean, overweight and obese participants may help to understand the role of the gut-brain axis in food craving and cognitive ageing. We find that higher BMI and visceral fat accumulation correlate with accelerated brain age, microstructure of the hypothalamus, lower thickness and connectivity in default mode- and reward-related areas, as well as with subtle grey matter atrophy and white matter lesion load in non-demented individuals. Mediation analyses indicated that higher visceral fat affects brain tissue through systemic low-grade inflammation, and that obesity-related regional changes translate into cognitive disadvantages. Considering longitudinal studies, some, but not all data indicate beneficial effects of weight loss and healthy diets such as plant-based nutrients and dietary patterns on brain ageing and cognition. Confounding effects of concurrent changes in other lifestyle factors or false positives might help to explain these findings. Therefore a more holistic intervention approach, along with open science tools such as data and code sharing, in-depth pre-registration and pooling of data could help to overcome these limitations. In addition, as higher BMI relates to increased head micro-movements during MRI, and as head motion in turn systematically induces image artefacts, future studies need to rigorously control for head motion during MRI to enable valid neuroimaging results. In sum, our results support the view that overweight and obesity are intertwined with markers of brain health in the general population, and that weight loss and plant-based diets may help to promote brain plasticity. Meta-analyses and longitudinal cohort studies are underway to further differentiate causation from correlation in obesity- and nutrition-brain research.
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18
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Matsuyama Y, Fujiwara T, Murayama H, Machida M, Inoue S, Shobugawa Y. Differences in Brain Volume by Tooth Loss and Cognitive Function in Older Japanese Adults. Am J Geriatr Psychiatry 2022; 30:1271-1279. [PMID: 35831211 DOI: 10.1016/j.jagp.2022.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND We investigated the association between tooth loss and structural brain volume and its mediating effect on the association between tooth loss and cognitive function in older Japanese. METHODS A cross-sectional study was conducted by using the data of 494 randomly sampled community-dwelling individuals aged 65-84 years living in Tokamachi City, Japan. Total brain volume (TBV), gray matter volume (GMV), white matter volume (WMV), and hippocampal volume (HV) were measured with magnetic resonance imaging. The association of self-reported number of teeth (≥20, 1-19, and 0) with cognitive function assessed with the Japanese version of the Quick Mild Cognitive Impairment screen and structural brain volume was examined. Causal mediation analysis was performed to evaluate the mediating effect of structural brain volume. Age, sex, socioeconomic status, health behavior, comorbid conditions, and total intracranial volume were adjusted. RESULTS Respondents with no teeth showed lower cognitive function (coefficient = -4.01; 95% confidence interval [CI]: -7.19, -0.82), lower TBV (coefficient = -10.34; 95% CI: -22.84, 2.17), and lower GMV (coefficient = -6.92; 95% CI: -14.84, 0.99) than those with ≥20 teeth (P for trends were 0.003, 0.035, and 0.047, respectively). The number of teeth was not significantly associated with WMV or HV. GMV showed a significant mediating effect on the association between the number of teeth and cognitive function (coefficient = -0.38; 95% CI: -1.14, -0.002, corresponding to 9.0% of the total effect), whereas TBV did not. CONCLUSIONS GMV was suggested to mediate the relationship between tooth loss and lower cognitive function.
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Affiliation(s)
- Yusuke Matsuyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (YM, TF), Tokyo, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (YM, TF), Tokyo, Japan
| | - Hiroshi Murayama
- Research Team for Social participation and Community Health, Tokyo Metropolitan Institute of Gerontology (HM), Tokyo, Japan
| | - Masaki Machida
- Department of Preventive Medicine and Public Health, Tokyo Medical University (MM, SI), Tokyo, Japan; Department of Infection Prevention and Control, Tokyo Medical University Hospital (MM), Tokyo, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University (MM, SI), Tokyo, Japan
| | - Yugo Shobugawa
- Department of Active Ageing (donated by Tokamachi city, Niigata Japan), Niigata University Graduate School of Medical and Dental Sciences (YS), Niigata, Japan
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19
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Perus L, Busto GU, Mangin JF, Le Bars E, Gabelle A. Effects of preventive interventions on neuroimaging biomarkers in subjects at-risk to develop Alzheimer's disease: A systematic review. Front Aging Neurosci 2022; 14:1014559. [PMID: 36506466 PMCID: PMC9730537 DOI: 10.3389/fnagi.2022.1014559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
Alzheimer's Disease (AD) is a multifactorial and complex neurodegenerative disorder. Some modifiable risk factors have been associated with an increased risk of appearance of the disease and/or cognitive decline. Preventive clinical trials aiming at reducing one or combined risk factors have been implemented and their potential effects assessed on cognitive trajectories and on AD biomarkers. However, the effect of interventions on surrogate markers, in particular imaging biomarkers, remains poorly understood. We conducted a review of the literature and analyzed 43 interventional studies that included physical exercise, nutrition, cognitive training or multidomain interventions, and assessed various brain imaging biomarkers, to determine the effects of preventive interventions on imaging biomarkers for subjects at-risk to develop AD. Deciphering the global and regional brain effect of each and combined interventions will help to better understand the interplay relationship between multimodal interventions, cognition, surrogate brain markers, and to better design primary and secondary outcomes for future preventive clinical trials. Those studies were pondered using generally-admitted quality criteria to reveal that interventions may affect the brain of patients with cognitive impairment rather than those without cognitive impairment thus indicating that particular care should be taken when selecting individuals for interventions. Additionally, a majority of the studies concurred on the effect of the interventions and particularly onto the frontal brain areas.
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Affiliation(s)
- Lisa Perus
- INM, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Department of Neurology, Memory Resources and Research Center, Gui de Chauliac Hospital, Montpellier, France
- Institut d'Imagerie Fonctionnelle Humaine, I2FH, Department of Neuroradiology, Gui de Chauliac Hospital and University of Montpellier, Montpellier, France
- CATI, US52-UAR2031, CEA, ICM, SU, CNRS, INSERM, APHP, Ile de France, France
| | - Germain U. Busto
- INM, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Department of Neurology, Memory Resources and Research Center, Gui de Chauliac Hospital, Montpellier, France
| | - Jean-François Mangin
- CATI, US52-UAR2031, CEA, ICM, SU, CNRS, INSERM, APHP, Ile de France, France
- Université Paris-Saclay, CEA, CNRS, Neurospin, UMR9027 Baobab, Gif-sur-Yvette, France
| | - Emmanuelle Le Bars
- Institut d'Imagerie Fonctionnelle Humaine, I2FH, Department of Neuroradiology, Gui de Chauliac Hospital and University of Montpellier, Montpellier, France
| | - Audrey Gabelle
- INM, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Department of Neurology, Memory Resources and Research Center, Gui de Chauliac Hospital, Montpellier, France
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Mulugeta A, Navale SS, Lumsden AL, Llewellyn DJ, Hyppönen E. Healthy Lifestyle, Genetic Risk and Brain Health: A Gene-Environment Interaction Study in the UK Biobank. Nutrients 2022; 14:nu14193907. [PMID: 36235559 PMCID: PMC9570683 DOI: 10.3390/nu14193907] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Genetic susceptibility and lifestyle affect the risk of dementia but there is little direct evidence for their associations with preclinical changes in brain structure. We investigated the association of genetic dementia risk and healthy lifestyle with brain morphometry, and whether effects from elevated genetic risk are modified by lifestyle changes. We used prospective data from up to 25,894 UK Biobank participants (median follow-up of 8.8 years), and defined healthy lifestyle according to American Heart Association criteria as BMI < 30, no smoking, healthy diet and regular physical activity). Higher genetic risk was associated with lower hippocampal volume (beta −0.16 cm3, 95% CI −0.22, −0.11) and total brain volume (−4.34 cm3, 95% CI −7.68, −1.01) in participants aged ≥60 years but not <60 years. Healthy lifestyle was associated with higher total brain, grey matter and hippocampal volumes, and lower volume of white matter hyperintensities, with no effect modification by age or genetic risk. In conclusion, adverse effects of high genetic risk on brain health were only found in older participants, while adhering to healthy lifestyle recommendations is beneficial regardless of age or genetic risk.
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Affiliation(s)
- Anwar Mulugeta
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Department of Pharmacology and Clinical Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Shreeya S. Navale
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Amanda L. Lumsden
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - David J. Llewellyn
- College of Medicine and Health, University of Exeter, Devon EX1 2LU, UK
- Alan Turing Institute, London NW1 2DB, UK
| | - Elina Hyppönen
- Australian Centre for Precision Health, Unit of Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-(08)-83022518
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Silberstein RB, Pipingas A, Scholey AB. Homocysteine Modulates Brain Functional Connectivity in a Memory Retrieval Task. J Alzheimers Dis 2022; 90:199-209. [DOI: 10.3233/jad-220612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Homocysteine, a methionine metabolite, is a recognized risk factor for accelerated age-related cognitive decline and dementia. Objective: In the light of studies indicating increases in brain activity and brain functional connectivity in the early stages of age-related cognitive decline, we undertook a study to examine the relationship between plasma homocysteine levels and brain functional connectivity in a group of late middle-aged males at risk of cognitive decline due to high body mass index and a sedentary lifestyle. Methods: Brain functional connectivity was measured using the steady state visual evoked potential event related partial coherence while 38 participants performed a memory task where each trial comprised an object recognition task followed by a location memory task. Results: We observed a significant transient peak in the correlation between plasma homocysteine levels and fronto-parietal brain functional connectivity immediately before the presentation of the memory location component of the task. Significantly, this correlation was only apparent if the participant pool included individuals with homocysteine concentrations above 11μmole/L. Conclusion: Our findings suggest that the increased brain functional connectivity observed in the earlier stages of age-related cognitive decline reflects pathognomonic changes in brain function and not compensatory changes engaged to enhance task performance. Our findings also suggest that homocysteine interferes with the inhibition of cortical networks where this inhibition is necessary for optimum task performance. Finally, we observed that the effect of homocysteine on brain functional connectivity is only apparent at concentrations above 11μmol/L.
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Affiliation(s)
- Richard B. Silberstein
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Neuro-Insight Pty Ltd, Hawthorn, VIC, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Andrew B. Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
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Townsend RF, Woodside JV, Prinelli F, O'Neill RF, McEvoy CT. Associations Between Dietary Patterns and Neuroimaging Markers: A Systematic Review. Front Nutr 2022; 9:806006. [PMID: 35571887 PMCID: PMC9097077 DOI: 10.3389/fnut.2022.806006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 12/13/2022] Open
Abstract
Dementia is a complex, growing challenge for population health worldwide. Dietary patterns (DPs) may offer an opportunity to beneficially influence cognitive ageing and potentially reduce an individuals’ risk of dementia through diet-related mechanisms. However, previous studies within this area have shown mixed results, which may be partly explained by the lack of sensitivity and accuracy within cognitive testing methods. Novel neuroimaging techniques provide a sensitive method to analyse brain changes preceding cognitive impairment which may have previously remained undetected. The purpose of this systematic review was to elucidate the role of DPs in relation to brain ageing processes, by summarising current prospective and intervention studies. Nine prospective studies met the inclusion criteria for the review, seven evaluated the Mediterranean diet (MeDi), one evaluated the Alternative Healthy Eating Index-2010, and one evaluated a posteriori derived DPs. No intervention studies were eligible for inclusion in this review. There was some evidence of an association between healthy DPs and neuroimaging markers including changes within these markers over time. Consequently, it is plausible that better adherence to such DPs may positively influence brain ageing and neurodegeneration. Future studies may benefit from the use of multi-modal neuroimaging techniques, to further investigate how adherence to a DP influences brain health. The review also highlights the crucial need for further intervention studies within this research area.
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Affiliation(s)
- Rebecca F Townsend
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
| | - Federica Prinelli
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Roisin F O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
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Abstract
PURPOSE OF REVIEW Cell senescence is implicated in numerous age-related conditions. Antiageing therapies and nutritional approaches have been researched for purposes of removing senescent cells (senolytics) to treat or prevent age-related diseases, such as cognitive impairment and Alzheimer's disease. In this updated review, we examined the evidence from the last 18 months regarding nutrition senolytics, with a focus on cognitive ageing among older adults. RECENT FINDINGS Overall, 19 systematic reviews and 17 intervention studies were included. Studies failed to provide evidence of nutritional senolytic agents or senescence-associated secretory phenotype (SASP) suppressors, for oral supplements providing beneficial effects on cognitive ageing among older adults. The protective role of food sources such as berries and nuts, and dietary patterns of Mediterranean diet and Mediterranean-DASH diet Intervention for Neurodegenerative Delay diet against cognitive decline or risk of dementia have been mostly supported by recent studies. SUMMARY The present review gathered additional evidence for both oral supplements and foods/diets rich in nutritional senolytic agents or SASP suppressors on cognitive health among older adults. In pursuing antiageing strategies, the importance of whole foods and healthy diets should not be overlooked, future studies are warranted on long-term effects and cytotoxicity of nutritional senolytics.
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Affiliation(s)
- Xi Chen
- Dementia Centre for Research Collaboration
| | - Henry Brodaty
- Dementia Centre for Research Collaboration
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales
| | - Fiona O'Leary
- Discipline of Nutrition and Dietetics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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