Interaction between plant-based dietary pattern and air pollution on cognitive function: a prospective cohort analysis of Chinese older adults

Increasing the frequency of plant-based food intake in daily diets reduces the risk of cardiovascular disease among elderly Chinese: a cohort study

Objective

There is limited research on the relationship between the frequency of plant-based food intake and the risk of cardiovascular disease (CVD) among elderly Chinese. This study aims to evaluate the association between plant-based dietary index (PDI) and CVD risks, providing evidence for elderly Chinese to reduce CVD risks by increasing the frequency of plant-based food consumption.

Methods

This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2011-2018, employing a multivariate modified Poisson regression model, trend tests, and restricted cubic spline (RCS) analysis to assess the linear and non-linear relationship between the PDI and CVD risks. Subgroup analyses and interaction tests were conducted to evaluate the robustness and population-specificity of the results.

Results

This study included a total of 1,414 elderly Chinese, and at the end of follow-up, 487 participants had developed CVD. The multivariate modified Poisson regression model revealed a negative association between PDI and CVD risks [RR = 0.983, 95%CI = (0.970, 0.997)]. Similarly, the multivariate trend test (p = 0.031) and RCS analysis (P for nonlinear = 0.600) indicated a linear relationship between PDI and CVD risks. Subgroup analyses showed that the relationship between PDI and CVD risk was not influenced by gender, BMI, smoking, alcohol use, or exercise.

Conclusion

The PDI was negatively correlated with CVD risks, indicating that increasing the frequency of plant-based food intake in the diet may reduce CVD risks among elderly Chinese.

Risk factors associated with heatwave mortality in Chinese adults over 65 years

Aging populations are susceptible to heat-related mortality because of physiological factors and comorbidities. However, the understanding of individual vulnerabilities in the aging population is incomplete. In the Chinese Longitudinal Healthy Longevity Survey, we assessed daily heatwave exposure individually for 13,527 participants (median age = 89 years) and 3,249 summer mortalities during follow-up from 2008 to 2018. The mortality risk during heatwave days according to relative temperature is approximately doubled (hazard ratio (HR) range = 1.78-1.98). We found that heatwave mortality risks were increased for individuals with functional declines in mobility (HR range = 2.32-3.20), dependency in activities of daily living (HR range = 2.22-3.27), cognitive impairment (HR = 2.22) and social isolation reflected by having nobody to ask for help during difficulties (HR range = 2.14-10.21). Contrary to current understanding, older age was not predictive of heatwave mortality risk after accounting for individual functional declines; no statistical differences were detected according to sex. Beyond age as a risk factor, our findings emphasize that functional aging is an underlying factor in enhancing heatwave resilience. Assessment of functional decline and implementing care strategies are crucial for targeted prevention of mortality during heatwaves.

Taste preferences, cardiometabolic diseases and mild cognitive impairment: a prospective cohort analysis of older Chinese adults

Taste preference is a pivotal predictor of nutrient intake, yet its impact on mild cognitive impairment (MCI) remains poorly understood. We aimed to investigate the association between taste preferences and MCI and the role of cardiometabolic diseases (CMD) in this association. The study included older adults, aged 65-90 years, with normal cognitive function at baseline who were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. MCI was measured by the Mini-Mental State Examination, and multivariable Cox regression models were applied. Among 6423 participants, 2534 (39·45 %) developed MCI with an incidence rate of 63·12 - per 1000 person-years. Compared with individuals with insipid taste, those preferring sweetness or spiciness had a higher MCI risk, while saltiness was associated with a lower risk. This association was independent of objective dietary patterns and was more pronounced among urban residents preferring sweetness and illiterate participants preferring spiciness. Notably, among sweet-liking individuals, those with one CMD experienced a significant detrimental effect, and those with co-occurring CMD had a higher incidence rate of MCI. Additionally, regional variations were observed: sweetness played a significant role in regions known for sweet cuisine, while the significance of spiciness as a risk factor diminishes in regions where it is commonly preferred. Our findings emphasize the role of subjective taste preferences in protecting cognitive function and highlight regional variations. Target strategies should focus on assisting individuals with CMD to reduce excessive sweetness intake and simultaneously receiving treatment for CMD to safeguard cognitive function.

Plant-based dietary patterns and risk of esophageal cancer: A prospective cohort study spanning 17 years

Objective

Plant-based diets have multiple health benefits for cancers; however, little is known about the association between plant-based dietary patterns and esophageal cancer (EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.

Methods

We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) of EC across 3 plant-based diet indices and further stratified the analysis by subgroups.

Results

The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365 person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50 (95% CI, 0.32-0.77) for hPDI. In addition, the HR per 10-point increase in the hPDI score was 0.42 (95% CI, 0.27-0.66) for ECs. Conversely, uPDI was positively associated with the risk of EC, and the HR was 1.80 (95% CI, 1.16-2.82). The HR per 10-point increase in the uPDI score was 1.90 (95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.

Conclusions

A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.

Interaction between activities of daily living and cognitive function on risk of depression

Objective

There is a lack of literature about the joint effects of activities of daily living (ADL) limitation and cognitive impairment on depression. This study aimed to estimate the association of ADL limitation and cognitive impairment with depression among Chinese older adults aged 65 and above and to test their interaction on both additive and multiplicative scales.

Methods

Data was drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,025 eligible participants. Logistic regression models were fitted, and both multiplicative and additive interactions for ADL limitation and cognitive impairment were tested.

Results

A total of 3,019(27.4%) participants reported depressive symptoms. After controlling for potential confounding factors, ADL limitation and cognitive impairment were both positively associated with depression. The adjusted additive interaction of basic and instrumental activities of daily living limitation were 2.47 (95%CI:1.92-3.19) and 3.67 (95%CI:2.88-4.66), respectively, but the multiplicative interaction items were both insignificant.

Conclusion

ADL limitation and cognitive impairment were both risk factors for depression among Chinese older adults. Moreover, the significant interaction of ADL limitation and cognitive impairment was found in the additive model, suggesting that improving ADL may be helpful in reducing the risk of depression among older people with cognitive impairment.

The dilution effect of healthy lifestyles on the risk of cognitive function attributed to socioeconomic status among Chinese older adults: A national wide prospective cohort study

Background

Lower socioeconomic status (SES) is a risk factor for poor cognitive function, while a healthy lifestyle is associated with better cognitive function. We examined the complex relationship between SES and a healthy lifestyle and cognitive function among older Chinese adults.

Methods

We used a national prospective cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008-18, aged 65 years and older with normal cognition at baseline. Participants were categorised into the favourable group if they had four to six healthy lifestyle factors and the unfavourable group for zero to three factors. SES was classified as higher and lower by assessing the socioeconomic vulnerability index (SEVI) with six components. Cognitive function was measured using the Mini-Mental State Examination (MMSE) scores and the standardised Z-scores. We applied the linear mixed effects and time-dependent Cox regression models to explore associations and further stratified the analysis by healthy lifestyles.

Results

A total of 6851 participants were included (the mean age was 80.87, 43.44% had a favourable lifestyle, and 49.29% had higher SES). Over the 10-year follow-up period, SES status and lifestyle profiles significantly affected the decline in the standardised Z-scores (P < 0.05). The higher SES group with favourable lifestyles exhibited a slower cognitive decline than those with lower SES (by 0.031 points per year, P < 0.05). The association was not observed in those in the unfavourable group (0.010 points per year, P > 0.05). During a follow-up, 25.06% of participants developed cognitive impairment (MMSE<18). We also observed a significant interaction between SES and healthy lifestyles (P < 0.05), with the corresponding associations of SES being more pronounced among participants with unfavourable lifestyles (hazard ratio (HR) = 0.821; 95% confidence interval (CI) = 0.701-0.960) than those with favourable lifestyles (HR = 1.006; 95% CI = 0.844-1.200).

Conclusions

A healthy lifestyle may attenuate the adverse impacts of lower SES on cognitive function among older adults. This study might provide important information for protecting cognitive function, especially in low- and middle-income countries.

Association of adherence to the Chinese version of the MIND diet with reduced cognitive decline in older Chinese individuals: Analysis of the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Current evidence suggests that the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) diet intervention for Neurodegenerative Delay (MIND) is associated with a reduced risk of cognitive impairment among North American and Oceanian populations. However, there has been limited exploration of whether this association extends to the Asian population. This study aimed to assess the correlation between the Chinese version of the MIND (cMIND) diet and cognitive impairment in older Chinese individuals.

METHODS

We utilized data from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey. Participants aged ≥65 years with normal cognitive function at baseline were enrolled. The cMIND diet score (cMINDDS) was calculated by assessing dietary patterns based on survey responses. The Chinese version of the Mini-Mental State Examination (MMSE) was employed to diagnose cognitive impairment in participants. We stratified the analysis by cMINDDS and conducted additional sensitivity analyses.

RESULTS

The cohort consisted of 6411 participants. Over a 3-year follow-up, 1165 (18.6%) individuals who initially had normal cognitive function developed cognitive impairment. A linear association was observed between cMINDDS and cognitive impairment. The increased cMINDDS was associated with a reduced risk of cognitive impairment (quartile 1 vs. quartile 4: the adjusted odds ratio [OR] = 0.77, 95% confidence interval [CI]: [0.60, 0.97], p trend = 0.023). Regarding food composition, higher consumption of fresh fruits and nuts was associated with a decreased risk of cognitive impairment (OR = 0.77, 95% CI: [0.66, 0.89] and OR = 0.70, 95% CI [0.58, 0.86], respectively).

CONCLUSIONS

Adherence to the cMIND diet was associated with lower risks of cognitive impairment in older Chinese individuals. The cMIND diet, based on the MIND dietary pattern, could serve as a preventive measure against cognitive impairment.

Association of healthy lifestyle with life expectancy free of five major disabilities in Chinese older adults

Background

Whether and to what extent multiple healthy lifestyles affect the longevity of people with disabilities, including those in basic activities of daily living, mobility, vision, hearing and cognition, is crucial to policymakers. We aimed to determine the impact of combined lifestyles on life expectancy (LE) lived with and without five disabilities.

Methods

We recruited participants (n = 15 121 from the China Longitudinal Healthy Longevity Survey between 2008 and 2018. Healthy lifestyle levels were estimated from six factors: smoking, drinking, physical exercise, diet, cognitive activity, and sleep, which we categorised as favourable and unfavourable using the latent class growth mixture model throughout the follow-up period. We used Multi-state Markov models to assess the different disability stages of LE.

Results

Of the total LE at age 65, older adults with a favourable lifestyle spent 59.60% (disability-free LE (DFLE) = 10.24 years) without five disabilities in combination, whereas those with unfavourable lifestyle spent 56.74% (DFLE = 7.28 years). Furthermore, the percentage of DFLE was 64.98 (7.71 years) and 68.38 (9.91 years) in males with unfavourable and favourable lifestyle levels, respectively, and 47.92 (6.62 years) and 55.12 (10.30 years) for females. Compared to older adults with low socioeconomic status (SES) and unfavourable lifestyle level, those with lower SES and favourable lifestyle level had more 3.77 years of DFLE, those with higher SES and unfavourable lifestyle level had more 1.94 years, as well as those with higher SES and favourable lifestyle level had more 5.10 years at age 65. Corresponding associations were found separately for each of the five individual disabilities.

Conclusions

A favourable lifestyle level was associated with longer total LE along with a higher proportion of DFLE and may contribute to narrowing socioeconomic health inequalities. Policymakers should develop lifestyle interventions and scale up rehabilitation services in primary care, thereby delaying disabilities to later ages, especially in low- and middle-income countries.

Long-term impact of PM2.5 exposure on frailty, chronic diseases, and multimorbidity among middle-aged and older adults: insights from a national population-based longitudinal study

Particulate Matter 2.5 (PM2.5) is a significant risk factor for frailty and chronic diseases. Studies on the associations between PM2.5 and frailty, chronic diseases, and multimorbidity are scarce, especially from large cohort studies. We aimed to explore the potential association between PM2.5 exposure and the risk of frailty, chronic diseases, and multimorbidity. We collected data from a national cohort (CHARLS) with a follow-up period of 11-18 years, totaling 13,366 participants. We obtained PM2.5 concentration data from the Atmospheric Composition Analysis Group at Dalhousie University. PM2.5 exposure is based on the average annual concentration in the prefecture-level city where residents live. We define frailty as the comprehensive manifestation of declining various body functions, characterized by a frailty index of 0.25 or greater, and multimorbidity as the presence of at least two or more chronic conditions. Cox proportional hazards regression was used to estimate the hazard ratio (HR) with its 95% confidence interval (95%CI). A 10-μg/m3 increase for PM2.5 was significantly associated with an increased risk of frailty (HR = 1.289, 95%CI = 1.257-1.322, P < 0.001). A 10-μg/m3 increase for PM2.5 was significantly associated with the elevated risk for most chronic diseases. Compared to those with no morbidity or only single morbidity, a 10-μg/m3 increase for PM2.5 was significantly associated with the elevated risk for multimorbidity (HR = 1.220, 95%CI = 1.181-1.260, P < 0.001). Ambient PM2.5 exposure is a significant risk factor for frailty, chronic diseases, and multimorbidity, and some measures need to be taken to reduce PM2.5 concentration and prevent frailty and chronic diseases.

Association between Plant-based Diet and Risk of Chronic Diseases and All-Cause Mortality in Centenarians in China: A Cohort Study

Background

Numerous studies have suggested the health benefits of a plant-based dietary pattern. However, whether this dietary pattern is associated with health benefits for centenarians remains unexplored. Our study aimed to investigate the correlation between 16 widely consumed Chinese food items and the incidence rates of chronic diseases and all-cause mortality among centenarians.

Methods

We conducted a dietary survey on 3372 centenarians with an average age of 102.33 y in China. After rigorous screening, we identified 2675 centenarians, who underwent a 10-y follow-up study with all-cause mortality as the primary outcome. We developed 6 dietary patterns on the basis of the food consumption frequency of each participant. To model the impact of missing values, we employed multiple imputation methods, verifying the robustness of models.

Results

The overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), unhealthy plant-based diet index (uPDI), healthy plant-based foods index (HPF), unhealthy plant-based foods index (uHPF), and animal-based foods index (AF) scores among centenarians in China were 46.95 ± 6.29, 44.43 ± 5.76, 51.09 ± 6.26, 21.63 ± 4.79, 9.91 ± 2.41, and 14.59 ± 3.58, respectively. High scores of PDI, hPDI, and HPF were associated with a lower risk of chronic diseases. In the 10-y follow-up study, 92.90% of centenarians have died. The high scores of the PDI (HRPDI = 0.81), hPDI (HRhPDI = 0.79), and HPF (HRHPF = 0.81) scores were significantly associated with a lower risk of death compared with the low scores. Conversely, the high AF score (HRAF = 1.17) was significantly associated with a higher risk of death compared with the low scores.

Conclusion

Despite the fact that a higher score in both a predominantly plant-based dietary pattern and a healthy dietary pattern can decrease the death among centenarians, not all HPFs have this effect. A higher AF predicted a higher risk of mortality, whereas higher PDI, hPDI, and HPF were associated with a lower risk of mortality among Chinese centenarians.

Plant-Based Diet Indices and Their Association with Frailty in Older Adults: A CLHLS-Based Cohort Study

Within the realm of aging, the nexus between diet and health has garnered considerable attention. However, only select studies have amalgamated insights into the correlation between plant and animal food consumption and frailty. Our aim was to appraise the connections between the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) and frailty in the elderly, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). This cohort study drew upon CLHLS data spanning from 2008 to 2018. The PDI, hPDI, and uPDI were gauged using a simplified food frequency questionnaire (FFQ). A frailty index, encompassing 35 variables across major health domains, was formulated. Cox proportional hazard models were employed to scrutinize the associations between the three plant-based dietary indices and frailty in older adults, including an exploration of gender disparities in these associations. A cohort of 2883 study participants was encompassed, with 1987 (68.9%) observed to be either frail or in the pre-frail stage. The Cox model with penalized spline exhibited linear associations of PDI, hPDI, and uPDI with the frailty index. Following covariate adjustments, it was discerned that older adults situated in the highest quartiles of PDI (HR = 0.86, 95% CI: 0.77-0.95) and hPDI (HR = 0.83, 95% CI: 0.74-0.93) experienced a 14% and 17% diminished risk of frailty compared to those in the lowest quartiles of PDI and hPDI, respectively. Conversely, when contrasted with those in the lowest quartile of uPDI, older adults adhering to the highest tertile of uPDI exhibited a 21% elevated risk of frailty (HR = 1.21, 95% CI: 1.08-1.36), with both associations achieving statistical significance (p < 0.01). Moreover, additional subgroup analyses revealed that the protective effects of PDI and hPDI against frailty and the deleterious effects of uPDI were more conspicuous in men compared to women. To forestall or decelerate the progression of frailty in the elderly, tailored dietary interventions are imperative, particularly targeting male seniors.

cMIND Diet, Indoor Air Pollution, and Depression: A Cohort Study Based on the CLHLS from 2011 to 2018

This study aims to explore the interaction between a Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet and indoor air pollution and its effect on depression among older adults. This cohort study used 2011-2018 data from the Chinese Longitudinal Healthy Longevity Survey. Participants included 2724 adults aged 65 and older without depression. The Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet scores ranged from 0 to 12 based on validated food frequency questionnaire responses. Depression was measured using the Phenotypes and eXposures Toolkit. Cox proportional hazards regression models were used to explore the associations, and the analysis was stratified using the cMIND diet scores. A total of 2724 participants (54.3% males and 45.9% 80 years and older) at baseline were included. Living with severe indoor pollution was associated with a 40% increase in the risk of depression (HR: 1.40, 95% CI: 1.07, 1.82) compared to living without indoor pollution. Indoor air pollution exposure was significantly associated with cMIND diet scores. Participants with a lower cMIND diet score (HR: 1.72, 95% CI: 1.24, 2.38) had a greater association with severe pollution than those with a higher cMIND diet score. The cMIND diet may alleviate depression caused by indoor pollution among older adults.

Plant-Based Diet and Risk of Frailty in Older Chinese Adults

OBJECTIVES

This study examined the relationship between the consumption of plant-based diet and frailty in older Chinese adults.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

The final sample included data from 3990 older adults from 2011-2014 from the Chinese Longitudinal Healthy Longevity Survey.

MEASUREMENTS

A plant-based diet index (PDI) was calculated based on a qualitative food frequency questionnaire. Frailty was defined using modified Fried criteria. A Generalized Estimating Equation was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for frailty. We further performed subgroup analyses stratified by sex and lifestyle factors.

RESULTS

557 cases of frailty were observed. After adjustment for covariates, the RR for frailty of a high PDI was 0.792 (95% CI: 0.644-0.973), relative to a low PDI. During follow-up, compared with respondents with a continually low PDI, the respondents with a continually high PDI had a significantly reduced risk of frailty (RR = 0.683, 95% CI: 0.514-0.908). In further subgroup analysis, a consistently high PDI over time resulted in a significantly reduced risk of frailty for male (RR = 0.591, 95% CI: 0.391-0.893); for never smokers (RR = 0.670, 95% CI: 0.458-0.979); for people who did never consume alcohol (RR = 0.654, 95% CI: 0.454-0.941); and for people with current or former exercise habits (RR = 0.488, 95% CI: 0.313-0.762).

CONCLUSION

Plant-based diet was associated with low risk of frailty in men and in older adults with healthy lifestyle. These findings stress that plant-based diet should be recommended as a dietary strategy to prevent and reduce frailty in older adults; in addition, more dietary interventions along with lifestyle modification should be adopted to promote successful ageing, especially for women.

Linking Air Pollution Exposure to Blood-Based Metabolic Features in a Community-Based Aging Cohort with and without Dementia

BACKGROUND

Long-term exposure to air pollution has been associated with changes in levels of metabolites measured in the peripheral blood. However, most research has been conducted in ethnically homogenous, young or middle-aged populations.

OBJECTIVE

To study the relationship between the plasma metabolome and long-term exposure to three air pollutants: particulate matter (PM) less than 2.5μm in aerodynamic diameter (PM2.5), PM less than 10μm in aerodynamic diameter (PM10), and nitrogen dioxide (NO2) in an ethnically diverse, older population.

METHODS

Plasma metabolomic profiles of 107 participants of the Washington Heights and Inwood Community Aging Project in New York City, collected from 1995-2015, including non-Hispanic white, Caribbean Hispanic, and non-Hispanic Black older adults were used. We estimated the association between each metabolic feature and predicted annual mean exposure to the air pollutants using three approaches: 1) A metabolome wide association study framework; 2) Feature selection using elastic net regression; and 3) A multivariate approach using partial-least squares discriminant analysis.

RESULTS

79 features associated with exposure to PM2.5 but none associated with PM10 or NO2. PM2.5 exposure was associated with altered amino acid metabolism, energy production, and oxidative stress response, pathways also associated with Alzheimer's disease. Three metabolites were associated with PM2.5 exposure through all three approaches: cysteinylglycine disulfide, a diglyceride, and a dicarboxylic acid. The relationship between several features and PM2.5 exposure was modified by diet and metabolic diseases.

CONCLUSIONS

These relationships uncover the mechanisms through which PM2.5 exposure can lead to altered metabolic outcomes in an older population.

Association between Changes in Protein Intake and Risk of Cognitive Impairment: A Prospective Cohort Study

Little is known about the role of change in protein intake in affecting cognitive function among older adults. Therefore, we aimed to investigate the associations between the change in protein intake from various food groups and cognitive impairment among older adults in a prospective cohort study. A total of 6951 participants without cognitive impairment or dementia were included in this study. The frequency of protein intake from various food groups was measured by a food frequency questionnaire at baseline and follow-up. Multivariable Cox hazard models with time as the underlying time metric applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). During the 37,535 person-years of follow-up, 1202 (17.3%) participants developed cognitive impairment. The improvement in overall protein intake was negatively associated with cognitive impairment with multivariable-adjusted HR of 0.98 (95% CI = 0.97-0.99). Compared with participants with stable change, those with an extreme decline in animal-based protein intake had a 48% higher risk of cognitive impairment. The associations of changes in protein from six food groups with cognitive impairment were in a similar direction to the main result. Protective associations between improving protein intake and a reduced risk of cognitive impairment were observed.

Associations between PM2.5 exposure and Alzheimer's Disease prevalence Among elderly in eastern China

BACKGROUND

Studies showed that PM_2.5 might be associated with various neurogenic diseases such as Alzheimer's Disease (AD). However, this topic had been little studied in Zhejiang province of China.  METHODS: In 2018, we established a cohort of AD high-risk population with 1,742 elderly aged 60 and above. In 2020, the cohort was followed up, a total of 1,545 people participated the 2 surveys. Data collection included questionnaires and basic physical examinations. The average residential exposure to PM_2.5 for each participant, that in a 5-years period prior to the first survey, was estimated using a satellite-based spatial statistical model. We determined the association between PM_2.5 and AD prevalence by cox proportional hazards regression model.  RESULTS: This study showed that an increase in the PM_2.5 level was an important associated risk factor that contributed to AD. The average PM_2.5 exposure levels among the study population ranged from 32.69 μg/m³ to 39.67 μg/m³ from 2013 to 2017, which were much higher than 5 μg/m³ that specified in the WHO air quality guidelines. There was an association between PM_2.5 exposure and AD, and the correlations between PM_2.5 and Mini-Mental State Examination, Montreal cognitive assessment scale scores were statistically significant. An increase in the PM_2.5 level by 10 μg/m³ elevated the risk of AD among residents by 2%-5% (HR _{model 2-model 4} = 1.02 to 1.05, CI _{model 2-model 4} = 1.01-1.10). The subgroups of male, with old age, with low education levels, used to work as farmers or blue-collar workers before retirement, overweight and obese were associated with a higher effect of PM_2.5.

CONCLUSIONS

Reducing PM_2.5 exposure might be a good way to prevent AD.

Urinary Antibiotics and Dietary Determinants in Adults in Xinjiang, West China

The Xinjiang autonomous region, located in west China, has a unique ethnic structure and a well-developed livestock industry. People in this region have a high risk of exposure to antibiotics, but the exposure level to antibiotics in relation to dietary determinants is unknown. In this study, 18 antibiotics, including four human antibiotics (HAs), four veterinary antibiotics (VAs), and 10 preferred veterinary antibiotics (PVAs) were detected in the urine of approximately half of the 873 adults in Xinjiang, including Han Chinese (24.6%), Hui (25.1%), Uighur (24.6%), and Kazakh (25.7%). Logistic regression was used to analyze the association between antibiotic exposure levels and adult diet and water intake. The detection percentage of antibiotics in the urine of adults in Xinjiang ranged from 0.1% to 30.1%, with a total detection percentage of all antibiotics of 49.8%. HAs, VAs and PVAs were detected in 12.3%, 10.3%, and 40.5%, respectively. Fluoroquinolones were the antibiotics with the highest detection percentage (30.1%) and tetracyclines were the antibiotics with the highest detected concentration (17 ng/mL). Adults who regularly ate pork, consumed fruit daily, and did not prefer a plant-based diet were associated with thiamphenicol, norfloxacin, and fluoroquinolones, respectively. These results indicated that adults in the Xinjiang autonomous region were extensively exposed to multiple antibiotics, and some types of food were potential sources of exposure. Special attention should be paid to the health effects of antibiotic exposure in humans in the future.

The triple benefits of slimming and greening the Chinese food system

The Chinese food system has undergone a transition of unprecedented speed, leading to complex interactions with China's economy, health and environment. Structural changes experienced by the country over the past few decades have boosted economic development but have worsened the mismatch between food supply and demand, deteriorated the environment, driven obesity and overnutrition levels up, and increased the risk for pathogen spread. Here we propose a strategy for slimming and greening the Chinese food system towards sustainability targets. This strategy takes into account the interlinkages between agricultural production and food consumption across the food system, going beyond agriculture-focused perspectives. We call for a food-system approach with integrated analysis of potential triple benefits for the economy, health and the environment, as well as multisector collaboration in support of evidence-based policymaking.

Association of Body Mass Index and Plant-Based Diet with Cognitive Impairment among Older Chinese Adults: A Prospective, Nationwide Cohort Study

To examine the association of body mass index (BMI) and a plant-based diet (PBD) with cognitive impairment in older adults, this cohort study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national, community-based, longitudinal, prospective study in China. Cognitive function was evaluated via the Mini-Mental State Examination (MMSE). Diet was assessed using a simplified food frequency questionnaire (FFQ), and PBD patterns were estimated using the overall plant-based diet index (PDI), the healthful plant-based diet index (hPDI), and the unhealthful plant-based diet index (uPDI). BMI was measured objectively during the physical examination. Cox proportional hazard models and restricted cubic spline analyses were used. A total of 4792 participants with normal cognition at baseline were included, and 1077 participants were identified as having developed cognitive impairment during the 24,156 person-years of follow-up. A reverse J-shaped association was observed between BMI and cognitive impairment (p = 0.005 for nonlinearity). Participants who were overweight (HR = 0.79; 95% CI 0.66–0.95) and obese (HR = 0.72; 95% CI 0.54–0.96) had a decreased risk of cognitive impairment, while those who were underweight (HR = 1.42; 95% CI 1.21–1.66) had an increased risk. Lower PDI, lower hPDI, and higher uPDI were associated with an increased risk of cognitive impairment (HR = 1.32; 95% CI 1.16–1.50 for PDI; HR = 1.46; 95% CI 1.29–1.66 for hPDI; HR = 1.21; 95% CI 1.06–1.38 for uPDI). The protective effect of being overweight on cognitive impairment was more pronounced among participants with a higher PDI (HR = 0.74; 95% CI 0.57–0.95) than those with a lower PDI (HR = 0.87; 95% CI 0.67–1.12), among participants with a higher hPDI (HR = 0.73; 95% CI 0.57–0.94) than those with a lower hPDI (HR = 0.93; 95% CI 0.72–1.10), and among participants with a lower uPDI (HR = 0.61; 95% CI 0.46–0.80) than those with a higher uPDI (HR = 1.01; 95% CI 0.80–1.27). Our results support the positive associations of overweight status, obesity, an overall PBD, and a healthful PBD with cognitive function in older adults. A lower adherence to an overall PBD, a healthful PBD, and a higher adherence to an unhealthful PBD may attenuate the protective effect of being overweight on cognitive function.

The Risk of Hearing Impairment From Ambient Air Pollution and the Moderating Effect of a Healthy Diet: Findings From the United Kingdom Biobank

The link between hearing impairment and air pollution has not been established, and the moderating effect of a healthy diet has never been investigated before. The purpose of this study was to investigate the association between air pollution and hearing impairment in British adults aged 37-73 years, and whether the association was modified by a healthy diet. We performed a cross-sectional population-based study with 158,811 participants who provided data from United Kingdom Biobank. A multivariate logistic regression model was used to investigate the link between air pollution and hearing impairment. Subgroup and effect modification analyses were carried out according to healthy diet scores, gender, and age. In the fully adjusted model, we found that exposure to PM₁₀, NO_X, and NO₂ was associated with hearing impairment [PM₁₀: odds ratio (OR) = 1.15, 95% confidence interval (95% CI) 1.02-1.30, P = 0.023; NO_X: OR = 1.02, 95% CI 1.00-1.03, P = 0.040; NO₂: OR = 1.03, 95% CI 1.01-1.06, P = 0.044], while PM_2.5 and PM_2.5 absorbance did not show similar associations. We discovered an interactive effect of age and air pollution on hearing impairment, but a healthy diet did not. The findings suggested that exposure to PM₁₀, NO_X and NO₂ was linked to hearing impairment in British adults, whereas PM_2.5 and PM_2.5 absorbance did not show similar associations. These may help researchers focus more on the impact of air pollution on hearing impairment and provide a basis for developing effective prevention strategies.