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Lou J, Wang J, Fu Y, Huang D, Liu M, Zhao R, Deng J. Association between Oral Health and Depressive Symptoms in Chinese Older Adults: The Mediating Role of Dietary Diversity. Nutrients 2024; 16:1231. [PMID: 38674922 PMCID: PMC11054946 DOI: 10.3390/nu16081231] [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: 03/16/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Diet is a modifiable factor in healthy population aging. Additionally, oral health and diet are important factors affecting depressive symptoms. To assess the mediating role of dietary diversity (DD) in oral health and depressive symptoms in older adults, we selected 8442 participants aged ≥ 65 years from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS) for a cross-sectional study. Depressive symptoms were determined based on scores on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Dietary diversity scores (DDS) were established based on the frequency of intake of food groups. Oral health was measured by denture use and toothbrushing frequency. Stepwise multiple linear regression and PROCESS macros were used for mediated effects analysis and testing. The sample had a positive detection rate of 44.1% for depressive symptoms, 40.8% for denture use, and 41.9% for once-a-day toothbrushing. Denture use (ρ = -0.077, p < 0.01) and toothbrushing frequency (ρ = -0.115, p < 0.01) were negative predictors of depressive symptoms in older adults. DD significantly mediated the association between denture use (indirect effect -0.047; 95%CI: -0.068-0.028; p < 0.001), toothbrushing frequency (indirect effect -0.041; 95%CI: -0.054-0.030; p < 0.001), and depressive symptoms. Denture use and toothbrushing frequency not only directly reduce the risk of depressive symptoms in older adults, but also indirectly affect depressive symptoms through DD.
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Affiliation(s)
- Jiaxu Lou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Jian Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Yingjie Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Derong Huang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Mei Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Ruonan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Jiahui Deng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (J.L.); (Y.F.); (D.H.); (M.L.); (R.Z.); (J.D.)
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
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Liu D, Zhang WT, Wang JH, Shen D, Zhang PD, Li ZH, Chen PL, Zhang XR, Huang QM, Zhong WF, Shi XM, Mao C. Association between Dietary Diversity Changes and Cognitive Impairment among Older People: Findings from a Nationwide Cohort Study. Nutrients 2022; 14:1251. [PMID: 35334911 PMCID: PMC8952508 DOI: 10.3390/nu14061251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about the role of dietary diversity changes in affecting cognitive function among older people. Therefore, we aimed to evaluate the associations between dietary diversity scores (DDS) changes with cognitive impairment among older adults in a large prospective cohort. METHODS Cognitive function was assessed using the Mini-Mental State Examination questionnaire at baseline and follow-up. A total of 9726 participants without Parkinson's disease, dementia, or cognitive impairment were enrolled at baseline. Nine food groups were collected using simplified FFQ at baseline and follow-up surveys. Then nine food groups change patterns and DDS change patterns (overall, plant-based and animal-based) were assessed. The associations of above DDS changes patterns with subsequent cognitive impairment were evaluated. A multivariable-adjusted Cox proportional hazards model was used to estimate HRs and 95%CIs. RESULTS We documented 2805 cognitive impairments during 52,325 person-years of follow-up. Compared to high-to-high overall DDS change patterns, the multivariable adjusted HRs (95%CI) for high-to-medium, medium-to-medium, medium-to-low, low-to-medium and low-to-low DDS change patterns were 1.33 (1.12-1.57), 1.11 (0.94-1.32), 1.61 (1.39-1.86), 2.00 (1.66-2.40), 2.30 (1.90-2.78) and 2.80 (2.23-3.53), respectively. Compared with participants with stable DDS change pattern, those who in large improvement of DDS had a 13% lower risk of cognitive impairment (HRs, 0.87; 95%CI: 0.78-0.98). The associations of plant-based DDS, animal-based DDS, or nine food groups DDS change patterns with cognitive impairment were in a similar direction to the main result. CONCLUSIONS Protective associations between maintaining high DDS and a reduced risk of cognitive impairment were observed. In contrast, lowering or maintaining a lower DDS increases the risk of cognitive impairment.
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Affiliation(s)
- Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Wen-Ting Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Jia-Hui Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Pei-Dong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Qing-Mei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Wen-Fang Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
- Department of Laboratory Medicine, Microbiome Medicine Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
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Association of dietary diversity changes and mortality among older people: A prospective cohort study. Clin Nutr 2021; 40:2620-2629. [PMID: 33933728 DOI: 10.1016/j.clnu.2021.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS The association between dietary diversity (DD) changes and mortality remains unclear. We aimed to investigate the association between DD changes and all-cause mortality among older people. METHODS A total of 17,959 participants with a mean age of 84.8 years old were enrolled at baseline. Food groups were collected at baseline and follow-up using simplified food frequency questionnaire (FFQ), and then overall, plant-based and animal-based dietary diversity score (DDS) were calculated. DDS changes were calculated using DDS at baseline and the first follow-up. The association between three DDS changes (overall, plant-based and animal-based DDS) and subsequent all-cause mortality were evaluated. Nonparametrically restricted cubic splines and a multivariable-adjusted Cox proportional hazards model were used to estimate HRs and 95% CIs. RESULTS We documented 12,974 deaths over a 129,590 person-years of follow up. Compared with high-to-high DDS pattern, participants with lower overall DDS patterns had increased mortality risk with HRs (95%CI) of 1.39 (1.29-1.49), 1.53 (1.37-1.70), 1.38 (1.18-1.60) and 1.55 (1.31-1.83) for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. And compared with high-to-high DDS pattern, the estimates were 1.34 (1.23-1.46), 1.49 (1.35-1.65), 1.43 (1.23-1.67) and 1.62 (1.40-1.88) for plant-based DDS, and 1.23 (1.15-1.31), 1.29 (1.20-1.40), 1.24 (1.12-1.37) and 1.28 (1.15-1.44) for animal-based DDS for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. There was a U-shaped association between DDS change scores and mortality, and compared with participants with whose DDS remained stable, those with extreme declines and extreme improvements had higher risks of mortality with HRs (95% CI) of 1.15 (1.09-1.22) and 1.11 (1.04-1.17). CONCLUSIONS Maintaining a lower DDS, extreme declines and extreme improvements in DDS were all associated with an increased risk of all-cause mortality.
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Arencibia-Albite F. Serious analytical inconsistencies challenge the validity of the energy balance theory. Heliyon 2020; 6:e04204. [PMID: 32685707 PMCID: PMC7355950 DOI: 10.1016/j.heliyon.2020.e04204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 12/05/2019] [Accepted: 06/09/2020] [Indexed: 11/16/2022] Open
Abstract
Energy metabolism theory affirms that body weight stability is achieved as over time the average energy intake equals the average energy expenditure, a state known as energy balance. Here it is demonstrated, however, that weight stability coexists with a persistent energy imbalance. Such unexpected result emerges as a consequence of the answers to three fundamental problems: 1. Is it possible to model body weight fluctuations without the energy balance theory? And if so, what are the benefits over the energy balance strategy? 2. During energy balance, how the oxidized macronutrient distribution that underlies the average energy expenditure is related to the macronutrient distribution of the average energy intake? 3. Is energy balance possible under a low-fat diet that simultaneously satisfies the following conditions? (a) The fat fraction of the absorbed energy intake is always less than the oxidized fat fraction of the energy expenditure. (b) The carbohydrate fraction of the absorbed energy intake is always greater or equal to the oxidized carbohydrate fraction of the energy expenditure. The first of these issues is addressed with the axiomatic method while the rest are managed through analythical arguments. On the whole, this analysis identifies inconsistencies in the principle of energy balance. The axiomatic approach results also in a simple mass balance model that fits experimental data and explains body composition alterations. This model gives rise to a convincing argument that appears to elucidate the advantage of low-carbohydrate diets over isocaloric low-fat diets. It is concluded, according to the aforementioned model, that weight fluctuations are ultimately dependent on the difference between daily food mass intake and daily mass loss (e.g., excretion of macronutrient oxidation products) and not on energy imbalance. In effect, it is shown that assuming otherwise may caused unintended weight gain.
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Farrell SW, DeFina LF, Radford NB, Leonard D, Barlow CE, Pavlovic A, Willis BL, Haskell WL, Lee IM. Relevance of Fitness to Mortality Risk in Men Receiving Contemporary Medical Care. J Am Coll Cardiol 2020; 75:1538-1547. [DOI: 10.1016/j.jacc.2020.01.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
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Bromley L, Horvath PJ, Bennett SE, Weinstock-Guttman B, Ray AD. Impact of Nutritional Intake on Function in People with Mild-to-Moderate Multiple Sclerosis. Int J MS Care 2019; 21:1-9. [PMID: 30833865 DOI: 10.7224/1537-2073.2017-039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background We sought to assess the associations between nutrition and ambulation, daily activity, quality of life (QOL), and fatigue in individuals with mild-to-moderate disability with multiple sclerosis (MS). Methods This cross-sectional pilot study included 20 ambulatory adult volunteers with MS (14 women and 6 men; mean ± SD age, 57.9 ± 10.2 years; mean ± SD Expanded Disability Status Scale score = 4.1 ± 1.8). Primary outcome variables included dietary assessment and the 6-Minute Walk Test (6MWT). Secondary measures included the Timed 25-Foot Walk test, Timed Up and Go test, daily activity, and three self-report questionnaires: the 12-item Multiple Sclerosis Walking Scale, the 36-item Short Form Health Survey (SF-36), and the Modified Fatigue Impact Scale. Results Significant correlations were seen between the percentage of diet comprising fats and the 6MWT (r = 0.51, P = .02) and the physical functioning component of the SF-36 (r = 0.47, P = .03). The percentage of carbohydrates was significantly correlated with the 6MWT (r = -0.43, P = .05), daily activity (r = -0.59, P = .005), and the physical functioning component of the SF-36 (r = -0.47, P = .03). Cholesterol, folate, iron, and magnesium were significantly positively correlated with the physical functioning component of the SF-36 and the 6MWT. Conclusions These findings indicate better ambulation, daily function, and QOL with increased fat intake, decreased carbohydrate intake, and increased intake of the micronutrients cholesterol, folate, iron, and magnesium in people with mild-to-moderate MS. This pilot study highlights the potential impact of diet on function and QOL in MS.
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