Nutrition and cognition in older adults : studies on the role of glucose, sucrose, protein, vitamin B12 and folic acid

The age-related cognitive decline and the increase in dementia patients are large problems in societies with growing ageing populations. No cure is present for dementia, while the available medication only focuses on alleviating symptoms. It is therefore of major importance to find risk factors that can modify the development of cognitive decline and dementia. Pre-clinical and observational studies suggest a role for nutrients. Evidence derived from randomized controlled trials (RCTs) is, however, limited and equivocal with most studies showing no effect and only a few studies showing a beneficial effect of a nutritional intervention. In the current thesis, we investigated the acute and longer-term effects of different nutrients, i.e. glucose and sucrose, protein, resistance-type exercise training with or without protein, and vitamin B12 and folic acid in order to optimize and preserve cognitive functions in non-demented elderly people. A comprehensive literature review was performed on the acute effects of glucose and sucrose on cognitive performance (Chapter 2). Glucose is the most important fuel for the brain, and as such, manipulation of the supply of glucose may affect cognitive functions. The main conclusion of our review was that a glucose load may have a short-term beneficial effect on episodic memory. Enhancing effects on other cognitive domains were less clear, partly due to the small number of studies examining these effects. Limited research was also done on the possible effects of sucrose on cognitive functions. Therefore, we investigated the acute effects of 50 g of glucose and 100 g of sucrose on a broad spectrum of cognitive functions reflecting performance on episodic memory, working memory, attention and information processing speed, and executive functions (Chapter 3). This was done by a cross-over study in 43 elderly participants who had self-reported memory complaints. In contrast to the conclusion of our review, we did not observe an effect of glucose or sucrose on episodic memory, though we showed a beneficial effect of sucrose on attention and information processing speed. Protein supplementation was the next nutritional intervention that was investigated. Several amino acids are precursors for neurotransmitters, and their supply may affect the synthesis and release of these neurotransmitters, and may consequently affect cognitive performance. A 24-week randomized placebo-controlled trial was carried out in 65 frail and pre-frail elderly people (Chapter 4). The protein supplementation included twice a day 15 grams of protein in the form of a drink. Reaction time improved more in the protein group compared to the placebo group, but the scores on the cognitive domains, i.e. episodic memory, attention and working memory, information processing speed, and executive functions, or the other single test scores, did not differ between treatment groups. In addition, we investigated the effects of 24 weeks resistance-type exercise training with and without protein supplementation in pre-frail and frail elderly people (Chapter 5). Exercise training without extra protein (n=62) improved performance on the domain attention and working memory. Exercise training together with protein supplementation (n=65) improved performance on information processing speed. Last, the role of vitamin B12 and folate on cognitive health was investigated. Low levels of these nutrients can increase homocysteine levels, which is a suggested risk factor for cognitive decline. The effect of daily supplementation with 500 µg vitamin B12 and 400 µg folic acid was investigated in 2,919 participants for two years (Chapter 6). Global cognitive function and episodic memory were assessed in the total study population, whereas extensive neuropsychological testing was done in a subpopulation (n=856). B-vitamin supplementation did not improve cognitive domain scores. Only a small, though significant, effect was observed on global cognitive performance, measured by the Mini-Mental State Examination, but this was suggested to be due to chance. Brain MRI scans were made in a subgroup (n=218) after two years of intervention to obtain volumetric measures of grey and white matter, and total brain volume (Chapter 7). We investigated the cross-sectional associations between follow-up levels of folate, homocysteine and three vitamin B12 status biomarkers, e.g. methylmalonic acid, holotranscobalamin and serum vitamin B12, and brain volumes. Fully adjusted regression models showed a borderline significant association between plasma homocysteine and total brain volume, with a stronger association in the group that received B-vitamin supplementation. Serum B12 and holotranscobalamin were not associated with brain volumes, whereas high methylmalonic acid levels were associated with lower brain volumes in the group that received B-vitamins. In contrast, higher folate levels were associated with lower total brain volumes. In addition, when comparing the group that received two years of B-vitamin supplementation and those who did not, we observed lower brain volumes in the B-vitamin group, which might be a result of a difference in age between the two groups. To conclude, the nutritional intervention studies showed little evidence for a beneficial effect on cognitive performance in relatively healthy older adults. Given the large problem of dementia, research on modifiable risk factors, including nutrition, should continue, with well thought out research methods, including large and long-term observational and intervention studies with high-sensitive study populations and early biomarkers (e.g. imaging techniques) for cognitive decline in combination with neuropsychological tests. In this way, nutrition can be added to the list of lifestyle factors that can fight dementia.</p

Made to Order: A Preliminary Review of Crime Risk Assessments in New South Wales, Australia

In 2001, guidelines were introduced in New South Wales (NSW) to ensure that proposed developments/redevelopments of the built environment reflected key crime prevention through environmental design (CPTED) principles. The guidelines state that in certain circumstances a crime risk assessment report is required on the proposed development. To date, these guidelines have not been evaluated, making it impossible to assess their impact and the utility of the associated crime risk assessment reports. Partially to address this gap, a small number (four) of publicly available crime risk assessment reports have been reviewed and key issues highlighted here. In particular, the relevance of some aspects of these reports is questioned, as is the impact of the relationship between the client (i.e. developer) commissioning the report and the ‘independent’ consultant. The small sample of risk assessment reports reviewed here cannot be considered representative of the larger body of such reports. Further research is required to determine the veracity of the findings of this small review.Sydney Institute of Criminology; School of Social Sciences at the University of Western Sydne

Effects of glucose and sucrose on mood: a systematic review of interventional studies

Context: Glucose is the main energy source for the brain, and as such, manipulation of glucose supply may affect brain function. It has been suggested that a change in blood glucose may influence mood. Objective: The aim of this review was to investigate the potential effects of glucose and sucrose, compared with placebo, on mood. Data Sources: The electronic databases PubMed and Scopus were searched. Reference lists of selected articles were checked manually. Data Extraction: Randomized controlled trials or crossover trials comparing the effects of glucose or sucrose on mood that were published up to May 2017 were eligible. Potentially eligible articles were selected independently by 2 reviewers. Results: In total, 19 studies were found. Thirteen studies investigated the effects of glucose consumption compared with placebo on mood. Seven of these 13 studies found no effect of glucose on mood. The other 6 studies found small and partial effects that may also be due to other factors like palatability and expectation. Seven of the 19 studies investigated the effects of sucrose ingestion versus placebo on mood. None of these studies found a positive effect on mood, and 1 study observed an adverse effect. One of the studies investigated the effects of both glucose and sucrose.Conclusions: The results from this review show limited effects of glucose ingestion on mood and no effect of sucrose on mood

Dietary sources of vitamin B-12 and their association with vitamin B-12 status markers in healthy older adults in the B-PROOF study

Low vitamin B-12 concentrations are frequently observed among older adults. Malabsorption is hypothesized to be an important cause of vitamin B-12 inadequacy, but serum vitamin B-12 may also be differently affected by vitamin B-12 intake depending on food source. We examined associations between dietary sources of vitamin B-12 (meat, fish and shellfish, eggs, dairy) and serum vitamin B-12, using cross-sectional data of 600 Dutch community-dwelling adults (≥65 years). Dietary intake was assessed with a validated food frequency questionnaire. Vitamin B-12 concentrations were measured in serum. Associations were studied over tertiles of vitamin B-12 intake using P for trend, by calculating prevalence ratios (PRs), and splines. Whereas men had significantly higher vitamin B-12 intakes than women (median (25th–75th percentile): 4.18 (3.29–5.38) versus 3.47 (2.64–4.40) µg/day), serum vitamin B-12 did not differ between the two sexes (mean ± standard deviation (SD): 275 ± 104 pmol/L versus 290 ± 113 pmol/L). Higher intakes of dairy, meat, and fish and shellfish were significantly associated with higher serum vitamin B-12 concentrations, where meat and dairy—predominantly milk were the most potent sources. Egg intake did not significantly contribute to higher serum vitamin B-12 concentrations. Thus, dairy and meat were the most important contributors to serum vitamin B-12, followed by fish and shellfish

A Randomized Controlled Trial to Examine the Effect of 2-Year Vitamin B12 and Folic Acid Supplementation on Physical Performance, Strength, and Falling: Additional Findings from the B-PROOF Study

Elevated homocysteine concentrations are associated with a decline in physical function in elderly persons. Homocysteine-lowering therapy may slow down this decline. This study aimed to examine the effect of a 2-year intervention of vitamin B12 and folic acid supplementation on physical performance, handgrip strength, and risk of falling in elderly subjects in a double-blind, randomized placebo-controlled trial. Participants aged ≥65 years with elevated plasma homocysteine concentrations [12–50 µmol/L (n = 2919)] were randomly assigned to daily supplementation of 500 µg vitamin B12, 400 µg folic acid, and 600 I

Low vitamin D status is associated with more depressive symptoms in Dutch older adults

Purpose: The existence of vitamin D receptors in the brain points to a possible role of vitamin D in brain function. We examined the association of vitamin D status and vitamin D-related genetic make-up with depressive symptoms amongst 2839 Dutch older adults aged ≥65 years. Methods: 25-Hydroxyvitamin D (25(OH)D) was measured, and five ‘vitamin D-related genes’ were selected. Depressive symptoms were measured with the 15-point Geriatric Depression Scale. Results were expressed as the relative risk of the score of depressive symptoms by quartiles of 25(OH)D concentration or number of affected alleles, using the lowest quartile or minor allele group as reference. Results: A clear cross-sectional and pr

Effect of Vitamin B<inf>12</inf> and Folic Acid Supplementation on Bone Mineral Density and Quantitative Ultrasound Parameters in Older People with an Elevated Plasma Homocysteine Level: B-PROOF, a Randomized Controlled Trial

High plasma homocysteine (Hcy) levels are associated with increased osteoporotic fracture incidence. However, the mechanism remains unclear. We investigated the effect of Hcy-lowering vitamin B12 and folic acid treatment on bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) parameters. This randomized, double-blind, placebo-controlled trial included participants aged ≥65 years with plasma Hcy levels between 12 and 50 µmol/L. The intervention comprised 2-year supplementation with either a combination of 500 µg B12, 400 µg folic acid, and 600 IU vitamin D or placebo with 600 IU vitamin D only. In total, 1111 participants underwent repeated dual-energy X-ray assessment and 1165 participants underwent QUS. Femoral neck (FN) BMD, lumbar spine (LS) BMD, calcaneal broadband ultrasound attenuation (BUA), and calcaneal speed of sound (SOS) were assessed. After 2 years, FN-BMD and BUA had significantly decreased, while LS-BMD significantly increased (all p 80 years (estimated marginal mean 64.4 dB/MHz for the intervention group and 61.0 dB/MHz for the placebo group, p = 0.04 for difference). In conclusion, this study showed no overall effect of treatment with vitamin B12 and folic acid on BMD or QUS parameters in elderly, mildly hyperhomocysteinemic persons, but suggests a small beneficial effect on BUA in persons >80 years who were compliant in taking the supplement

Cognitive performance: a cross-sectional study on serum vitamin D and its interplay with glucose homeostasis in Dutch older adults

Objectives First, the association between serum 25-hydroxyvitamin D (25[OH]D) and cognitive performance was examined. Second, we assessed whether there was evidence for an interplay between 25(OH)D and glucose homeostasis in the association with cognitive performance. Design, Setting, and Participants Associations were studied using cross-sectional data of 776 (3 domains) up to 2722 (1 domain) Dutch community-dwelling older adults, aged 65 years or older. Measurements Serum 25(OH)D, plasma glucose, and insulin concentrations were obtained. Cognitive performance was assessed with an extensive cognitive test battery. Prevalence ratios (PRs) were calculated to quantify the association between 25(OH)D and cognition; poor performance was defined as the worst 10% of the distribution of the cognitive scores. Results The overall median MMSE score was 29 (IQR 28–30). Higher serum 25(OH)D was associated with better attention and working memory, PR 0.50 (95% CI 0.29–0.84) for the third serum 25(OH)D tertile, indicating a 50% lower probability of being a poor performer than participants in the lowest tertile. Beneficial trends were shown for 25(OH)D with executive function and episodic memory. Serum 25(OH)D was not associated with plasma glucose or insulin. Plasma insulin only modified the association between serum 25(OH)D and executive function (P for interaction: .001), suggesting that the improvement in executive function with high 25(OH)D concentrations is stronger in participants with high plasma insulin concentrations compared with those with low plasma insulin concentrations. Conclusion Higher 25(OH)D concentrations significantly associated with better attention and working memory performance. This study does not demonstrate an interplay between serum 25(OH)D and glucose homeostasis in the association with cognitive performance

Fragiele ouderen sterker en scherper door eiwit

Fragiele ouderen die extra eiwit krijgen, vertonen fysieke en ook enige mentale vooruitgang. Dit is aangetoond door een onderzoeksgroep van de afdeling Humane Voeding van Wageningen Universiteit. Promovendus Nikita van der Zwaluw en prof. dr. ir Lisette de Groot vertellen over het cognitieve deel van de studie