Dietary intake people1 Rosa
M
Ortega,
M Rosario
Ana
nitive
were
intake
days.
Folstein
et al’s
Mental
adequate unsaturated higher
intakes
Subjects
made
with
no
errors
those
lower
on
fruit,
with
the
PMSQ
of other
authors
indicating
or the consumption with
better
search is required particular nutrient incipient
impaired
may
affect
also
ment.
A diet
cognition.
with
KEY
folate, results.
intakes
of
vitamin
C,
of saturated results agree
of different
fatty with
nutrients
diet is associated
However,
more
folate,
(iron
re-
Am
elderly
but
Nutr
1997;66:803-9.
psychic
deterioration,
J Clin
more
C and
E,
may be advisable
of the
function,
intake,
impair-
and
vitamins
of a for
factors
cognitive
and zinc)
health
function.
dietary
of
fat, and cholesterol,
general
Cognitive
humans,
confounding risk
(especially
the
cognitive
and
fat, saturated
and minerals
WORDS
elderly,
and
greater
global
also
SUBJECTS
was
used
as
level
established
(125.5
de
Madrid
cognitively rise
(1,
impaired 3).
persons
older
individuals
Understanding
maintenance
the
of cognitive
ability
can
factors
be
that
is therefore
expected
to
contribute
of high
to
priority
cies
(1-19).
;t,nJ
Clin
studies can
have be caused
However, Nutr
shown
1997;66:803-9.
that
cognitive
or worsened for
normally Printed
deterioration
by nutritional aging
in USA.
older © 1997
in
deficienadults, American
scant Society
or 30 kcal).
de
were
illness
(eg,
test,
or diabetes
Salud
this
value,
equal
This
and
to the
resulted
y Consumo)].
I
From
2
mellitus
de Madrid,
Madrid.
possible
through
de Madrid
provided
the
Address
E-mail:
financial reprint
de
(Area
endocrine
been
Higiene
for
SE
a
was
in a required
These
clubs
the
a major on
are
diagnosed
and
function
or if they
as suffering
the Laboratorio
Universidad
collaboration
underlying
a hepatic
disorders,
Alimentaria,
de Salud
de T#{233}cnicas
Complutense, Excelentisimo,
of the
y Consumo)
from
Madrid, Ayunta-
Excelentisimo
and Danone
Ayun-
SA, which
support. requests
Farmacia,
to RM
Universidad
Ortega, Complutense,
Departamento
de Nutrici#{243}n,
28040-Madrid,
Spain.
[email protected].
Received
March
Accepted
for publication
for Clinical
or other
de Farmacia, de
had result
de Nutricidn
Facultad
tamiento
they
abnormal
of or had
Departamento
Made
if
an
the Departamento
the
miento
excluded
neoplasm),
signs
Facultad
Several the elderly
kJ,
From
a precision
people who return to their own was sought of all members who January and May 1995; 42.6% selected clubs agreed to participate. However, 10.3% (n 30) were later excluded for not fulfilling all the inclusion criteria.
3
(3).
(20).
of 95%,
(Area
and
of older
nutrition
frequented by healthy, elderly homes to sleep. Participation attended these clubs between (n 290) of the members of
is
population
between
sample size of 226 subjects. Three elderly persons’ clubs with > 200 members each were chosen randomly from day centers within Madrid. The selection was performed by the Madrid City Hall Department of Health and Consumer Affairs [Excelemtisimo Ayuntamiento
Instrumentales,
the
a reference
confidence
Subjects
deficit in memory or abstraction, reindependently and deterioration (1, 2). As increases, the number of
age-related
associations
The study subjects were 260 noninstitutionalized persons from Madrid, aged between 65 and 90 y. The characteristics of the study subjects are given in Table 1. To determine the required sample size for analysis, the variability of energy intake observed in another population of the same age group
Cognitive impairment, or an acquired function, problem solving, orientation, duces an individual’s ability to function of
the
METHODS
AND
showed
component
on
Subjects
aging
INTRODUCTION
a major
available
of mono-
folate,
elderly.
intake
vitamins
to improve
to improve
and
with
had
Unmeasured
dietary
less
fiber,
only
(MMSE)
to determine whether differences in intake are the result of or a conditioning factor
and j3-caotenes), not
in the
7
is
by
fiber,
intakes
satisfactory
function
both
carbohydrate,
that
of a more
cognitive
for
satisfactory
a-carotene, iron, and zinc, and lower intakes acids compared with those who made errors. Our those
and cognition (3). The aim of this investigation was to analyze the associations between cognitive function and dietary intake in a group of elderly Spanish people.
Subjects intakes
less
carbohydrate,
information
tested
was
Examination
had
Quintas,
cogDi-
record
(PMSQ).
M Elena
aged
impairment.
saturated fatty acids, and cholesterol, food, fruit, carbohydrate, thiamine,
total
vegetables,
State
and
people
capacity
28 points)
C compared who
total food,
acids, of
cognitive
Questionnaire (
intake
a weighed-food
Mini-Mental
results
fatty
vitamin
subjects’
M Ldpez-Sobaler,
of elderly
Rivas
elderly
cognitive
with
Status
MMSE
dietary
in a group
Nutrition
1, 1997. June
19,
1997.
803
Downloaded from www.ajcn.org by guest on July 13, 2011
Pfeiffer’s
The
Trinidad
in 260
of significant
monitored
function
Andr#{233}s, Ana
and
between
examined
free
was
consecutive using
were
Pedro
Navia,
Associations
y who
etary
and
Beatriz
performance
65-90
M Requejo,
Redondo,
ABSTRACT
and cognitive
ORTEGA
804 TABLE
1
Subjects’
age,
anthropometric
data,
results
and
on cognitive
function
te5ts’
152)
(n
108)
eating,
±
71.8
± 9.3
65.1
± 993
Height
(cm)
165.7
± 5.8
151.0
± 6.4
BMI (kglm2) Smokers
26.2 ± 3.1
Supplements
taken
sporadically
MMSE,
Mini-Mental
tus Questionnaire
Exam
26.2 ± 0.84
± 1 .4
(31); PMSQ,
Pfeiffer’s
Mental
different
distributed
from
variables,
men,
P
0.05
65 y of age. In agreement with the suggestion of Breteler et al (39), the present results show that subjects with greater quantities of energy supplied by SFAs had poorer MMSE and PMSQ results (Tables 2 and 3). Those with higher intakes of cholesterol also had poorer MMSE results (Table 2). Furthermore, MMSE results
worsened
as fats,
energy. The consumption has long been associated
SFAs,
and
cholesterol
of fats, fatty with increased
provided
more
acids, and cholesterol cholesterolernia and
Downloaded from www.ajcn.org by guest on July 13, 2011
12.8±3.4
808
ORTEGA
cardiovascular disease (45). It may be that this type also less adequate for the maintenance of cognitive Many studies have shown the importance of an folate supply in the maintenance of cognitive ability (2, 3, 6, 10,
13-15,
17).
In the
present
study,
folate
of diet is function. adequate in old age intake
was
significantly greater in subjects with better MMSE and PMSQ results (Tables 2 and 3). Folate could be involved in mental function in the elderly through its participation in transmethylation reactions ( 17). Folate deficiency leads to reduced concentrations of S-adenosylmethionine (6), a compound required in numerous transmethylation reactions involving nucleic acids,
proteins,
phospholipids,
amines,
and
some
folate
is involved
in
the
metabolism
of
the
This
agrees
with
the
findings
of Breteler
et al (39),
who established a relation between cardiovascular risk factors and cognitive function. Folate might, therefore, improve mental capability through its role in protection of the cardiovascular system. The influence of thiamine intake on cognitive function has been mentioned in many studies (3, 9, 10). In the present population,
a correlation
was
seen
between
thiamine
intake
function
(8).
In
adults,
oligodendrocytes
intake
of
carbohydrate,
fiber,
vitamins
vitamins C and E, and 3-carotenes), zinc) might be advisable to improve status and general health of the elderly ability.
(especially
folate,
and minerals (iron and not only the nutritive but also their cognitive
U
may
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responsible for iron regulation in the brain at the cellular level. Brain iron regulatory mechanisms are vulnerable to deficient supplies of iron (8). The influence of iron intake in cognitive processes has been shown in many studies (4, 7, 15, 18). The present results also show that subjects with poorer PMSQ results had lower iron intakes than those with better results (Table 3). Furthermore, a positive, significant correlation was seen between MMSE results and iron intake (r = 0.1738, P < 0.05). As admitted by Jama et al ( 1 ) and La Rue et al (3), we believe there to be several design issues that should be taken into account when interpreting our results. This is a crosssectional study and the design does not allow us to establish whether a difference in the intake of any nutrient preceded or was the result of impaired cognition. Furthermore, the reliability of the dietary data collected from cognitively impaired subjects may be compromised. We tried to address the latter problem by excluding individuals with manifest or diagnosed cognitive deterioration. Incipient dementia may also change
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