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Prospective Study of Ageing Trajectories in the European DO-HEALTH Study.
Ghisla, V, Chocano-Bedoya, PO, Orav, EJ, Abderhalden, LA, Sadlon, A, Egli, A, Krützfeldt, J, Kanis, JA, Bischoff-Ferrari, HA
Gerontology. 2023;69(1):57-64
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The term “healthy ageing” describes the ideal status of ageing while maintaining independence and quality of life in older adults while simultaneously delaying premature ageing and incident frailty. The start and progression of health deterioration varies between individuals. One of the best ways to assess ageing, as a dynamic process, is by long-term trajectories of functioning. The aim of this study was to assess the trajectories between healthy ageing status and frailty, including not only the progression in health deterioration but also improvement from unhealthier to healthier states, among community-dwelling adults 70 years and older without major comorbidities over 4 years of follow-up. This study is a secondary analysis of the multicentre, randomised clinical trial DO-HEALTH, designed to evaluate the effects of omega-3, vitamin D, and a home strength exercise programme. Participants were 2,157 community-dwelling older adults 70 years and older. Results show dynamic trajectories of ageing in a third of all participants, with 12.0% improving to a better and 22.8% declining to a lower healthy ageing state. Additionally, in the multivariate adjusted analyses, the odds of improvement to a healthier state declined by 6% for each additional year of age, while the odds of deteriorating were 35% higher for women. Authors conclude that since their findings show that women have a 35% lower chance to improve to a healthier state should be taken into consideration in future efforts to support healthy ageing in the older adult population.
Abstract
INTRODUCTION Ageing trajectories range from delayed ageing with extended health to accelerated ageing, with an increased risk of frailty. We evaluated the prevalence and prospective change between health states among community-dwelling European older adults. METHODS This prospective study is a secondary analysis of DO-HEALTH, a randomized trial that included adults aged 70 years and older across 5 European countries. Healthy agers (HA) fulfilled the Nurses' Health Study healthy ageing criteria and accelerated agers were non-HA being at least pre-frail according to the Fried frailty criteria. We assessed the proportion of participants changing between health states over 4 assessments and evaluated the odds of changing to a more favourable category. To increase reliability and avoid regression to the mean, we averaged the first 2 years and compared them to the average of the last 2 years. RESULTS Of 2,157 participants, 12.4% were excluded for meeting both healthy ageing and pre-frailty criteria simultaneously. Among the remaining 1,889 participants (mean age 75.1 years, 60.9% female), 23.1% were initially HA, 44.4% were non-HA but not pre-frail, and 32.6% were pre-frail or frail. Subsequently, 65.3% remained in the same health state, 12.0% improved to a healthier state, and 22.8% progressed to a less advantageous state. After adjusting for sex, study centre, treatment, and body mass index, each year of age was associated with 6% lower odds of improving health states. Women had 35% higher odds than men of following a disadvantageous trajectory. CONCLUSION We observed dynamic trajectories of ageing where transitioning to a healthier state became less likely with advancing age and among women.
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Can dementia risk be reduced by following the American Heart Association's Life's Simple 7? A systematic review and dose-response meta-analysis.
Wu, J, Xiong, Y, Xia, X, Orsini, N, Qiu, C, Kivipelto, M, Rizzuto, D, Wang, R
Ageing research reviews. 2023;83:101788
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The American Heart Association (AHA) has defined ideal levels of seven modifiable cardiovascular health (CVH) factors, known as Life's Simple 7, that consist of smoking, physical activity, diet, body mass index, fasting blood glucose, total cholesterol, and blood pressure. Maintaining ideal levels of these factors has been recommended as a prevention strategy against not only cardiovascular diseases but also neurodegenerative disorders, e.g., cognitive decline and dementia. However, studies exploring the beneficial effects of the AHA’s CVH metrics on cognitive outcomes, especially among older populations, have been uncertain, and solid evidence is lacking in this field. This systematic review and meta-analysis aimed to quantify the relationship between the AHA’s CVH metrics and cognitive outcomes. 14 longitudinal studies were included in the meta-analysis. The results showed a considerable effect of a favourable total CVH score on reduced risk of incident dementia in adults aged 70 years or older. When looking at the individual factors, dementia risk can be reduced significantly if older adults achieved the recommended level of physical activity, blood glucose, or total cholesterol. The association with smoking appeared to be borderline, and there was no association between diet, body mass index hazard ratio or blood pressure and dementia risk. The authors concluded that their findings provide evidence that maintaining a favourable level of CVH score, either in mid- or late- life, would substantially reduce the risk of dementia among older adults. Preserving cardiovascular health by quitting smoking, engaging in physical exercise, controlling blood glucose and total cholesterol might be especially effective for forestalling cognitive decline and dementia.
Abstract
This study aimed to quantify the relationships between the American Heart Association (AHA) Cardiovascular Health (CVH) metrics, namely AHA Life's Simple 7, and cognitive outcomes. We searched PubMed and Embase (January 1, 2010-August 24, 2022) and finally included 14 longitudinal studies (311654 participants with 8006 incident dementia cases). Random-effects meta-analysis and one-stage linear mixed-effects models were performed. Increased CVH score seemed to associate with decreased risk of incident dementia in a linear manner, but this relationship varied by the measurement age of CVH metrics. That is, midlife CVH tended to have a linear association with late-life dementia risk, whereas a J-shaped association was observed between the late-life CVH score and dementia. In addition, late-life dementia risk was reduced significantly if individuals maintained an ideal level of AHA's CVH guidelines of physical activity, fasting plasma glucose, total cholesterol, and smoking. However, our meta-analysis did not show a significant association between CVH score and global cognitive decline rate. Following AHA's CVH guidelines and maintaining CVH at an optimal level would substantially reduce the late-life dementia risk. More research is required to explore the link between a favorable CVH score and cognitive trajectories among cognitively asymptomatic older populations.
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Effect of short-term, high-dose probiotic supplementation on cognition, related brain functions and BDNF in patients with depression: a secondary analysis of a randomized controlled trial.
Schneider, E, Doll, JPK, Schweinfurth, N, Kettelhack, C, Schaub, AC, Yamanbaeva, G, Varghese, N, Mählmann, L, Brand, S, Eckert, A, et al
Journal of psychiatry & neuroscience : JPN. 2023;48(1):E23-E33
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Major depressive disorder (MDD) is often thought of as being solely a mood disorder. However, several studies have shown that sufferers can also experience decreased brain function such as memory loss and poor attention. Current therapies for MDD focus on the balancing of mood and leaves the problem of reduced brain function unattended. The gut microbiota has recently been shown to influence brain function and altered gut microbiota composition has been seen in individuals with MDD. Targeting the gut microbiota may therefore represent a novel target for MDD treatments. This secondary analysis of a randomised control trial aimed to determine whether a probiotic multistrain supplement could improve brain function in 60 individuals with depression. The results showed that probiotics improved the brain function in two different ways, the immediate recall of words, and the improvement of decreased neural function in the hippocampal part of the brain, which has been associated with MDD. It was concluded that probiotic supplementation can enhance verbal episodic memory and improve neural function associated with impaired brain function in MDD. This study could be used by healthcare professionals to understand that the health of the gut microbiota can have an influence on brain function and that probiotics may help individuals with MDD who are suffering from poorer memory.
Abstract
BACKGROUND In major depressive disorder (MDD), cognitive dysfunctions strongly contribute to functional impairments but are barely addressed in current therapies. Novel treatment strategies addressing cognitive symptoms in depression are needed. As the gut microbiota-brain axis is linked to depression and cognition, we investigated the effect of a 4-week high-dose probiotic supplementation on cognitive symptoms in depression. METHODS This randomized controlled trial included 60 patients with MDD, of whom 43 entered modified intention-to-treat analysis. A probiotic supplement or indistinguishable placebo containing maltose was administered over 31 days in addition to treatment as usual for depression. Participant scores on the Verbal Learning Memory Test (VLMT), Corsi Block Tapping Test, and both Trail Making Test versions as well as brain-derived neurotrophic factor levels were assessed at 3 different time points: before, immediately after and 4 weeks after intervention. Additionally, brain activation changes during working memory processing were investigated before and immediately after intervention. RESULTS We found a significantly improved immediate recall in the VLMT in the probiotic group immediately after intervention, and a trend for a time × group interaction considering all time points. Furthermore, we found a time × group interaction in hippocampus activation during working memory processing, revealing a remediated hippocampus function in the probiotic group. Other measures did not reveal significant changes. LIMITATIONS The modest sample size resulting from our exclusion of low-compliant cases should be considered. CONCLUSION Additional probiotic supplementation enhances verbal episodic memory and affects neural mechanisms underlying impaired cognition in MDD. The present findings support the importance of the gut microbiota-brain axis in MDD and emphasize the potential of microbiota-related regimens to treat cognitive symptoms in depression. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier NCT02957591.
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Mixed Tree Nuts, Cognition, and Gut Microbiota: A 4-Week, Placebo-Controlled, Randomized Crossover Trial in Healthy Nonelderly Adults.
Haskell-Ramsay, CF, Dodd, FL, Smith, D, Cuthbertson, L, Nelson, A, Lodge, JK, Jackson, PA
The Journal of nutrition. 2023;152(12):2778-2788
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Cognitive impairment is a growing worldwide health concern as our population ages. In the absence of effective pharmaceutical treatments, modifiable lifestyle factors such as nutrition represent crucial targets in preventing cognitive decline. The aim of this study was to investigate the cognitive and mood effects of mixed tree nut supplementation in healthy non-elderly adults aged 18 to 49 years. This study is a randomised, placebo-controlled, double-blind, counterbalanced crossover design. Participants (n = 81) were randomly assigned to one of the two groups; the treatment or placebo group. Results showed that nut consumption led to improved picture recognition in terms of increased accuracy and faster reaction time. Furthermore, there was an enrichment of an unclassified type of bacterial community (Lachnospiraceae) but limited changes to the urinary metabolome. On the other hand, supplementation with mixed nuts failed to evince effects on mood. Authors conclude by pointing out that their findings are attributed to a sample of healthy and nonelderly participants. Thus, more profound effects may be shown with higher quantities of nuts or in those at risk, such as those experiencing cognitive decline or in those suffering gut dysbiosis.
Abstract
BACKGROUND Beneficial effects of nut supplementation on cognitive function have previously been demonstrated in young and older adults. Alterations to gut microbiota have also been shown following tree nut consumption. However, no data exists on the effects of nuts on cognition and intestinal microbial communities assessed within the same study. OBJECTIVES The study aimed to examine the effects of daily consumption of tree nuts for 4 wk on cognitive function (primary outcome), mood, metabolomics, and gut microbial species (secondary outcomes) in healthy, nonelderly adults. METHODS This randomized, placebo-controlled, double-blind, counterbalanced crossover study assessed the effects of 4 wk of supplementation with 30 g/d mixed tree nuts versus placebo on cognition and mood in 79 healthy adults aged 18-49 y. Metabolic responses, gut bacterial community structure, and the potential for these to impact cognition were explored using a multi-omic approach. Bacterial community analysis was conducted in Quantitative Insights Into Microbial Ecology 2 (QIIME2). RESULTS Mixed model analysis indicated that nut consumption led to significant improvements to accuracy (placebo M = 92.2% compared with NUTS M = 94.5%; P = 0.019) and speed of response (placebo M = 788 ms compared with NUTS M = 757 ms; P = 0.004) on a picture recognition task. No significant changes to bacterial community α or β diversity were observed when comparing nut consumption to the placebo arm. However, an unclassified Lachnospiraceae amplicon sequence variant (ASV) was significantly enriched in participants when supplemented with nuts (P = 0.015). No correlations were observed between the changes to picture recognition and the changes to the unclassified Lachnospiraceae ASV. There were no significant changes to the urinary metabolome. CONCLUSIONS These findings indicate a positive effect of nut on cognition following only 4 wk of consumption in a healthy nonelderly sample, as well as upregulation of a microbial taxa associated with gut health. The effects appear to be independent of one another, but further exploration is required in those experiencing cognitive decline and/or gut dysbiosis.
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Effects of a 2-year exercise training on neuromuscular system health in older individuals with low muscle function.
Monti, E, Tagliaferri, S, Zampieri, S, Sarto, F, Sirago, G, Franchi, MV, Ticinesi, A, Longobucco, Y, Adorni, E, Lauretani, F, et al
Journal of cachexia, sarcopenia and muscle. 2023;14(2):794-804
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Ageing is accompanied by a progressive decline in muscle mass and functionality, associated with an increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality, possibly leading to a clinical syndrome known as sarcopenia. Among the causes of sarcopenia, motoneuron and neuromuscular junction (NMJ) degeneration have been proposed as key determinants. The aim of this study was to investigate the effects of a 2-year multimodal training intervention involving aerobic, strength and balance exercises on muscle mass and function, motoneuronal and NMJ health in a population of older individuals classified as sarcopenic. This study was a randomised controlled trial which enrolled 45 sarcopenic participants (34 females and 11 males) who were randomly assigned to one of the two groups: intervention or control group. Results show that the 2-year multimodal training intervention seemingly preserved NMJ stability, preventing serum C-terminal agrin fragment (CAF) [a biomarker of muscle wasting and weakness] concentration rise in the intervention group, although this biomarker increased significantly only in the control group. Conversely, neurofilament light chain (NfL) [clinical biomarker of many neurodegenerative diseases] concentration did not change in either group. Finally, improvements of physical performance were correlated with changes of serum biomarkers of NMJ stability. Authors conclude that a 2-year multimodal training intervention including aerobic, strength and balance exercises is effective for preventing CAF concentration increments, suggesting a positive effect on NMJ stability.
Abstract
BACKGROUND Ageing is accompanied by a progressive loss of skeletal muscle mass and strength, potentially determining the insurgence of sarcopenia. Evidence suggests that motoneuron and neuromuscular junction (NMJ) degeneration contribute to sarcopenia pathogenesis. Seeking for strategies able to slow down sarcopenia insurgence and progression, we investigated whether a 2-year mixed-model training involving aerobic, strength and balance exercises would be effective for improving or preserving motoneuronal health and NMJ stability, together with muscle mass, strength and functionality in an old, sarcopenic population. METHODS Forty-five sarcopenic elderly (34 females; 11 males) with low dual-energy X-ray absorptiometry (DXA) lean mass and Short Physical Performance Battery (SPPB) score <9 were randomly assigned to either a control group [Healthy Aging Lifestyle Education (HALE), n = 21] or an intervention group [MultiComponent Intervention (MCI), n = 24]. MCI trained three times per week for 2 years with a mix of aerobic, strength and balance exercises matched with nutritional advice. Before and after the intervention, ultrasound scans of the vastus lateralis (VL), SPPB and a blood sample were obtained. VL architecture [pennation angle (PA) and fascicle length (Lf)] and cross-sectional area (CSA) were measured. As biomarkers of neuronal health and NMJ stability status, neurofilament light chain (NfL) and C-terminal agrin fragment (CAF) concentrations were measured in serum. Differences in ultrasound parameters, NfL and CAF concentration and physical performance between baseline and follow-up were tested with mixed ANOVA or Wilcoxon test. The relationship between changes in physical performance and NfL or CAF concentration was assessed through correlation analyses. RESULTS At follow-up, MCI showed preserved VL architecture (PA, Lf) despite a reduced CSA (-8.4%, P < 0.001), accompanied by maintained CAF concentration and ameliorated overall SPPB performance (P = 0.007). Conversely, HALE showed 12.7% decrease in muscle CSA (P < 0.001), together with 5.1% and 5.5% reduction in PA and Lf (P < 0.001 and P = 0.001, respectively), and a 6.2% increase in CAF (P = 0.009) but improved SPPB balance score (P = 0.007). NfL concentration did not change in either group. In the population, negative correlations between changes in CAF concentration and SPPB total score were found (P = 0.047), whereas no correlation between NfL and SPPB variations was observed. CONCLUSIONS The present findings suggest that our 2-year mixed aerobic, strength and balance training seemed effective for preventing the age and sarcopenia-related increases in CAF concentration, preserving NMJ stability as well as muscle structure (PA and Lf) and improving physical performance in sarcopenic older individuals.
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Effect of a dietary intervention based on the Mediterranean diet on the quality of life of patients recovered from depression: Analysis of the PREDIDEP randomized trial.
Cabrera-Suárez, BM, Lahortiga-Ramos, F, Sayon-Orea, C, Hernández-Fleta, JL, González-Pinto, A, Molero, P, Vega-Pérez, R, Sánchez-Villegas, A
Experimental gerontology. 2023;175:112149
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Unipolar depression is a prevalent and disabling condition that negatively influences quality of life. Patients with depression are more vulnerable to have a poorer health-related quality of life (HRQoL). The aim of this study was to assess the effect of 2-year intervention with Mediterranean Diet enriched with extra virgin olive oil on HRQoL. This study is a multicentre, randomised, controlled, single-blind trial. The study included 52 men and 144 women aged between 18 and 86 years who had suffered at least one depression episode and who were in a stage of clinical remission. The participants were randomly assigned to the intervention or control group. Results show that a Mediterranean diet–based nutritional intervention enriched with extra virgin olive oil compared with usual care, resulted in a significantly greater increase in HRQoL in recovered depressed patients. This association was greater for the mental dimensions rather than the physical dimensions. Furthermore, this association was also observed for participants aged 60 or more. Authors conclude that since depression is an important condition for its high prevalence, economic cost and personal suffering, it is important to evaluate cost-effective, safe, and inexpensive interventions, such as Mediterranean Diet nutritional interventions.
Abstract
INTRODUCTION There is substantial evidence supporting that improving diet quality leads to improved health-related quality of life (HRQoL). Our major aim was to assess the effectiveness of a Mediterranean diet-based nutritional intervention to improve HRQoL in the context of a secondary prevention trial of depression. Secondarily to assess its effectiveness among adults aged 60 or more years. METHODS The PREDIDEP study is a 2-year multicentre, randomized, single-blinded nutritional trial. At baseline and at 1-year and 2-year follow-up, SF-36 health survey questionnaire was collected to evaluate participants' HRQoL (total and specific range for each of the 8 dimensions: 0 to 100 points). Mixed effect linear models were used to assess changes in HRQoL according to adherence to the Mediterranean diet. The trial was registered at ClinicalTrials.govNCT03081065. RESULTS After 2 years of intervention, the Mediterranean Diet intervention group compared to control group (without nutritional intervention, only usual clinical care) showed an improvement in some dimensions of HRQoL such as Mental Health (7.22; 95 % CI = 2.22-12.22) (between-group difference: 6.79; 95 % CI -0.14-13.73, p = 0.055); Vitality (9.51; 95 % CI = 4.00-15.03) (between-group difference: 9.00; 95 % CI 1.75-16.25, p = 0.020); Mental Summary Component (2.83; 95 % CI = 0.55-5.11) (between-group difference: 1.17; 95 % CI = -1.96-4.30, p = 0.462); and General Health (10.70; 95 % CI = 5.58-15.81) (between-group difference: 6.20; 95 % CI = -0.89-13.28, p = 0.086). Similar results were observed for participants aged 60 or more years. CONCLUSION The intervention based on Mediterranean diet in patients with previous depression seems to be effective in improving HRQoL, especially the mental dimensions. This effect is also observed among participants aged 60 or more years.
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Effects of iron supplementation on neural indices of habituation in Bangladeshi children.
Larson, LM, Feuerriegel, D, Hasan, MI, Braat, S, Jin, J, Tipu, SMU, Shiraji, S, Tofail, F, Biggs, BA, Hamadani, JD, et al
The American journal of clinical nutrition. 2023;117(1):73-82
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Adversity during early life, including malnutrition, may influence the long-term cognitive development of children. Micronutrients, especially iron, may play a critical role in the developing infant brain The aim of this study was to determine the effects of supplementation with iron syrup and iron containing multiple micronutrient powders (MNPs) on neural indices of habituation in Bangladeshi children. This neurocognitive substudy was nested within the Benefits and Risks of Iron Supplementation in Children (BRISC) trial. BRISC was a 3-arm, double-blind, double-dummy, individual randomised, superiority trial. Children were randomly assigned to 1 of the 3 arms using a 1:1:1 allocation. Results showed that iron supplementation (provided through 2 different modes) did not affect neural indices of habituation. There wasn’t any identification of treatment effects for any of the outcomes measured, despite finding improvements in haemoglobin and ferritin concentrations for children given iron syrup or MNPs. Authors conclude that despite established links between iron availability and neurophysiological development, increased iron availability in children under one year of age does not lead to measurable changes in neural indices of habituation.
Abstract
BACKGROUND Iron deficiency and anemia have been associated with poor cognition in children, yet the effects of iron supplementation on neurocognition remain unclear. OBJECTIVE We aimed to examine the effects of supplementation with iron on neural indices of habituation using auditory event-related brain potentials (ERPs). METHODS This substudy was nested within a 3-arm, double-blind, double-dummy, individual randomized trial in Bangladesh, in which 3300 8-mo-old children were randomly selected to receive 3 mo of daily iron syrup (12.5 mg iron), multiple micronutrient powders (MNPs) (including 12.5 mg iron), or placebo. Children were assessed after 3 mo of intervention (mo 3) and 9 mo thereafter (mo 12). The neurocognitive substudy comprised a randomly selected subset of children from the main trial. Brain activity elicited during an auditory roving oddball task was recorded using electroencephalography to provide an index of habituation. The differential response to a novel (deviant) compared with a repeated (standard) sound was examined. The primary outcome was the amplitude of the mismatch response (deviant minusstandard tone waveforms) at mo 3. Secondary outcomes included the deviant and standard tone-evoked amplitudes, N2 amplitude differences, and differences in mean amplitudes evoked by deviant tones presented in the second compared with first half of the oddball sequence at mo 3 and 12. RESULTS Data were analyzed from 329 children at month 3 and 363 at mo 12. Analyses indicated no treatment effects of iron interventions compared with placebo on the amplitude of the mismatch response (iron syrup compared with placebo: mean difference (MD) = 0.07μV [95% CI: -1.22, 1.37]; MNPs compared with placebo: MD = 0.58μV [95% CI: -0.74, 1.90]) nor any secondary ERP outcomes at mo 3 or 12, despite improvements in hemoglobin and ferritin concentrations from iron syrup and MNPs in this nested substudy. CONCLUSION In Bangladeshi children with >40% anemia prevalence, iron or MNP interventions alone are insufficient to improve neural indices of habituation. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12617000660381.
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Improving stress management, anxiety, and mental well-being in medical students through an online Mindfulness-Based Intervention: a randomized study.
Fazia, T, Bubbico, F, Nova, A, Buizza, C, Cela, H, Iozzi, D, Calgan, B, Maggi, F, Floris, V, Sutti, I, et al
Scientific reports. 2023;13(1):8214
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Medical students commonly experience anxiety, depression, burnout and emotional discomfort due to the pressures of medical school. This randomised, controlled study of 362 medical students at Italian Universities evaluated the effectiveness of a 5-week online mindfulness-based intervention (MBI), consisting of an introductory session, 8 sessions of 35 min integral meditation and 10 min yoga, and one dietary advice/question and answer session with a nutritionist. The control group received no intervention. Effectiveness was measured through a variety of validated questionnaires for perceived stress, anxiety, wellbeing, emotional health, resilience and cognition. Overall, at baseline, participants of this study fared worse for stress than other studies had shown for general populations. The MBI was effective in improving perceived stress, mental wellbeing, emotional regulation, resilience, tendency to mind-wandering, ability to maintain attention and overall distress, although effect sizes for all outcomes were small. No statistically significant effect was seen for the anxiety rating. Interestingly, two cohorts were included in this study and whilst one benefitted from the programme, the other did not, one explanation of which may be that they were done during different phases of the COVID pandemic. The authors conclude that adopting MBI may help improve students’ wellbeing.
Abstract
Pressures and responsibilities of medical school put a strain on medical student's personal wellbeing, leading among all to high rates of anxiety, emotional discomfort and stress. In this work we evaluated the effectiveness of a comprehensive Mindfulness-Based Intervention (MBI) in reducing this load. The intervention comprised 10 twice-a-week Integral Meditation classes, dietary advice, and brief yoga sessions. We performed a randomized trial on two cohort of medical students from Italian universities: 239 in cohort 1 (106 treated and 133 controls), and 123 in cohort 2 (68 treated and 55 control) for a total sample of 362 students. Nine questionnaires for evaluating the effectiveness of our intervention on stress (PSS), state anxiety (STAIX-1), well-being (WEMWBS), mind-wandering (MW-S), overall distress (PANAS), emotion regulation (DERS), resilience (RS-14), and attentional control (ACS-C and ACS-D) were collected both pre and post intervention. Linear mixed effect models were run on the whole sample showing that, after multiple testing correction, our intervention was effective in reducing perceived stress (β = - 2.57 [- 4.02; - 1.12], p = 0.004), improving mental well-being (β = 2.82 [1.02; 4.63], p = 0.008) and emotional regulation (β = - 8.24 [- 12.98; - 3.51], p = 0.004), resilience (β = 3.79 [1.32; 6.26], p = 0.008), reducing the tendency to wander with the mind (β = - 0.70 [- 0.99; - 0.39], p = 0.0001), ameliorating the ability to maintain attention (AC-S (β = - 0.23 [- 0.44; - 0.02], p = 0.04) and AC-D (β = - 0.19 [- 0.36; - 0.01], p = 0.04)), and the overall distress (β = 1.84 [0.45; 3.23], p = 0.02).
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Habitual daily intake of a sweet and fatty snack modulates reward processing in humans.
Edwin Thanarajah, S, DiFeliceantonio, AG, Albus, K, Kuzmanovic, B, Rigoux, L, Iglesias, S, Hanßen, R, Schlamann, M, Cornely, OA, Brüning, JC, et al
Cell metabolism. 2023;35(4):571-584.e6
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The prolific amount of sugar and fat in modern Western diets is regarded as a significant contributor to overeating and consequential weight gain. Dopamine, a neurotransmitter involved in learning and reward signalling, is also important in regulating food intake. Energy-dense foods, often high in both sugar and fat, stimulate pleasure-signalling dopamine to encourage eating, even if no more energy is needed. It is acknowledged that in many cases of obesity, the function of dopamine appears to be altered. Yet it is uncertain whether this was pre-existing to obesity, a result of obesity or whether it was re-shaped though exposure to high sugar and high-fat diets. To gain more insights, this study evaluated whether adding a high-fat/high-sugar (HF/HS) snack or a low-fat/low-sugar (LF/LS) snack to a regular diet could change the candidates liking for fat, their brain responses to likeable foods like fat and sugar and if it impacted on sensory associative learning. The randomised controlled study was conducted for 8-weeks and included 49 people of normal-weight. The candidates were also monitored for any changes in weight and body fat, insulin resistance, leptin levels, and blood fats, and all completed self-reported dietary intake forms. The findings demonstrated that repeated exposure to HF/HS food reduced the preference for low-fat foods and up-regulated the brain responses when anticipating and consuming such highly palatable, energy-dense foods. Beyond increased brain response to HF/HS food, HF/HS exposure also induced a general rewiring of the brain by enhancing new sensory associations and behavioural adaptations that were unrelated to food. Notably, these changes all occurred independent of weight gain or alterations in metabolic function, thus suggesting that repeated exposure to HF/HS foods can change the physiology in healthy weight individuals to reduce their liking of healthier foods whilst at the same time increasing the reward responses to more palatable HF/ HS foods. The authors highlighted this as a risk for overeating and weight gain, arguing that reducing the exposure to energy-dense HF/HS food items therefore is critical in the prevention and management of obesity.
Abstract
Western diets rich in fat and sugar promote excess calorie intake and weight gain; however, the underlying mechanisms are unclear. Despite a well-documented association between obesity and altered brain dopamine function, it remains elusive whether these alterations are (1) pre-existing, increasing the individual susceptibility to weight gain, (2) secondary to obesity, or (3) directly attributable to repeated exposure to western diet. To close this gap, we performed a randomized, controlled study (NCT05574660) with normal-weight participants exposed to a high-fat/high-sugar snack or a low-fat/low-sugar snack for 8 weeks in addition to their regular diet. The high-fat/high-sugar intervention decreased the preference for low-fat food while increasing brain response to food and associative learning independent of food cues or reward. These alterations were independent of changes in body weight and metabolic parameters, indicating a direct effect of high-fat, high-sugar foods on neurobehavioral adaptations that may increase the risk for overeating and weight gain.
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Effect of vitamin D supplementation on depression in older Australian adults.
Rahman, ST, Waterhouse, M, Romero, BD, Baxter, C, English, DR, Almeida, OP, Berk, M, Ebeling, PR, Armstrong, BK, McLeod, DSA, et al
International journal of geriatric psychiatry. 2023;38(1):e5847
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Depression can considerably impair daily function. However, although medications and psychological therapy can be effective in treating depression, non‐compliance with and/or side effects of antidepressants are common. Thus, identifying alternative or adjunctive therapies to prevent or treat depression may help to overcome some limitations of current management strategies. The aim of this study was to examine whether supplementing older Australians with monthly doses of 60,000 IU of vitamin D3 for 5 years would reduce depressive symptoms or incidence of antidepressant use, as a surrogate for a formal diagnosis of depression. This study used data from the D‐Health Trial, a large population‐based randomised controlled trial. Authors randomly selected potential participants aged between 60 and 79 years from the Australian Commonwealth Electoral Roll. The participants who accepted the invitation were randomly allocated to either 60,000 IU of cholecalciferol (vitamin D3) or placebo in a 1:1 ratio. Results show that there wasn’t an overall benefit of monthly supplementation with 60,000 IU of vitamin D for up to 5 years on measures of depression. However, pre‐specified subgroup analyses suggested a potential beneficial effect of vitamin D supplementation in people taking antidepressants at baseline or with lower predicted baseline vitamin D3 concentration. However there was an unfavourable effect in participants with a body mass index <25 kg/m2 or those with higher predicted baseline vitamin D3 concentration. Authors conclude that routine supplementation with vitamin D in populations with a low prevalence of vitamin D deficiency is unlikely to be of benefit for depression and may cause harm in people with low body mass index or normal vitamin D status.
Abstract
OBJECTIVES To investigate whether vitamin D supplementation reduces depressive symptoms and incidence of antidepressant use. METHODS We used data from the D-Health Trial (N = 21,315), a randomized double-blind placebo-controlled trial of monthly vitamin D3 for the prevention of all-cause mortality. Participants were Australians aged 60-84 years. Participants completed the Patient Health Questionnaire (PHQ-9) at 1, 2 and 5 years after randomization to measure depressive symptoms; national prescribing records were used to capture antidepressant use. We used mixed models and survival models. RESULTS Analyses of PHQ-9 scores included 20,487 participants (mean age 69·3 years, 46% women); the mean difference (MD) in PHQ-9 score (vitamin D vs. placebo) was 0·02 (95% CI -0·06, 0·11). There was negligible difference in the prevalence of clinically relevant depression (PHQ-9 score ≥10) (odds ratio 0·99; 95% CI 0·90, 1·08). We included 16,670 participants in the analyses of incident antidepressant use (mean age 69·4 years, 43% women). Incidence of antidepressant use was similar between the groups (hazard ratio [HR] 1·04; 95% CI 0·96, 1·12). In subgroup analyses, vitamin D improved PHQ-9 scores in those taking antidepressants at baseline (MD -0·25; 95% CI -0·49, -0·01; p-interaction = 0·02). It decreased risk of antidepressant use in participants with predicted 25(OH)D concentration <50 nmol/L (HR 0·88; 95% CI 0·75, 1·02; p-interaction = 0·01) and increased risk in those with predicted 25(OH)D ≥ 50 nmol/L (HR 1·10; 95% CI 1·01, 1·20). CONCLUSION Monthly supplementation with high-dose vitamin D3 was not of benefit for measures of depression overall, but there was some evidence of benefit in subgroup analyses. CLINICAL TRIAL REGISTRATION The trial is registered on the Australian New Zealand Clinical Trials Registry: ACTRN12613000743763. https://www.anzctr.org.au/.