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The feasibility of a multidomain dementia risk reduction randomised controlled trial for people experiencing cognitive decline: the Body, Brain, Life for Cognitive Decline (BBL-CD).
McMaster, M, Kim, S, Clare, L, Torres, SJ, Cherbuin, N, Anstey, KJ
Aging & mental health. 2023;(11):2111-2119
Abstract
OBJECTIVES To evaluate the feasibility of a proof-of-concept multidomain dementia risk reduction intervention. METHOD An 8-week, parallel-group RCT, focused on increasing adherence to lifestyle domains of Mediterranean diet (MeDi), Physical Activity (PA), and Cognitive Engagement (CE). Feasibility was evaluated against the Bowen Feasibility Framework objectives of: Acceptability of the intervention, compliance with the protocol, and efficacy of the intervention to change behaviour in the three domains of interest. RESULTS High acceptability of the intervention was demonstrated through a participant retention rate of 80.7% (Intervention: 84.2%; Control: 77.4%). Compliance to the protocol was strong with 100% of participants completing all educational modules and all MeDi and PA components, with 20% compliance for CE. Linear mixed models demonstrated efficacy to change behaviour through significant effects of adherence to MeDi (χ2 = 16.75, df = 3, p < .001) and CE (χ2 = 9.83, df = 3, p =.020), but not PA (χ2 = 4.48, df = 3, p =.211). CONCLUSION Overall the intervention was shown to be feasible. Recommendations for future trials in this area are: The implementation of practical, one-on-one sessions as they are more effective than passive education at eliciting behaviour change; use of booster sessions to increase likelihood of lifestyle changes being sustained; and collection of qualitative data to identify barriers to change.
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Lifestyle Risk Factors and Cognitive Outcomes from the Multidomain Dementia Risk Reduction Randomized Controlled Trial, Body Brain Life for Cognitive Decline (BBL-CD).
McMaster, M, Kim, S, Clare, L, Torres, SJ, Cherbuin, N, DʼEste, C, Anstey, KJ
Journal of the American Geriatrics Society. 2020;(11):2629-2637
Abstract
BACKGROUND/OBJECTIVES To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). DESIGN The study was an 8-week two-arm single-blind proof-of-concept randomized controlled trial. SETTING Community-dwelling individuals living in Canberra, Australia, and surrounding areas. PARTICIPANTS Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI. INTERVENTION The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants' lifestyles: dietitian sessions, an exercise physiologist session, and online brain training. MEASUREMENTS Lifestyle risk factors for AD were assessed using the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale-Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test-B, and Category Fluency. RESULTS The primary analysis showed that the intervention group had a significantly lower ANU-ADRI score (χ2 = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ2 = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ2 = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ2 = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ2 = 6.46; df = 2; P = .040). Results were robust to intention-to-treat analysis controlling for missing data. CONCLUSION Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.
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An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial.
Anstey, KJ, Cherbuin, N, Kim, S, McMaster, M, D'Este, C, Lautenschlager, N, Rebok, G, McRae, I, Torres, SJ, Cox, KL, et al
Journal of medical Internet research. 2020;(9):e19431
Abstract
BACKGROUND There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. OBJECTIVE This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. METHODS A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). RESULTS Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001). CONCLUSIONS A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results. TRIAL REGISTRATION Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx.
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Effects of progressive resistance training combined with a protein-enriched lean red meat diet on health-related quality of life in elderly women: secondary analysis of a 4-month cluster randomised controlled trial.
Torres, SJ, Robinson, S, Orellana, L, O'Connell, SL, Grimes, CA, Mundell, NL, Dunstan, DW, Nowson, CA, Daly, RM
The British journal of nutrition. 2017;(11):1550-1559
Abstract
Resistance training (RT) and increased dietary protein are recommended to attenuate age-related muscle loss in the elderly. This study examined the effect of a lean red meat protein-enriched diet combined with progressive resistance training (RT+Meat) on health-related quality of life (HR-QoL) in elderly women. In this 4-month cluster randomised controlled trial, 100 women aged 60-90 years (mean 73 years) from self-care retirement villages participated in RT twice a week and were allocated either 160 g/d (cooked) lean red meat consumed across 2 meals/d, 6 d/week or ≥1 serving/d (25-30 g) carbohydrates (control group, CRT). HR-QoL (SF-36 Health Survey questionnaire), lower limb maximum muscle strength and lean tissue mass (LTM) (dual-energy X-ray absorptiometry) were assessed at baseline and 4 months. In all, ninety-one women (91 %) completed the study (RT+Meat (n 48); CRT (n 43)). Mean protein intake was greater in RT+Meat than CRT throughout the study (1·3 (sd 0·3) v. 1·1 (sd 0·3) g/kg per d, P<0·05). Exercise compliance (74 %) was not different between groups. After 4 months there was a significant net benefit in the RT+Meat compared with CRT group for overall HR-QoL and the physical component summary (PCS) score (P<0·01), but there were no changes in either group in the mental component summary (MCS) score. Changes in lower limb muscle strength, but not LTM, were positively associated with changes in overall HR-QoL (muscle strength, β: 2·2 (95 % CI 0·1, 4·3), P<0·05). In conclusion, a combination of RT and increased dietary protein led to greater net benefits in overall HR-QoL in elderly women compared with RT alone, which was because of greater improvements in PCS rather than MCS.
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Dietary fat restriction increases fat taste sensitivity in people with obesity.
Newman, LP, Bolhuis, DP, Torres, SJ, Keast, RS
Obesity (Silver Spring, Md.). 2016;(2):328-34
Abstract
OBJECTIVE Individuals with obesity may be less sensitive to the taste of fat, and it is hypothesized that this is due to excess dietary fat intake. This study assessed the effect of a 6-week low-fat (LF) or portion control (PC) diet matched for weight loss on fat taste thresholds, fat perception, and preference in people with overweight/obesity. METHODS Participants (n = 53) completed a randomized dietary intervention and consumed either a LF diet (25% fat) or PC diet (33% fat) for 6 weeks. Fat taste thresholds (lowest detectable fat concentration), fat perception (discrimination ability), preference, and anthropometry were assessed at baseline and week 6. RESULTS Consumption of a LF diet (n = 26) and PC diet (n = 27) reduced participants' weight (P < 0.001), with no significant differences between groups (LF, -2.9%, PC, -2.7%). Both diets resulted in a decrease in fat taste thresholds (P = 0.014), and the effect tended to be stronger in the LF diet vs. the PC diet (P = 0.060). The ability to perceive different fat concentrations in foods was increased after the LF diet only (P = 0.017); however, food preference did not change on either diet. CONCLUSIONS A PC and LF diet both increase fat taste sensitivity in people with overweight/obesity, with the strongest effect after the LF diet.
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The influence of a high-fat meal on fat taste thresholds.
Newman, LP, Torres, SJ, Bolhuis, DP, Keast, RS
Appetite. 2016;:199-204
Abstract
A high-fat diet for four weeks has been shown to attenuate fat taste sensitivity in healthy weight individuals. However, there is minimal evidence as to whether a single high-fat meal immediately prior to fat taste threshold testing has an effect on thresholds. Therefore, the aim of the study was to determine the effect of a high-fat meal immediately prior to detection threshold testing for oleic acid (C18:1). Thirty-two participants (15 males, 17 females, aged 39.1 ± 3.1 years, Body Mass Index 23.1 ± 0.7 kg/m(2)) attended three laboratory sessions. In each session, participants were randomly assigned to one of three different types of breakfast: a high-fat (60% energy from fat), or low-fat (20% energy from fat) or macronutrient balanced (33% energy from fat) frittata. Fat taste thresholds were evaluated using ascending forced choice triangle tests on two occasions each day; once one-hour post breakfast and then one-hour post the completion of the first threshold test. There was no effect of breakfast type on fat taste detection thresholds for the first testing session of each day (P = 0.288), or the second testing session of each day (P = 0.754). There was also no effect of breakfast within each day (day 1: P = 0.198, day 2: P = 0.199, day 3: P = 0.125). There was no effect of macronutrient composition on the ability of participants to rank the level of fat in food (P = 0.345), or preference for the level of fat in food (P = 0.187-0.868). This study provides preliminary evidence that the composition of the meal consumed by a participant immediately prior to testing does not affect fat taste thresholds.
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Dietary patterns are associated with cognition among older people with mild cognitive impairment.
Torres, SJ, Lautenschlager, NT, Wattanapenpaiboon, N, Greenop, KR, Beer, C, Flicker, L, Alfonso, H, Nowson, CA
Nutrients. 2012;(11):1542-51
Abstract
There has been increasing interest in the influence of diet on cognition in the elderly. This study examined the cross-sectional association between dietary patterns and cognition in a sample of 249 people aged 65-90 years with mild cognitive impairment (MCI). Two dietary patterns; whole and processed food; were identified using factor analysis from a 107-item; self-completed Food Frequency Questionnaire. Logistic regression analyses showed that participants in the highest tertile of the processed food pattern score were more likely to have poorer cognitive functioning; in the lowest tertile of executive function (OR 2.55; 95% CI: 1.08-6.03); as assessed by the Cambridge Cognitive Examination. In a group of older people with MCI; a diet high in processed foods was associated with some level of cognitive impairment.
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A moderate-sodium DASH-type diet improves mood in postmenopausal women.
Torres, SJ, Nowson, CA
Nutrition (Burbank, Los Angeles County, Calif.). 2012;(9):896-900
Abstract
OBJECTIVE We compared the effect on mood of a moderate sodium Dietary Approaches to Stop Hypertension-type diet, which included lean red meat (vitality diet [VD]), with a healthy diet (HD; decreased fat and increased wholegrain breads and cereal). METHODS In a randomized, parallel intervention study, postmenopausal women were assigned to the VD or HD for 14 wk. Mood was measured every 2 wk by the Profile of Mood States. Dietary adherence was assessed using 24-h urine collections. Data were analyzed using one-way between-groups multivariate analysis of variance and correlations. RESULTS Forty-six subjects completed the VD and 49 completed the HD. The two groups showed an improvement in anger, confusion, depression, fatigue, tension, vigor, and the Profile of Mood States global score over the length of the intervention (P < 0.01 for time), but there was a significant diet group by time effect for anger (P < 0.05), such that anger improved more in the VD compared with the HD group. For the two groups combined, urinary sodium excretion was associated with the Profile of Mood States global score, such that a low sodium intake was associated with a better mood (r = 0.267, P < 0.05). In addition, red meat consumption (a component of the VD) was associated with a decrease in depression (r = -0.21, P < 0.05) and an increase in fruit consumption was associated with a decrease in confusion (r = -0.26, P < 0.05). CONCLUSION In addition to the health benefits of a moderate-sodium Dietary Approaches to Stop Hypertension diet on blood pressure and bone health, this diet had a positive effect on improving mood in postmenopausal women.
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Dietary electrolytes are related to mood.
Torres, SJ, Nowson, CA, Worsley, A
The British journal of nutrition. 2008;(5):1038-45
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Abstract
Dietary therapies are routinely recommended to reduce disease risk; however, there is concern they may adversely affect mood. We compared the effect on mood of a low-sodium, high-potassium diet (LNAHK) and a high-calcium diet (HC) with a moderate-sodium, high-potassium, high-calcium Dietary Approaches to Stop Hypertension (DASH)-type diet (OD). We also assessed the relationship between dietary electrolytes and cortisol, a stress hormone and marker of hypothalamic-pituitary-adrenal (HPA) axis activity. In a crossover design, subjects were randomized to two diets for 4 weeks, the OD and either LNAHK or HC, each preceded by a 2-week control diet (CD). Dietary compliance was assessed by 24 h urine collections. Mood was measured weekly by the Profile of Mood States (POMS). Saliva samples were collected to measure cortisol. The change in mood between the preceding CD and the test diet (LNAHK or HC) was compared with the change between the CD and OD. Of the thirty-eight women and fifty-six men (mean age 56.3 (sem 9.8) years) that completed the OD, forty-three completed the LNAHK and forty-eight the HC. There was a greater improvement in depression, tension, vigour and the POMS global score for the LNAHK diet compared to OD (P < 0.05). Higher cortisol levels were weakly associated with greater vigour, lower fatigue, and higher levels of urinary potassium and magnesium (r 0.1-0.2, P < 0.05 for all). In conclusion, a LNAHK diet appeared to have a positive effect on overall mood.
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Effect of a weight-loss program on mental stress-induced cardiovascular responses and recovery.
Torres, SJ, Nowson, CA
Nutrition (Burbank, Los Angeles County, Calif.). 2007;(7-8):521-8
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OBJECTIVE We assessed the effect of weight loss on blood pressure (BP) and pulse rate during rest, psychological stress, and recovery after stress. METHODS Two groups of men completed two mental stress tests 12 wk apart. The control group continued their usual diet, whereas the weight-loss group underwent a dietary weight-loss program in which they were randomized to a high-fruit/vegetable and low-fat dairy diet or a low-fat diet. RESULTS Fifty-five men with a baseline BP of 125.9 +/- 6.9/83.6 +/- 7.1 mmHg (mean +/- SD) completed the study (weight-loss group, n = 28; control group, n = 27). The weight-loss group lost weight (mean +/- SEM, -4.3 +/- 0.3 versus +0.4 +/- 0.4 kg, P = 0.001) compared with controls and had a significant decrease in resting systolic BP (SBP; -2.0 +/- 1.1% versus +2.0 +/- 1.1%, P < 0.05). There was a greater decrease in SBP (P < 0.05) and pulse rate (P < 0.05) at all time points during the stress test in the weight loss compared with the control group. At week 12, SBP in 23 (82%) subjects in the weight-loss group and 24 (89%) in the control group returned to resting levels, with recovering levels in the weight-loss group returning to resting levels 6.1 +/- 2.6 min earlier than in the control group (P < 0.05). There was an overall greater decrease in diastolic BP (DBP; P < 0.05) and DBP during recovery up to 27 min after stress (P < 0.05) in the high-fruit/vegetable and low-fat dairy diet group (n = 14) compared with the low-fat diet group (n = 14). CONCLUSION A 5% loss of weight decreased BP during rest and returned SBP to resting levels faster, thus decreasing the period of increased BP as a result of mental stress, which is likely to lower the risk of cardiovascular disease in the long term.