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BMC Geriatrics

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Open Access 01-12-2024 | Nutrition | Research

The impact of diet quality on cognitive ability of Chinese older adults: evidence from the China Health and Nutrition Survey (CHNS)

Authors: Ziwei Xu, Shuaizhen Chen, Min Guo, Tianlei Zhang, Xiaoxuan Niu, Yuxin Zhou, Jialong Tan, Jian Wang

Published in: BMC Geriatrics | Issue 1/2024

Abstract

Background

Numerous studies have demonstrated a positive correlation between diet quality and cognitive performance, indicating that improving diet quality may be beneficial in preventing cognitive decline in older adults. However, few study has investigated the causal relationship between diet quality and cognitive performance. The purpose of this study is to evaluate the causal effects of diet quality on cognitive performance in Chinese adults aged 55 years and older. Particularly, we utilize the Chinese Diet Quality Index (CHEI), a dietary assessment tool tailored for Chinese populations, as a proxy for older adults’ diet quality.

Methods

Data were obtained from the China Health and Nutrition Survey (CHNS) (\(N = 2337\), \(\ge\)55 years old) conducted in 2004 and 2006. Cognitive function was tested by a subset of items from the Telephone Interview for Cognitive Status-Modified (TICS-m). Data on dietary intake was retrieved from three consecutive 24 hour recalls by participants and its quality was assessed by the 17-items Chinese Healthy Eating Index (CHEI). An Instrumental Variable technique was used to deal with the potential endogeneity of dietary quality. The instrumental variable used in our study is the community mean of CHEI.

Results

After adjusting for socio-demographic factors (age, gender, education, per capita household income), lifestyle habits (smoking, alcohol consumption, physical activity, BMI), and chronic diseases (hypertension, diabetes), our findings revealed that improving diet quality had a significant positive effect on cognitive performance (\(P = 0.020\)), particularly in females aged 55-65 years (\(P = 0.003\)) and females with primary education and below (\(P < 0.001\)).

Conclusion

Our study suggests that improving diet quality and adhering to the Dietary Guidelines for Chinese may enhance cognitive performance in Chinese adults aged 55 years and older.

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World Health Organization. Dementia. 2023. https://www.who.int/news-room/fact-sheets/detail/dementia. Accessed 24 Sept 2023.

Bai W, Chen P, Cai H, Zhang Q, Su Z, Cheung T, et al. Worldwide prevalence of mild cognitive impairment among community dwellers aged 50 years and older: a meta-analysis and systematic review of epidemiology studies. Age Ageing. 2022;51(8):173.

Chen X, Giles J, Yao Y, Yip W, Meng Q, Berkman L, et al. The path to healthy ageing in China: a Peking University-Lancet Commission. Lancet. 2022;400(10367):1967–2006.CrossRefPubMedPubMedCentral

Xinhua. Approximately five adults support one elderly person in China: report. 2021. http://english.www.gov.cn/statecouncil/ministries/202110/19/content_WS616e8aa8c6d0df57f98e37a6.html. Accessed 24 Sept 2023. Updated October 19, 2021.

Nie H, Xu Y, Liu B, Zhang Y, Lei T, Hui X, et al. The prevalence of mild cognitive impairment about elderly population in China: a meta-analysis. Int J Geriatr Psychiatr. 2011;26(6):558–63.CrossRef

Jia L, Du Y, Chu L, Zhang Z, Li F, Lyu D, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health. 2020;5(12):661-71.

Steele M, Stuchbury G, G Münch. The molecular basis of the prevention of Alzheimer’s disease through healthy nutrition. Exp Gerontol. 2007;42(1-2):28–36. https://doi.org/10.1016/j.exger.2006.06.002.

Kuo HK, Yen CJ, Chang CH, Kuo CK, Chen JH, Sorond F. Relation of C-reactive protein to stroke, cognitive disorders, and depression in the general population: systematic review and meta-analysis. Lancet Neurol. 2005;4(6):371–380. Publisher: Elsevier. https://doi.org/10.1016/S1474-4422(05)70099-5.

Gorelick PB, Scuteri A, Black SE, DeCarli C, Greenberg SM, Iadecola C, et al. Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2011;42(9):2672–713. https://doi.org/10.1161/STR.0b013e3182299496.CrossRefPubMedPubMedCentral

10.

Serra MC, Dondero KR, Larkins D, Burns A, Addison O. Healthy Lifestyle and Cognition: Interaction between Diet and Physical Activity. Curr Nutr Rep. 2020;9(2):64–74. https://doi.org/10.1007/s13668-020-00306-4.CrossRefPubMed

11.

Mao S, Xie L, Lu N. Activity engagement and cognitive function among chinese older adults: moderating roles of gender and age. BMC Geriatr. 2023;23(1):223. https://doi.org/10.1186/s12877-023-03912-3.CrossRefPubMedPubMedCentral

12.

Siu My, Lee DTF. Effects of tai chi on cognition and instrumental activities of daily living in community dwelling older people with mild cognitive impairment. BMC Geriatr. 2018;18(1):37. https://doi.org/10.1186/s12877-018-0720-8.

13.

Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM. Insomnia and daytime cognitive performance: a meta-analysis. Sleep Med Rev. 2012;16(1):83–94. https://doi.org/10.1016/j.smrv.2011.03.008.CrossRefPubMed

14.

Panza F, Solfrizzi V, Barulli MR, Bonfiglio C, Guerra V, Osella A, et al. Coffee, tea, and caffeine consumption and prevention of late-life cognitive decline and dementia: a systematic review. J Nutr Health Aging. 2015;19(3):313–28. https://doi.org/10.1007/s12603-014-0563-8.CrossRefPubMed

15.

Milte CM, McNaughton SA. Dietary patterns and successful ageing: a systematic review. Eur J Nutr. 2016;55(2):423–50. https://doi.org/10.1007/s00394-015-1123-7.CrossRefPubMed

16.

Vauzour D, Camprubi-Robles M, Miquel-Kergoat S, Andres-Lacueva C, Bánáti D, Barberger-Gateau P, et al. Nutrition for the ageing brain: towards evidence for an optimal diet. Ageing Res Rev. 2017;35:222–240. https://doi.org/10.1016/j.arr.2016.09.010.

17.

Bo, Qin, Plassman, Brenda, L , Edwards, et al. Fish Intake Is Associated with Slower Cognitive Decline in Chinese Older Adults. J Nutr. 2014. https://doi.org/10.3945/jn.114.193854.

18.

Li M, Shi Z. A Prospective Association of Nut Consumption with Cognitive Function in Chinese Adults Aged 55+ _ China Health and Nutrition Survey. J Nutr Health Aging. 2019;23(2):211–6. https://doi.org/10.1007/s12603-018-1122-5.CrossRefPubMed

19.

Zhang Y, Li Y, Zheng X, Zhu L, Xu B. Association between alcohol consumption in midlife and cognitive function in old age: Findings from the China health and Nutrition Survey. Nutr Metab Cardiovasc Dis. 2021;31(11):3044–3053. Publisher: Elsevier. https://doi.org/10.1016/j.numecd.2021.07.023.

20.

Kakutani S, Watanabe H, Murayama N. Green Tea Intake and Risks for Dementia, Alzheimer’s Disease, Mild Cognitive Impairment, and Cognitive Impairment: A Systematic Review. Nutrients. 2019;11(5):1165. Number: 5 Publisher: Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/nu11051165.

21.

Wu L, Sun D, He Y. Coffee intake and the incident risk of cognitive disorders: A dose-response meta-analysis of nine prospective cohort studies. Clin Nutr. 2016:730–736. https://doi.org/10.1016/j.clnu.2016.05.015.

22.

Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13(1):3. https://journals.lww.com/co-lipidology/Abstract/2002/02000/Dietary_pattern_analysis__a_new_direction_in.2.aspx. Accessed 20 May 2023.

23.

Chen X, Maguire B, Brodaty H, O’Leary F. Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. J Alzheimers Dis. 2019;67(2):583–619. Publisher: IOS Press. https://doi.org/10.3233/JAD-180468.

24.

Shi Z, El-Obeid T, Li M, Xu X, Liu J. Iron-related dietary pattern increases the risk of poor cognition. Nutr J. 2019;18(1):48. https://doi.org/10.1186/s12937-019-0476-9.CrossRefPubMedPubMedCentral

25.

Kanoski SE, Davidson TL. Western diet consumption and cognitive impairment: links to hippocampal dysfunction and obesity. Physiol Behav. 2011;103(1):59–68. https://doi.org/10.1016/j.physbeh.2010.12.003.CrossRefPubMed

26.

Cespedes EM, Hu FB. Dietary patterns: from nutritional epidemiologic analysis to national guidelines2. Am J Clin Nutr. 2015;101(5):899–900. https://doi.org/10.3945/ajcn.115.110213.CrossRefPubMedPubMedCentral

27.

Gil A. Indicadores de evaluación de la calidad de la dieta. Nutr Hosp. 2015;3:128–44. https://doi.org/10.3305/nh.2015.31.sup3.8761.

28.

Schwingshackl L, Hoffmann G. Diet Quality as Assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension Score, and Health Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. J Acad Nutr Diet. 2015;115(5):780-800.e5. https://doi.org/10.1016/j.jand.2014.12.009.CrossRefPubMed

29.

Fan Y, Zhang Y, Li J, Liu Y, Chang H, Jiang Y, et al. Association between healthy eating index-2015 and various cognitive domains in US adults aged 60 years or older: the National Health and Nutrition Examination Survey (NHANES) 2011–2014. BMC Public Health. 2021;21(1):1862. https://doi.org/10.1186/s12889-021-11914-2.CrossRefPubMedPubMedCentral

30.

Lu Z, Chen C, Zhang J, Wang X, Zhang D, Li S. The Relationship between Alternative Healthy Diet Index and Cognitive Function in the Older Adults: The Mediating Effect of Depressive Symptoms. Nutrients. 2022;14(14):2856. Number: 14 Publisher: Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/nu14142856.

31.

He Y, Zhai F, Ge K. Approaching Chinese diet balance index. J Hyg Res. 2005;34(2):208–11.

32.

Stookey JD, Wang Y, Ge K, Lin H, Popkin BM. Measuring diet quality in China: the INFH-UNC-CH Diet Quality Index. Eur J Clin Nutr. 2000;54(11):811–821. Number: 11 Publisher: Nature Publishing Group. https://doi.org/10.1038/sj.ejcn.1601098.

33.

Xu X, Hall J, Byles J, Shi Z. Do older Chinese people’s diets meet the Chinese Food Pagoda guidelines? Results from the China Health and Nutrition Survey 2009. Public Health Nutr. 2015;18(16):3020–3030. Publisher: Cambridge University Press. https://doi.org/10.1017/S1368980015000129.

34.

Wang L, Zhang B, Wang H, Du W, Zhang J, Wang Z. Establishment and application of China Elderly Dietary Guideline Index 2018 in the elderly of 15 provinces (autonomous regions and municipalities)in China. J Hyg Res. 2019;48(1):41–8.

35.

Yuan YQ, Li F, Dong RH, Chen JS, He GS, Li SG, et al. The Development of a Chinese Healthy Eating Index and Its Application in the General Population. Nutrients. 2017 Sep;9(9):977. Number: 9 Publisher: Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/nu9090977.

36.

Zhang X, Wang Y, Liu W, Wang T, Wang L, Hao L, et al. Diet quality, gut microbiota, and microRNAs associated with mild cognitive impairment in middle-aged and elderly Chinese population. Am J Clin Nutr. 2021;114(2):429–40. https://doi.org/10.1093/ajcn/nqab078.CrossRefPubMed

37.

Yuan YQ, Li F, Wu H, Wang YC, Chen JS, He GS, et al. Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index. Nutrients. 2018;10(2):114. Number: 2 Publisher: Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/nu10020114.

38.

Liu Mw, McNaughton SA, He Qq, Leech R. Longitudinal trajectories of diet quality and subsequent mortality among Chinese adults: results from the China health and nutrition survey 1997–2015. Int J Behav Nutr Phys Act. 2021;18(1):51. https://doi.org/10.1186/s12966-021-01118-7.

39.

Cui N, Ouyang Y, Li Y, Yang Y, Liu S, Li J, et al. Better adherence to the Chinese Healthy Eating Index is associated with a lower prevalence of metabolic syndrome and its components. Nutr Res. 2022;104:20–8. https://doi.org/10.1016/j.nutres.2022.02.008.CrossRefPubMed

40.

Popkin BM, Du S, Zhai F, Zhang B. Cohort Profile: The China Health and Nutrition Survey-monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol. 2010;39(6):1435–40. https://doi.org/10.1093/ije/dyp322.CrossRefPubMed

41.

Xu X, Hall J, Byles J, Shi Z. Dietary Pattern Is Associated with Obesity in Older People in China: Data from China Health and Nutrition Survey (CHNS). Nutrients. 2015;7(9):8170–88. https://doi.org/10.3390/nu7095386.CrossRefPubMedPubMedCentral

42.

Yang Y, Wang G, Pan X. Chinese food composition table 2002. Beijing: Peking University Medical Press; 2002.

43.

Yang Y. Chinese food composition table 2004. Beijing: Peking University Medical Press; 2005.

44.

Pehrsson PR, Cutrufelli RL, Gebhardt SE, Lemar LE, Holcomb GT, Haytowitz DB, et al. USDA database for the added sugars content of selected foods. U.S. Dept. of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Nutrient Data Laboratory; 2005. https://www.ars.usda.gov/research/publications/publication/?seqNo115=190613.

45.

Yang Y. Chinese Nutrition Society. Dietary guidelines for chinese(2016). Beijing: People’s Medical Publishing Press; 2017.

46.

Plassman BL, Welsh KA, Helms M, Brandt J, Page WF, Breitner JCS. Intelligence and education as predictors of cognitive state in late life: A 50-year follow-up. Neurology. 1995 Aug;45(8):1446–1450. Publisher: Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology Section: ARTICLES. https://doi.org/10.1212/WNL.45.8.1446.

47.

Welsh KA, Breitner JC, Magruder-Habib KM. Detection of dementia in the elderly using telephone screening of cognitive status. Cogn Behav Neurol. 1993;6(2):103–10.

48.

Smith MM, Tremont G, Ott BR. A review of telephone-administered screening tests for dementia diagnosis. Am J Alzheimers Dis Other Dement®. 2009;24(1):58–69.

49.

Wolfson C, Kirkland SA, Raina PS, Uniat J, Roberts K, Bergman H, et al. Telephone-administered cognitive tests as tools for the identification of eligible study participants for population-based research in aging. Can J Aging/La Rev Can Vieillissement. 2009;28(3):251–9.CrossRef

50.

Wooldridge J. Introductory Econometrics: A Modern Approach. 7th ed. United States of America: South-Western College Publishing; 2019.

51.

Angrist JD. Mostly harmless econometrics. United States of America: Princeton University Press; 2008.CrossRef

52.

Greene WH. Econometric Analysis: International Edition (5th ed.). the United Kingdom: Pearson; 2003.

53.

Prakash RS, Voss MW, Erickson KI, Kramer AF. Physical Activity and Cognitive Vitality. Annu Rev Psychol. 2015;66(1):769–97. https://doi.org/10.1146/annurev-psych-010814-015249.CrossRefPubMed

54.

Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9):S498. https://journals.lww.com/acsm-msse/Fulltext/2000/09001/Compendium_of_Physical_Activities__an_update_of.9.aspx. Accessed 20 May 2023.

55.

Lehtisalo J, Levälahti E, Lindström J, Hänninen T, Paajanen T, Peltonen M, et al. Dietary changes and cognition over 2 years within a multidomain intervention trial—the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Alzheimers Dement. 2019;15(3):410–417. https://doi.org/10.1016/j.jalz.2018.10.001_eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1016/j.jalz.2018.10.001.

56.

Haring B, Wu C, Mossavar-Rahmani Y, Snetselaar L, Brunner R, Wallace RB, et al. No Association between Dietary Patterns and Risk for Cognitive Decline in Older Women with 9-Year Follow-Up: Data from the Women’s Health Initiative Memory Study. J Acad Nutr Diet. 2016;116(6):921-930.e1. https://doi.org/10.1016/j.jand.2015.12.017.CrossRefPubMedPubMedCentral

57.

Chen X, Liu Z, Sachdev PS, Kochan NA, Brodaty H, O’Leary F. Association of adherence to the Australian Dietary Guidelines with cognitive performance and cognitive decline in the Sydney Memory and Ageing Study: a longitudinal analysis. J Nutr Sci. 2021;10:e86. Publisher: Cambridge University Press. https://doi.org/10.1017/jns.2021.44.

58.

Otaegui-Arrazola A, Amiano P, Elbusto A, Urdaneta E, Martínez-Lage P. Diet, cognition, and Alzheimer’s disease: food for thought. Eur J Nutr. 2014;53(1):1–23. https://doi.org/10.1007/s00394-013-0561-3.

59.

McGrattan AM, McGuinness B, McKinley MC, Kee F, Passmore P, Woodside JV, et al. Diet and Inflammation in Cognitive Ageing and Alzheimer’s Disease. Curr Nutr Rep. 2019;8(2):53–65. https://doi.org/10.1007/s13668-019-0271-4.CrossRefPubMedPubMedCentral

60.

Luchsinger JA, Mayeux R. Dietary factors and Alzheimer’s disease. Lancet Neurol. 2004;3(10):579–587. Publisher: Elsevier. https://doi.org/10.1016/S1474-4422(04)00878-6.

61.

Proctor C, Thiennimitr P, Chattipakorn N, Chattipakorn SC. Diet, gut microbiota and cognition. Metab Brain Dis. 2017;32(1):1–17. https://doi.org/10.1007/s11011-016-9917-8.CrossRefPubMed

62.

Diet Ettinger S, Microbiome Gut, Decline Cognitive. Curr Nutr Rep. 2022;11(4):643–52. https://doi.org/10.1007/s13668-022-00435-y.CrossRef

63.

Akbaraly TN, Singh-Manoux A, Marmot MG, Brunner EJ. Education Attenuates the Association between Dietary Patterns and Cognition. Dement Geriatr Cogn Disord. 2009;27(2):147–154. Publisher: Karger Publishers. https://doi.org/10.1159/000199235.

64.

Lei X, Hu Y, McArdle JJ, Smith JP, Zhao Y. Gender Differences in Cognition among Older Adults in China. J Hum Resour. 2012;47(4):951–971. Publisher: University of Wisconsin Press Section: Articles. https://doi.org/10.3368/jhr.47.4.951.

65.

Yuan C, Cao Y, Ascherio A, Okereke OI, Zong G, Grodstein F, et al. Long-term diet quality and its change in relation to late-life subjective cognitive decline. Am J Clin Nutr. 2022;115(1):232–43. https://doi.org/10.1093/ajcn/nqab326.CrossRefPubMed

66.

Berendsen AAM, Kang JH, Van De Rest O, Feskens EJM, De Groot LCPGM, Grodstein F. The Dietary Approaches to Stop Hypertension Diet, Cognitive Function, and Cognitive Decline in American Older Women. J Am Med Dir Assoc. 2017;18(5):427–432. https://doi.org/10.1016/j.jamda.2016.11.026.

67.

Liu T, Luo H, Tang JY, Wong GH. Does lifestyle matter? Individual lifestyle factors and their additive effects associated with cognitive function in older men and women. Aging Ment Health. 2020;24(3):405–12. https://doi.org/10.1080/13607863.2018.1539833.CrossRefPubMed

Title: The impact of diet quality on cognitive ability of Chinese older adults: evidence from the China Health and Nutrition Survey (CHNS)
Authors: Ziwei Xu
Shuaizhen Chen
Min Guo
Tianlei Zhang
Xiaoxuan Niu
Yuxin Zhou
Jialong Tan
Jian Wang
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Nutrition
Published in: BMC Geriatrics / Issue 1/2024
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-023-04630-6

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