Serum retinol levels are associated with cognitive function among community-dwelling older Mexican adults.

BACKGROUND: Vitamin A (VA) provides neuroprotection against oxidative stress and brain inflammation. VA deficiency (VAD) increases the risk of neurodegeneration in animal models, but results are inconclusive in humans: particularly in the older adult (OA) population which is at higher risk for micronutrient deficiencies and cognitive impairment. OBJECTIVE: To estimate the association between serum retinol levels and cognitive function (CF) in older Mexican adults. METHODS: Cross-sectional study with 803 adults aged ≥60 years with fasting blood sample from the southern region of Mexico, collected in summer of 2015. Low serum retinol (LSR) was defined if serum retinol ≤20 µg/dl. CF was evaluated using Semantic Verbal Fluency Test (SVFT). Mild cognitive impairment (MCI) was defined using normative values for SVFT. Linear and logistic regression models were used to estimate the association of LSR with CF and MCI, respectively. RESULTS: Prevalence of MCI was 9.35% and LSR 3.36%. OA with LSR evoked less words in the SVFT (ß = -2.8, CI95% -4.6, -0.9) and had higher probability of MCI (OR = 2.7, CI95% 0.9, 7.7). Associations remained significant when considered IL-6. CONCLUSION: Frequency of LSR in older Mexican adults was low, but strongly associated with MCI. This result suggests that VA plays a role in maintaining CF in the elderly population. Since VAD is a reversible condition, further studies are needed in order to identify the main causes of LSR and prevent MCI in populations which are at higher risk for malnutrition.Trial registration: ClinicalTrials.gov identifier: NCT04820465.

The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?

BACKGROUND: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. METHODS: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. RESULTS: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. CONCLUSIONS: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.