Breakfast Skipping and Declines in Cognitive Score Among Community-Dwelling Older Adults: A Longitudinal Study of the HEIJO-KYO Cohort.

Previous studies outlined the correlation of adverse effects of breakfast skipping with cognitive function. However, the majority of these studies have focused on the short-term effects; to date, the long-term effect of breakfast skipping on cognitive function among older adults remains unclear. In this prospective cohort study of 712 older adults (mean age, 70.8 years), breakfast skipping was defined as skipping breakfast one or more times per week, and declines in cognitive score was defined as decreases in Mini-Mental State Examination (MMSE) score of two or more in the observed period. During follow-up (median, 31 months), 135 of 712 participants developed declines in cognitive score. Poisson regression models revealed that the incidence rate for declines in cognitive score was significantly higher in breakfast skipper (n = 29) than breakfast eaters (n = 683) [incidence rate ratio (IRR), 2.10; 95% CI, 1.28-3.44]. Additional propensity score adjustments related to breakfast skipping from baseline parameters (age, gender, smoking and drinking status, BMI, household income, educated level, depressive symptoms, hypertension, diabetes, sleep medication, physical activity, caloric intake, and baseline cognition) produced consistent results (IRR, 2.21; 95% CI, 1.33-3.68). Sensitivity analysis, when the cut-off value of decreases in MMSE score was changed to three points, suggested a significant and stronger association (IRR, 3.03; 95% CI, 1.72-5.35). Regarding daily intakes of food groups, breakfast skippers consumed a significantly lower amount of vegetables, fruits, and fish than breakfast eaters. In conclusion, our findings suggest that breakfast skipping is longitudinally associated with declines in cognitive score among older adults.

Association between social network and dietary variety among community-dwelling older adults.

OBJECTIVE: Social networks are critical social health factors for older adults. This study examined the association between social networks and dietary variety among community-dwelling older adults. DESIGN: A cross-sectional study, using the dietary variety score (DVS) developed for older Japanese people to assess dietary variety and the Lubben Social Network Scale (LSNS-6) to assess social networks. SETTING: N City, H Prefecture, Japan. PARTICIPANTS: Community-dwelling older adults aged ≥ 65 years (n 1229). RESULTS: The LSNS-6 score in the low DVS group was lower than that in the middle and high DVS groups (12·2 ± 5·6 v. 13·4 ± 5·4 and 14·4 ± 5·7, P < 0·001). The population of social isolation (LSNS-6, < 12) in the low DVS group was higher than that in the middle and high DVS groups (43·5 % v. 35·8 % and 31·0 %, P = 0·005). Multivariate linear regression analysis showed that the LSNS-6 score was positively correlated with DVS (standardised coefficient, 0·092; P = 0·002). Social isolation was also significantly associated with a low DVS in the multivariate-adjusted logistic analysis model (OR, 1·30; 95 % CI 1·00, 1·68; P = 0·048). Stratified analysis results revealed the LSNS-6 and DVS were significantly associated in participants with the following characteristics: younger age (< 75 years), women and those living with someone. CONCLUSIONS: Social networks were associated with dietary variety; social isolation was related to poor dietary variety among community-dwelling older adults. An association between social networks and dietary variety was observed among young-old older adults, women and those living with someone.

Social contact impacts physical activity and sedentary behavior among older adults in Japan due to COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has adversely affected social contact and physical activity. This study investigated the correlation between physical activity, social contact, and sedentary time among adults aged 65 years and above during the COVID-19 pandemic. METHODS: This study was conducted in N City, H Prefecture, Japan. The authors randomly selected 4,996 adults, aged 65 years and above (mean age 74.1 ± 6.1 years), living in N City, and survey forms were distributed by mail in mid-August 2020. Altogether, 1,925 participants were included in this study. The survey comprised questions concerning the participants' sex, height, weight, age, smoking and drinking habits, living arrangements, social contact assessments, physical activity levels, and sedentary time. Moreover, linear regression analysis was utilized to investigate the associations between the variables. RESULTS: The reported median physical activity was 1272 metabolic equivalent of task-min/week (interquartile range 528-2628), and the reported median sedentary time was 360 min/week (interquartile range 240-600). COVID-19 "somewhat," "quite a lot," or "completely" hindered the frequency of in-person contact with friends among 75.5% of the respondents and hampered the frequency of virtual contact with friends among 38.8% of the respondents. Physical activity was associated significantly with in-person contact indicators: "interaction with friends" (B = -0.111; 95%CI: -0.187, -0.035; p = 0.004) and "social participation" (B = -0.163; 95%CI: -0.248, -0.079; p < 0.001). These associations remained significant for both multivariate analysis Models 1 (sex and age) and 2 (addition of body mass index [BMI], alcohol use, smoking, living alone, and the number of illnesses to Model 1). Additionally, sedentary time was significantly associated with the social contact variable of "interaction with friends" (B = 0.04; 95%CI: 0.016, 0.064; p = 0.001). This association remained significant in both multivariate analysis models. CONCLUSIONS: Significant associations were confirmed between reduced social contact, decreased physical activity, and more sedentary behavior among older adults due to COVID-19. Hence, continuous monitoring and support for social activities among susceptible older adults in extraordinary circumstances are essential.

Lower dietary variety is associated with worse sleep quality in community-dwelling elderly Japanese women.

BACKGROUND AND OBJECTIVES: Sleep disturbance is a common health problem in the elderly population. We examined the association between dietary variety and subjective sleep quality in community-dwelling elderly Japanese women. METHODS AND STUDY DESIGN: This cross-sectional study recruited 160 community-dwelling elderly women aged ≥65 years. Subjective sleep quality and dietary variety were assessed by Pittsburgh Sleep Quality Index (PSQI) and dietary variety score (DVS), respectively. DVS was calculated from the eating frequency of 10 food groups. Sleep disturbance was defined as PSQI score of ≥6. RESULTS: The DVS in subjects with sleep disturbance was significantly lower than that of those without the disturbance (4.1±2.1 vs 5.3±2.1, p<0.01). In the multivariable regression model, the PSQI score was negatively correlated with the DVS score in age-adjusted model (standardized coefficient; -0.234, p<0.01). In the further adjusted model that included depression levels, the negative association between PSQI score and DVS score was retained (standardized coefficient; -0.211, p<0.05). Among 10 food groups comprising DVS, the eating frequency of soybean and soybean products was the determinant of sleep disturbance in the stepwise liner regression analysis. In the further model that contained DVS, DVS was the independent determinant of sleep disturbance, while the eating frequency of soybean and soybean products was excluded. CONCLUSIONS: A worse sleep quality was associated with lower DVS in elderly Japanese women. Diet comprising various food groups was better for sleep quality than consuming only a particular food in the elderly.

Development and validation of nutrient estimates based on a food-photographic record in Japan.

BACKGROUND: Previous studies have reported that estimates of portion size, energy, and macronutrients such as carbohydrates, proteins, and fat based on the food-photographic record closely correlate with directly weighed values. However, the correlation based on a large sample of the test meal with the evidence of many nutrients is yet to be determined. We conducted this study to assess the correlation and difference between the food-photographic record and weighed results for 44 nutrients based on a larger number of test meals than those in previous studies. METHODS: We assessed the nutrients of test meals using a food-photographic record and direct weighing and compared the results of the two methods. Twenty participants prepared a total of 1163 test meals. Each participant cooked 28-29 different kinds of dishes. Five participants cooked the same dish with their own recipes. For the most commonly consumed 41 dishes, 20 participants served a meal with their usual portion size. For the remaining 73 dishes, five participants served a meal with their usual portion size. An independent researcher weighed each ingredient and calculated the nutrients of the test meals. The participants took photographs of the test meals using a digital camera. Two independent, trained analysts measured the longitudinal and transverse diameters of the food area on the photographs of the test meals, compared the portion size with the reference photographs, and calculated the nutrients based on a database that contained reference photographs. RESULTS: Rank correlation coefficients between estimates from the food-photographic record of each test meal and weighed results were high for portion size (r = 0.93), energy (r = 0.93), protein (r = 0.90), fat (r = 0.92), and carbohydrate (r = 0.94), and those for the 44 nutrients ranged from 0.78 to 0.94. We found high reproducibility between the two analysts for all the nutrients (r > 0.90). CONCLUSIONS: We found a high correlation and small difference between the food-photographic record method and weighed results of a large number of nutrients in many test meals.

Low Dietary Variety Is Associated with Incident Frailty in Older Adults during the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study in Japan.

BACKGROUND: Stagnation of social activity due to the COVID-19 pandemic probably reduces motivation to maintain a healthy diet. It is important to report on the dietary changes observed in older adults during a period of restriction on outings and to clarify the relationship between dietary variety and frailty. This one-year follow-up study examined the association between frailty and dietary variety during the COVID-19 pandemic. METHODS: Baseline and follow-up surveys were conducted in August 2020 and August 2021, respectively. The follow-up survey was distributed by mail to 1635 community-dwelling older adults aged ≥65 years. Of the 1235 respondents, 1008 respondents who were non-frail at baseline are included in this study. Dietary variety was examined using a dietary variety score developed for older adults. Frailty was assessed using a five-item frailty screening tool. The outcome was frailty incidence. RESULTS: In our sample, 108 subjects developed frailty. A linear regression analysis revealed a significant association between dietary variety score and frailty score (ß, -0.032; 95% CI, -0.064 to -0.001; p = 0.046). This association was also significant in Model 1, adjusted for sex and age, (ß, -0.051; 95% CI, -0.083 to -0.019; p = 0.002) and in a multivariate analysis that added adjustments for living alone, smoking, alcohol use, BMI, and existing conditions to Model 1 (ß, -0.045; 95% CI, -0.078 to -0.012; p = 0.015). CONCLUSIONS: A low dietary variety score was associated with an increased frailty score during the COVID-19 pandemic. The restricted daily routine caused by the COVID-19 pandemic will probably continue to have a long-term effect in terms of reduced dietary variety. Thus, vulnerable populations, such as older adults, might require dietary support.

Association between asymmetric dimethylarginine and sarcopenia in community-dwelling older women.

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelium nitric oxide synthesis and causes endothelial dysfunction that may be related to sarcopenia. However, the association between ADMA and sarcopenia has not been studied. We evaluated the correlations between plasma ADMA levels and sarcopenia in community-dwelling older women. In total, 144 community-dwelling older women participated in this study. Plasma ADMA levels were measured using a competitive enzyme-linked immunosorbent assay. Skeletal muscle mass, measured in terms of bioimpedance and grip strength, was used to assess sarcopenia. Plasma ADMA levels were significantly higher in participants with sarcopenia than in those without sarcopenia. Through receiver-operating characteristic curve analysis, the cutoff value of plasma ADMA level for sarcopenia was estimated at 0.57 µM. Sarcopenia was significantly more prevalent in participants with higher plasma ADMA levels than in those with lower plasma ADMA levels. According to logistic regression analysis, the crude odds ratio of higher plasma ADMA levels in participants with sarcopenia was 4.57 (95% confidence interval, 1.82-11.47; p = 0.001). Reductions in the skeletal muscle mass index over 2 years were significantly greater in participants with higher plasma ADMA levels. In conclusion, plasma ADMA levels were significantly associated with sarcopenia in community-dwelling older women.

Relationship Between Dietary Variety and Frailty in Older Japanese Women During the Period of Restriction on Outings Due to COVID-19.

OBJECTIVES: To investigate the relationship between diet and frailty in community-dwelling older adults during the period of restriction on outings due to novel coronavirus disease 2019 (COVID-19). METHOD: A mail survey targeting adults aged 65 years or older, including questions on sex, age, height, weight, and social participation, was conducted in May 2020. The participants' dietary variety score and frailty score were then calculated. RESULTS: Overall, 322 women aged 65 years or older and who were living in the community were recruited for the study; 253 were finally analyzed. The mean age of the 253 participants was 80.0 ± 6.4 years. The dietary variety score and frailty scores were significantly correlated in the linear regression analysis (ß: -0.224, p < .001). In the multivariate regression analysis, these factors remained significantly correlated in Model 1, which was adjusted for age (ß: -0.229, p < .001), and Model 2, which was adjusted for age, body mass index, and other confounding factors (ß: -0.208, p = .001). DISCUSSION: Diet was correlated with frailty in older adults living in the community during the period of restriction on outings due to COVID-19.

Relationship Between Social Activity and Frailty in Japanese Older Women During Restriction on Outings due to COVID-19.

BACKGROUND: This study investigated the relationship between social activities and frailty during the restriction on outings due to COVID-19. DESIGN: A cross-sectional study. SETTING AND SUBJECTS: This study was conducted in City Nishinomiya of Prefecture Hyogo, in Japan. A mail survey was carried out among women aged 65 years or older in May 2020. A population of 293 women aged 65 years or older living in the community was recruited for the study and 213 of them were analyzed. MEASUREMENTS: The survey included questions on sex, age, height, weight, and social activity. Social activity consisted of participation in social organizations and their frequency, as well as frequency of interaction with family and friends. The survey also asked if regular social activity had been impeded by COVID-19. RESULTS: A significant association was found between frailty and hindered interaction with friends (ß: 0.176, p = .014). Multivariate linear regression analysis confirmed that this association was also significant in Model 1 (ß: 0.158, p = .025), and Model 2 (ß: 0.148, p = .034). CONCLUSIONS: No association between being hindered in social activity and frailty was found in older women living in the community during the restriction on outings due to COVID-19.

Distribution and major sources of flavonoid intakes in the middle-aged Japanese women.

We estimated the intake of individual flavonoids in a cross sectional study and clarified the major sources contributing to the flavonoid levels in the middle-aged Japanese women by a 24-h weighed dietary record study. The subjects included in the study were 516 free-living women. Each subject completed a 24-h weighed dietary record and received a health check-up. We used the Functional Food Factor database for estimating the intake of 5 major flavonoid intakes, i.e. flavan-3-ols, isoflavones, flavonols, flavanones and flavones. The mean intake of flavan-3-ols, isoflavones, flavonols, flavanones and flavones was 1277, 216, 58, 31 and 15 micromol/d, respectively. The richest source of flavan-3-ols was green tea. The 3 major food sources of isoflavone were the processed soy foods and those of flavonol were the onion, moroheiya (nalta jute) and Japanese radish leaves. Grapefruit and citrus fruit juices were the major sources of flavanones, and tsurumurasaki (malabar spinach), green pepper and grapefruit were the main sources of flavone. Furthermore, analysis of sub-samples from middle-aged Japanese women indicated that there may be an association between flavonoid intake and the levels of oxidized LDL, which might be related to the incidence of cardiovascular diseases.

Urinary sodium-to-potassium ratio and serum asymmetric dimethylarginine levels in patients with type 2 diabetes.

Obesity modifies the association between sodium and potassium intake and blood pressure. However, the impact of obesity on the relationship between the sodium-potassium balance and cardiovascular risk in type 2 diabetes (T2DM) patients remains unclear. We investigated the relationship between the 24-h urinary sodium-to-potassium ratio and serum asymmetric dimethylarginine (ADMA) level, which is a cardiovascular risk factor, in Japanese T2D patients with or without obesity. This cross-sectional study included 243 patients with T2DM who were hospitalized for diabetes education. Urinary sodium-to-potassium ratios were calculated from 24-h urine collection. The subjects were divided into two groups according to their BMIs (<25 and ≥25). The serum ADMA levels positively correlated with the urinary sodium-to-potassium ratios in non-obese patients, but not in obese patients. Multivariate linear regression analyses showed that the serum ADMA levels positively correlated with the urinary sodium-to-potassium ratios after adjustment for other confounders in non-obese patients. This correlation was observed in non-obese patients with hypertension, but not in those without hypertension. Measurement of the pulse wave velocity and intima-media thickness revealed that elevation of the serum ADMA levels was significantly associated with an increase in the degree of atherosclerotic progression in subjects with T2DM. Additionally, an assessment of dietary intake showed that the consumption of dairy products as well as of green and yellow vegetables was negatively associated with urinary sodium-to-potassium ratios in patients with T2DM. In conclusion, elevation of serum ADMA may be positively associated with the urinary sodium-to-potassium ratio in Japanese non-obese patients with T2DM.

Melatonin Secretion and Muscle Strength in Elderly Individuals: A Cross-Sectional Study of the HEIJO-KYO Cohort.

BACKGROUND: Decreased muscle strength is associated with functional limitation and disability and is a predictor of cardiovascular and all-cause mortality. Recently, oxidative stress and inflammation have been shown to contribute to the loss of muscle strength, and although melatonin has antioxidative and anti-inflammatory properties, the association between melatonin secretion and muscle strength remains unclear. METHODS: In this cross-sectional study of 760 community-based elderly individuals (mean age, 71.0 years), we measured overnight urinary 6-sulfatoxymelatonin excretion (UME) and grip strength and quadriceps strength. RESULTS: Median UME was 7.0 µg (interquartile range, 4.2-11.1), and mean grip and quadriceps strength were 27.5±8.4kg and 162.6±80.1 Nm, respectively. On dividing participants into quartiles by their UME level (lowest-highest UME, Q1-Q4), higher quartiles were significantly associated with increased grip strength and quadriceps strength (p for trend < .001, both). Multivariable analyses adjusted for potential confounders (age, gender, body mass index, smoking and drinking statuses, renal function, hypertension, diabetes, physical activity, depressed mood, cognitive impairment, bedtime, sleep duration, and day length) revealed that both grip and quadriceps strength were significantly increased in Q4 compared with that in Q1 (adjusted mean difference, Q4 - Q1: grip strength, 1.5kg; 95% confidence interval [CI], 0.4-2.6kg; p = .006; quadriceps strength, 14.2 Nm; 95% CI, 1.3-27.1 Nm; p = .031). CONCLUSIONS: Melatonin secretion was significantly associated with muscle strength in this elderly population. Further longitudinal studies are needed to ascertain the effect of melatonin levels on muscle strength.

Association of Serum Asymmetric Dimethylarginine With Muscle Strength and Gait Speed: A Cross-Sectional Study of the HEIJO-KYO Cohort.

Muscle strength and gait speed are related with functional limitations and disabilities and also predict cardiovascular and all-cause mortality. Nitric oxide (NO) plays an important role in regulating physiological process in skeletal muscles; however, the association between serum asymmetric dimethylarginine (ADMA) level, an endogenous competitive inhibitor of NO synthesis, and physical performance has not yet been studied. We investigated the associations of serum ADMA level with muscle strength and usual gait speed in a cross-sectional study of 550 elderly individuals (mean age, 71.2 ± 6.6 years). Mean ADMA level was 0.45 ± 0.06 µmol/L; mean grip and quadriceps strengths were 27.7 ± 8.4 kg and 165.1 ± 81.6 Nm, respectively; and mean gait speed was 1.37 ± 0.30 m/s. In multivariate linear regression analysis adjusted for potential confounding factors (age, gender, body weight, smoking and drinking status, household income, hypertension, diabetes, renal function, and physical activity), higher serum ADMA level was significantly associated with lower grip and quadriceps strengths and slower gait speed (grip strength: ß, -1.257; 95% confidence interval [CI], -1.990 to -0.525; p = 0.001; quadriceps strength: ß, -11.730; 95% CI, -20.924 to -2.536; p = 0.012; gait speed: ß, -0.065; 95% CI, -0.108 to -0.022; p = 0.003). Our findings indicate the significant association between serum ADMA level and physical performance among elderly individuals, which was independent of the important potential confounders. © 2015 American Society for Bone and Mineral Research.