The AUstralian multidomain Approach to Reduce dementia Risk by prOtecting brain health With lifestyle intervention study (AU-ARROW): A study protocol for a single-blind, multi-site, randomized controlled trial.

INTRODUCTION: The Finnish Geriatric Intervention Study (FINGER) led to the global dementia risk reduction initiative: World-Wide FINGERS (WW-FINGERS). As part of WW-FINGERS, the Australian AU-ARROW study mirrors aspects of FINGER, as well as US-POINTER. METHOD: AU-ARROW is a randomized, single-blind, multisite, 2-year clinical trial (n = 600; aged 55-79). The multimodal lifestyle intervention group will engage in aerobic exercise, resistance training and stretching, dietary advice to encourage MIND diet adherence, BrainHQ cognitive training, and medical monitoring and health education. The Health Education and Coaching group will receive occasional health education sessions. The primary outcome measure is the change in a global composite cognitive score. Extra value will emanate from blood biomarker analysis, positron emission tomography (PET) imaging, brain magnetic resonance imaging (MRI), and retinal biomarker tests. DISCUSSION: The finalized AU-ARROW protocol is expected to allow development of an evidence-based innovative treatment plan to reduce cognitive decline and dementia risk, and effective transfer of research outcomes into Australian health policy. Highlights: Study protocol for a single-blind, randomized controlled trial, the AU-ARROW Study.The AU-ARROW Study is a member of the World-Wide FINGERS (WW-FINGERS) initiative.AU-ARROW's primary outcome measure is change in a global composite cognitive score.Extra significance from amyloid PET imaging, brain MRI, and retinal biomarker tests.Leading to development of an innovative treatment plan to reduce cognitive decline.

Effect of Virgin Coconut Oil Supplementation on Cognition of Individuals with Mild-to-Moderate Alzheimer's Disease in Sri Lanka (VCO-AD Study): A Randomized Placebo-Controlled Trial.

BACKGROUND: Virgin coconut oil (VCO) is a potential therapeutic approach to improve cognition in Alzheimer's disease (AD) due to its properties as a ketogenic agent and antioxidative characteristics. OBJECTIVE: This study aimed to investigate the effect of VCO on cognition in people with AD and to determine the impact of apolipoprotein E (APOE) ɛ4 genotype on cognitive outcomes. METHODS: Participants of this double-blind placebo-controlled trial (SLCTR/2015/018, 15.09.2015) were 120 Sri Lankan individuals with mild-to-moderate AD (MMSE = 15-25), aged > 65 years, and they were randomly allocated to treatment or control groups. The treatment group was given 30 mL/day of VCO orally and the control group, received similar amount of canola oil, for 24 weeks. The Mini-Mental Sate Examination (MMSE) and Clock drawing test were performed to assess cognition at baseline and at the end of the intervention. Blood samples were collected and analyzed for lipid profile and glycated hemoglobin (HbA1 C) levels.∥Results:There were no significant difference in cognitive scores, lipid profile, and HbA1 C levels between VCO and control groups post-intervention. The MMSE scores, however, improved among APOE ɛ4 carriers who had VCO, compared to non-carriers (2.37, p = 0.021). APOE ɛ4 status did not influence the cognitive scores in the control group. The attrition rate was 30%.∥Conclusion:Overall, VCO did not improve cognition in individuals with mild-to-moderate AD following a 24-week intervention, compared to canola oil. However, it improved the MMSE scores in APOE ɛ4 carriers. Besides, VCO did not compromise lipid profile and HbA1 C levels and is thus safe to consume.

Ketone bodies mediate alterations in brain energy metabolism and biomarkers of Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of dementia. AD is a progressive neurodegenerative disorder characterized by cognitive dysfunction, including learning and memory deficits, and behavioral changes. Neuropathology hallmarks of AD such as amyloid beta (Aß) plaques and neurofibrillary tangles containing the neuron-specific protein tau is associated with changes in fluid biomarkers including Aß, phosphorylated tau (p-tau)-181, p-tau 231, p-tau 217, glial fibrillary acidic protein (GFAP), and neurofilament light (NFL). Another pathological feature of AD is neural damage and hyperactivation of astrocytes, that can cause increased pro-inflammatory mediators and oxidative stress. In addition, reduced brain glucose metabolism and mitochondrial dysfunction appears up to 15 years before the onset of clinical AD symptoms. As glucose utilization is compromised in the brain of patients with AD, ketone bodies (KBs) may serve as an alternative source of energy. KBs are generated from the ß-oxidation of fatty acids, which are enhanced following consumption of ketogenic diets with high fat, moderate protein, and low carbohydrate. KBs have been shown to cross the blood brain barrier to improve brain energy metabolism. This review comprehensively summarizes the current literature on how increasing KBs support brain energy metabolism. In addition, for the first time, this review discusses the effects of ketogenic diet on the putative AD biomarkers such as Aß, tau (mainly p-tau 181), GFAP, and NFL, and discusses the role of KBs on neuroinflammation, oxidative stress, and mitochondrial metabolism.

Food Insecurity and Perceived Effects of COVID-19 on Livelihoods in Rural Sri Lanka.

BACKGROUND: Little is known about how the COVID-19 pandemic has affected food security and livelihoods in Sri Lanka. OBJECTIVE: This article aims to assess food insecurity, perceived effects of COVID-19, and coping mechanisms among agriculture-based households in rural Sri Lanka. METHODS: We used 2 rounds of panel data from phone surveys (n = 1057 households) conducted in 5 districts. Food insecurity (30-day recall), perceived impacts of COVID-19 (6-month recall), and coping mechanisms (6-month recall) were assessed using a household questionnaire. To assess food insecurity, we used the 8-item Food Insecurity Experience Scale. We tested for differences between T1 (baseline: December 2020-February 2021) and T2 (follow-up: July 2021-September 2021) and explored the association between food insecurity and the perceived effect of COVID-19 on income using a logistic regression model. RESULTS: Food insecurity was highly prevalent (T1: 75%, T2: 80%) but varied across districts. Most respondents were affected by COVID-19 and/or COVID-19-associated mitigation measures (T1: 84%, T2: 89%). Among affected households, commonly reported impacts included those on income (T1: 77%, T2: 76%), food costs (T1: 84%, T2: 83%), and travel (∼90% in both rounds). Agricultural activities were also adversely affected (T1: 64%, T2: 69%). About half of COVID-19-affected households reported selling livestock or assets to meet basic needs. Households whose income was impacted by COVID-19 were more likely to be food insecure (adjusted odds ratio: 2.56, P < .001). CONCLUSIONS: Households in rural Sri Lanka experienced food insecurity and livelihood disturbances during the COVID-19 pandemic. Additional surveys are needed to assess recovery post-COVID-19 and to understand if programs that support livelihoods have been protective.

METHOD: This original article used household level survey data from 2 rounds of phone surveys conducted in 5 districts of Sri Lanka.Using a household-level questionnaire, we recorded experience of food insecurity in the last 30 days, perceived impact of COVID-19, and adopted coping mechanism in the 6 months prior to the survey.We reported statistical means and tested for differences between 2 survey rounds.We also explored association between food insecurity and the perceived effect of COVID-19 on income. RESULTS: Household-level food insecurity was highly prevalent during the pandemic.Households perceived a negative effect of the pandemic on their income and employment sources.Households whose income was impacted by the pandemic were more likely to be food insecure. CONCLUSION: Agriculture-based households in rural Sri Lanka experienced food insecurity and livelihood disturbances during the COVID-19 pandemic.Additional research is needed to assess recovery post COVID-19 and to understand whether livelihood support programs have been protective.

Plain language titleFood Insecurity and Perceived Effects of COVID-19 on Livelihoods in Rural Sri LankaPlain language summaryBackground: Sustained levels of high food insecurity are associated with a range of negative health, nutrition, and well-being effects.The COVID-19 pandemic is expected to aggravate food insecurity and worsen the livelihood situation.Little is known about how the COVID-19 pandemic affected food security and livelihoods of agriculture-based households in rural Sri Lanka.

Potential of coconut oil and medium chain triglycerides in the prevention and treatment of Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of dementia. Currently, there is no effective medication for the prevention or treatment of AD. This has led to the search for alternative therapeutic strategies. Coconut oil(CO) has a unique fatty acid composition that is rich in medium chain fatty acids(MCFA), a major portion of which directly reaches the liver via the portal vein, thereby bypassing the lymphatic system. Given that brain glucose hypometabolism is a major early hallmark of AD, detectable well before the onset of symptoms, ketone bodies from MCFA metabolism can potentially serve as an alternative energy source to compensate for lack of glucose utilisation in the brain. Additionally, neuroprotective antioxidant properties of CO have been attributed to its polyphenolic content. This review discusses how the metabolism of CO and MCFA may aid in compensating the glucose hypometabolism observed in the AD brain. Furthermore, we present the current evidence of the neuroprotective properties of CO on cognition, amyloid-ß pathogenicity, inflammation and oxidative stress. The current review addresses the influence of CO/MCFA on other chronic disorders that are risk factors for AD, and addresses existing gaps in the literature regarding the use of CO/MCFA as a potential treatment for AD.