Assessing the effect of anthocyanins through diet and supplementation on cognitive function in older adults at risk for dementia: protocol for a randomised controlled trial.

INTRODUCTION: Promising evidence is emerging for the procognitive, anti-inflammatory and neuroprotective properties of dietary flavonoids, particularly anthocyanins that provide red, purple and blue plant pigments. METHODS AND ANALYSIS: The 'Food for Thought' study is a multicentre, 6-month randomised, parallel 3-arm clinical trial. Its primary aim is to investigate whether anthocyanin consumption, either through diet or supplementation, can prevent memory loss progression and improve inflammatory and cardiovascular health in older adults at risk for dementia. Eligible participants will include those aged 60-85 years with a diagnosis of amnestic mild cognitive impairment or with a self-referral of memory concerns and scoring ≤13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment screening test. Participants will be randomised to one of three arms: High anthocyanin ('purple foods') diet (aiming for a target of 250 mg anthocyanins/day); freeze-dried product derived from blackcurrants (250 mg anthocyanins/day); or control (coloured maltose powder). The primary outcome is auditory anterograde memory functioning assessed by the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall. Secondary outcomes are additional cognitive functions including processing speed, working memory, aspects of executive functioning (attentional shifting and word generativity) and premorbid estimate as well as subjective memory problems and self-reported depression symptoms. Additional secondary outcomes are blood pressure, inflammatory biomarkers, brain-derived neurotrophic factor, fatty acid profile, apolipoprotein E and polyphenol metabolites, gut microbiota composition and function and vascular and microvascular endothelial function tests. Repeated measures analysis of variance and/or mixed linear modelling will evaluate changes over time, with the inclusion of covariates. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Greater Western Human Research Ethics Committee (2021/ETH12083). A Consumer Advisory Group was established to guide and review the protocol and dissemination strategy. The results of this trial are intended to be published in a peer-reviewed journal. TRIAL SPONSOR: National Health and Medical Research Centre Dementia Collaborative Research Centre.Start date of clinical trial: 02 September 2022.Expected end date: 11 October 2024. TRIAL REGISTRATION NUMBER: ACTRN12622000065796.

Anthocyanin intake is associated with improved memory in older adults with mild cognitive impairment.

Research on the role of dietary anthocyanins in preventing cognitive decline in older adults shows promise. This study investigated the association between usual anthocyanin intake and indices of memory and cognition in 40 older adults diagnosed with mild cognitive impairment that were recruited to a randomized clinical trial. It was hypothesized that daily anthocyanin intake would be similar to healthy older adults and that higher anthocyanin intake would be associated with better cognitive performance. Cognitive performance was assessed using a battery of tests including the Rey Auditory Verbal Learning Test (RAVLT). Dietary intake was assessed through 3-day food records and anthocyanin intake was quantified using the PhenolExplorer food composition database. Multivariate linear regression compared differences in cognitive performance between higher (>10 mg/d) and lower consumers (<10 mg/d). Overall, participants had low median intake of anthocyanins (5.3; interquartile range [IQR], 32.1 mg/d), with the lower consumer group eating negligible anthocyanins (median, 0.13; IQR, 1.5 mg/d), and the higher consumer group eating above the national average (median, 35.5; IQR, 71.5 mg/d). On the RAVLT, the higher anthocyanin consumer group recalled a greater number of words after a short delay and a distracter task (B, 2.07; standard error [SE], 0.93; 95% confidence interval [CI], 0.18-3.96; P = .03) and longer delay of 20 minutes (B, 2.68; SE, 1.11; 95% CI, 0.43-4.94; P = .02); and forgot less words after a long delay of 20 minutes (B, -2.63; SE, 0.63; 95% CI, -3.90 to -1.35; P< .001). Further investigation of the protective role of the usual consumption of dietary anthocyanins for memory and cognition in pathological and normal aging appears warranted. Trial registration: This cross-sectional study uses baseline data from a randomized controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001184268).

Model of nutritional care in older adults: improving the identification and management of malnutrition using the Mini Nutritional Assessment–Short Form (MNA®-SF) in general practice.

Despite clinical guidelines recommending routine nutrition screening, malnutrition in community-living older adults remains under-recognised. This study evaluated the uptake of a model of nutritional care in older adults designed to improve the identification and management of malnutrition. A pragmatic quasi-experimental study was conducted in eight general practices in regional New South Wales between January 2017 and June 2018. Study participants comprised GPs and practice nurses who participated in a training event on the identification and management of malnutrition and patients (aged >65 years) attending the practices recruited to the study. Nutritional screening was conducted using the Mini Nutritional Assessment-Short Form. The specific objectives of the study were to: (1) evaluate the effects of the intervention on knowledge, attitudes and practices of staff related to malnutrition screening using questionnaires and in-depth interviews; and (2) identify patients' experiences and outcome measures following malnutrition screening through self-completed surveys. Across the eight practices, 11 healthcare professionals completed in-depth interviews. Post-training knowledge surveys (n = 25) identified that knowledge increased in 96% of staff (P < 0.001). Fifty-five older adults who were screened (two malnourished, 10 'at risk of malnutrition') reported an increased awareness of risk factors for malnutrition. This study provides proof-of-concept that a model of care that includes routine malnutrition screening and accompanying pathways for management is acceptable to general practice staff and has promising effects on patient outcomes. However, the low number of patients screened suggests that additional processes are required to improve feasibility (e.g. incorporation into Medicare-funded nurse-led consultations such as the 75+ Health Assessment).

Identifying trends over time in food affordability: The Illawarra Healthy Food Basket survey, 2011-2019.

OBJECTIVE: To determine the affordability of a healthy food basket (HFB) for welfare recipients and average income earners in 2019 and to compare trends from 2011. METHODS: Fifty-seven food items' prices were collected from fifteen stores across five suburbs representing low, medium and high socio-economic status. Costs were compared with average weekly income and welfare payments to assess the baskets' affordability for a family of four and five. RESULTS: In 2019, a HFB was affordable (below 30% of household income) for a five-person reference family with a pensioner, representing 24.8% of weekly welfare payments, but not for a four-person reference family (33.0%). The cost of the HFB increased slightly over time from AU$288.91 in 2011 to AU$291.79 in 2019. The food affordability improved for a family of five including a pensioner over this period due to an increase of average weekly earnings and welfare payments. CONCLUSION: In 2019, the HFB was affordable for a five-person family; however, a four-person family receiving welfare benefits would have experienced significant "food stress," with the food basket costing above 30% of household income. IMPLICATIONS FOR HEALTH PROMOTION: Inequity in the affordability of healthy food is a major public health concern and one that demands recognition and national action. The impact of policies affecting welfare support and wages needs to be considered, as well as food pricing strategies and possible food subsidies for those at greatest risk of food insecurity.

Nutritional screening and intervention of older adults living in the community referred by the My Aged Care online portal.

OBJECTIVE: To assess whether nutritional screening and intervention improve the nutritional status of older adults living in the community. METHODS: The Kiama MOW service performed nutrition screening, after being trained by the research team and maintained the dataset. De-identified data was provided to the research team for analysis. Meals on Wheels staff also kept detailed notes during the nutrition screening process and in discussions with clients. These notes were provided to the research team along with the de-identified quantitative data, a summary of the measures taken following screening, including interventions that were recommended to clients by MOW staff. Staff were not formally interviewed about their experiences in conducting nutrition screening but their open-ended text comments were retrospectively summarised, as well as anecdotal comments made to the research team who were involved in training and supporting the MOW team during the intervention period. RESULTS: Forty-one individuals (25 women, mean age = 79.8 ± 8.9 years) were referred (21 well-nourished, 16 at risk of malnutrition and 4 malnourished). After reassessment (n = 19), nutritional status had significantly improved (P = .008 for all referrals and P < .001 for those at risk of malnutrition or malnourished). The main interventions provided were as follows: nutrition education (100%), home-delivered meals (78%) and social outings including meals (17%). CONCLUSION: The My Aged Care portal may be a feasible source of referral of this population to perform routine nutrition screening for appropriate intervention.

Food anthocyanins decrease concentrations of TNF-α in older adults with mild cognitive impairment: A randomized, controlled, double blind clinical trial.

BACKGROUND & AIMS: Vascular function, blood pressure and inflammation are involved in the pathogenesis of major chronic diseases, including both cardiovascular disease (CVD) and mild cognitive impairment (MCI). This study investigated the effects of food anthocyanins on microvascular function, 24-h ambulatory blood pressure (ABP) and inflammatory biomarkers in older adults with MCI. METHODS AND RESULTS: Thirty-one participants with MCI [19 female, 12 male, mean age 75.3 (SD 6.9) years and body mass index 26.1 (SD 3.3) kg/m2], participated in a randomized, controlled, double-blind clinical trial (Australian New Zealand Clinical Trials Registry: ACTRN12618001184268). Participants consumed 250 mL fruit juice daily for 8 weeks, allocated into three groups: a) high dose anthocyanins (201 mg); b) low dose anthocyanins (47 mg); c) control. Microvascular function (Laser Speckle Contrast Imaging combined with a post-occlusive reactive hyperaemia test), 24h ABP and serum inflammatory biomarkers were assessed before and after the nutritional intervention. RESULTS: Participants in the high anthocyanins group had a reduction in serum tumor necrosis factor alpha (TNF-α) (P = 0.002) compared to controls and the low anthocyanins group (all P's > 0.05). Serum IL-6, IL-1ß, c-reactive protein, and parameters of microvascular function and 24h ABP were not altered by any treatment. CONCLUSION: A daily high dose of fruit-based anthocyanins for 8 weeks reduced concentrations of TNF-α in older adults with MCI. Anthocyanins did not alter other inflammatory biomarkers, microvascular function or blood pressure parameters. Further studies with a larger sample size and longer period of follow-up are required to elucidate whether this change in the immune response will alter CVD risk and progression of cognitive decline.

Anthocyanins attenuate vascular and inflammatory responses to a high fat high energy meal challenge in overweight older adults: A cross-over, randomized, double-blind clinical trial.

BACKGROUND & AIMS: Postprandial metabolic imbalances are important indicators of later developing cardiovascular disease (CVD). This study investigated the effects of food anthocyanins on vascular and microvascular function, and CVD associated biomarkers following a high fat high energy (HFHE) meal challenge in overweight older adults. METHODS: Sixteen subjects (13 female, 3 male, mean age 65.9 SD 6.0 and body mass index 30.6 kg/m2 SD 3.9) participated in a crossover, randomized, controlled, double-blind clinical trial (registered under Australian New Zealand Clinical Trials Registry, identifier no. ACTRN12620000437965). Participants consumed a HFHE meal with a 250 mL dose of either intervention (anthocyanins-rich Queen Garnet Plum) or control (apricot) juice. Blood samples and blood pressure measures were collected at baseline, 2 h and 4 h following the HFHE meal. Vascular and microvascular function were evaluated at baseline and 2 h after the HFHE meal. RESULTS: Participants had a higher 2 h postprandial flow-mediated dilatation (+1.14%) and a higher microvascular post-occlusive reactive hyperaemia (+0.10 perfusion units per mmHg) when allocated to the anthocyanin compared to the control arm (P = 0.019 and P = 0.049, respectively). C-reactive protein was lower 4 h postprandially in the anthocyanins (1.80 mg/L, IQR 0.90) vs control arm (2.30 mg/L, IQR 1.95) (P = 0.026), accompanied by a trend for lower concentrations of interleukin-6 (P = 0.075). No significant postprandial differences were observed between treatments for blood pressure, triacylglycerol, total cholesterol, serum derivatives of reactive oxidative metabolites, tumor necrosis factor alpha, interleukin-1 beta, or maximum microvascular perfusion following iontophoresis of acetylcholine. CONCLUSION: Fruit-based anthocyanins attenuated the potential postprandial detrimental effects of a HFHE challenge on parameters of vascular and microvascular function, and inflammatory biomarkers in overweight older adults. Anthocyanins may reduce cardiovascular risk associated with endothelial dysfunction and inflammatory responses to a typical high fat 'Western' meal. Further studies are required to better elucidate the clinical implications of postprandial biomarkers of CVD.

Association between flavonoid intake and risk of hypertension in two cohorts of Australian women: a longitudinal study.

PURPOSE: Epidemiological evidence suggests higher dietary flavonoid intake is associated with lower risk of several chronic diseases. This study aimed to investigate the association between intake of flavonoids and their subclasses, and incidence of hypertension among Australian women in two age cohorts. METHODS: This population-based study included 6599 middle-aged (52.5 ± 1.5 years) and 6099 reproductive-aged (27.5 ± 1.5 years) women from the Australian Longitudinal Study on Women's Health. Food frequency questionnaires were used to quantify intake of flavonoids by cross-referencing with the Phenol-Explorer food composition database. Generalised Estimating Equation analyses investigated associations with incident hypertension, adjusting for demographic and dietary variables and hypertension risk factors. RESULTS: There were 1645 cases (24.9%) of hypertension during 15 years follow-up in the middle-aged cohort and 336 cases (5.5%) during 12 years follow-up in the reproductive-aged cohort. Higher intakes of flavones [adjusted relative risk (ARR) for quintile 5 vs. 1: 0.82, 95% CI 0.70-0.97], isoflavones (0.86, 0.75-0.99) and flavanones (0.83, 0.69-1.00) were associated with a lower risk of hypertension in the middle-aged cohort. In the reproductive-aged cohort, higher intakes of flavanols (0.70, 0.49-0.99) were associated with a lower risk of hypertension. Key foods that provided these flavonoids were oranges, orange juice, apples, red wine and soy milk. CONCLUSION: Higher intakes of total flavonoids and subclasses were associated with a lower risk of hypertension in Australian women. These findings can be used in nutrition messaging and policies for improved cardiovascular health of women.

Low anthocyanin plum nectar does not impact cognition, blood pressure and gut microbiota in healthy older adults: A randomized crossover trial.

Queen Garnet plum (QGP), known for its high levels of anthocyanins, is a hybrid of the Japanese plum developed in Queensland, Australia. Anthocyanins provide the red, blue, and purple pigments in plants with demonstrated beneficial health effects. This study hypothesized that low-dose anthocyanin QGP intake will have a significant positive effect on cognition, blood pressure, and gut microbiota in healthy older adults. A randomized crossover trial was conducted to determine the effect and within subject variance on cognition and 24 hr. ambulatory blood pressure in older adults without cognitive impairment following daily consumption of 200 mL low-dose anthocyanin (5 mg/100 g) QGP nectar (intervention) or raspberry cordial (control). Secondary outcomes included inflammatory markers (C-reactive protein), nerve growth factor (BDNF), and gut microbiota (16S rRNA gene sequencing). Twenty-eight participants (55+ years) were recruited. Each randomized treatment arm lasted for 8 weeks with a 4-week washout period. Cognition, blood pressure, and urine samples were measured at each visit (5 total) while blood and fecal samples were collected at baseline, 8 weeks, and 20 weeks. Repeated-measures ANOVA was used to analyze the data. Across the treatments, no significant difference was observed for the different domains of cognition, blood pressure, or anti-inflammatory biomarkers. No intervention effect was found for genera or class of gut microbes. Low anthocyanin nectar derived from the QGP did not have any significant effects on cognition, blood pressure, or gut microbiota in healthy older adults.

Audit of the national meal guidelines for home-delivered and centre-based meal programs.

OBJECTIVE: To evaluate the impact of the National Meal Guidelines on service providers and caterers involved in home-delivered and centre-based meal programs in Australia. METHODS: An anonymous online survey was conducted to explore the uptake of the guidelines by participants and evaluate the impact on their practice. Closed questions were analysed using χ2 and Fisher's exact tests, while open-ended questions underwent thematic analysis to identify key themes. RESULTS: A total of 101 out of 441 participants completed the survey (response rate of 23.0%). Most participants (69%) were currently referring to the guidelines, particularly for nutrition guidelines, menu planning and auditing tools. Key barriers to implementation were cost, supplier compliance issues and lack of staff education. CONCLUSIONS: The National Meal Guidelines have been successfully implemented in many services around Australia. Further research should investigate their impact on customer satisfaction and external supplier compliance.

The Postprandial Effect of Anthocyanins on Cardiovascular Disease Risk Factors: a Systematic Literature Review of High-Fat Meal Challenge Studies.

PURPOSE OF REVIEW: Recurrent post-prandial metabolic imbalances are important contributing factors to the development of cardiovascular disease (CVD). This study evaluated whether anthocyanin consumption attenuates the deleterious postprandial response of high-fat meals on CVD risk factors including blood pressure, vascular endothelial function, lipid profile and biomarkers related to oxidative stress, antioxidant status and immune response. RECENT FINDINGS: Five electronic databases were searched up to the period of 1 February 2020, yielding 13 eligible studies, including randomised or cross-over clinical trials (18-59 years of age), using PRISMA guidelines (PROSPERO registration: CRD42019126265). Potential bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials. Beneficial effects of anthocyanins were reported in biomarkers of oxidative stress and antioxidant status in 6 out of 9 studies, and in 3 out of 6 studies for inflammatory response. Two positive results were found concerning attenuation of post-prandial endothelial dysfunction, increased triacylglycerol and total cholesterol exerted by the high fat meal. Blood pressure and lipoproteins were the parameters with least beneficial results. Our systematic literature review revealed beneficial effects of dietary anthocyanin interventions on CVD risk factors following a HFM challenge; however, heterogeneity in results exists. The most promising results were for the attenuation of deleterious postprandial effects on oxidative stress and antioxidant status, triacylglycerol and total cholesterol concentrations, vascular endothelial function and inflammatory biomarkers. Post-prandial changes in blood pressure and lipoproteins were least affected by anthocyanins. Further studies are required in order to better elucidate the post-prandial effects of anthocyanins and CVD risk factors.

Effects of inulin-type fructans, galacto-oligosaccharides and related synbiotics on inflammatory markers in adult patients with overweight or obesity: A systematic review.

BACKGROUND & AIMS: Studies in humans with overweight or obesity have reported that some prebiotics and synbiotics have beneficial effects on metabolic endotoxaemia and immune function. However, to date, no systematic review of controlled clinical trials assessed this topic. The aim of this study was to evaluate the effects of inulin-type fructans, galacto-oligosaccharides and related synbiotics on inflammatory markers in adults with overweight or obesity. METHODS: A systematic review of the literature was performed until November 6, 2015 in four electronic databases and reference lists of all included articles and relevant reviews in the field, without using any filter. RESULTS: Ten trials (six prebiotic and four synbiotic trials) representing 534 overweight/obese adults were included. All trials evaluated C-reactive protein or high-sensitivity C-reactive protein, four trials evaluated cytokines (two prebiotic and two synbiotic trials) and five trials evaluated endotoxin (four prebiotic and one synbiotic trials). Six trials (two with galacto-oligosaccharide, one with inulin and three with different synbiotics) showed a reduction on high-sensitivity C-reactive protein. Four trials (one with oligofructose-enriched inulin, one with inulin and two with different synbiotics) showed a reduction on interleukin-6 and/or tumor necrosis factor. Four trials (one with galacto-oligosaccharide, one with oligofructose-enriched inulin, one with inulin and one with synbiotic) showed a reduction on endotoxin. CONCLUSIONS: Some prebiotics and synbiotics may have immunomodulatory action, however, more randomized controlled trials are needed to support the clinical use of inulin-type fructans, galacto-oligosaccharides or related synbiotics for the treatment of metabolic endotoxaemia or low-grade inflammation in overweight/obese people.

Vegetarian diets and gut microbiota: important shifts in markers of metabolism and cardiovascular disease.

Vegetarian diets have been associated with a lower incidence of several chronic diseases. The benefits of plant-based diets are related mainly to the improvement of metabolic parameters that can indicate risk for such diseases. Some metabolic factors, such as oxidative balance, lipid profile, and glucose homeostasis, can be improved directly by diet, but paradoxically, some characteristics of vegetarian diets may promote a negative scenario that increases the risk of certain chronic diseases. Additionally, many benefits of a vegetarian diet are mediated by the gut microbiota, members of which not only have taxonomic and functional differences but also produce diverse, specific metabolites that vary according to whether the host consumes an omnivorous or a vegetarian diet. This review examines the modulation of human metabolism and gut microbiota by vegetarian and omnivorous dietary patterns and explores how this modulation may affect the risk of cardiovascular disease.

A systematic review and meta-analysis of the prebiotics and synbiotics effects on glycaemia, insulin concentrations and lipid parameters in adult patients with overweight or obesity.

BACKGROUND & AIMS: Several studies have reported the effects of prebiotics and synbiotics supplementation in lipid profile and glucose homeostasis, however a pooled analysis of clinical trials that assessed these parameters has not been performed in overweight or obese individuals. The aim of this study was to evaluate the effects of prebiotics and synbiotics on plasma lipid profile, fasting insulin and fasting glucose in adults with overweight or obesity. METHODS: Randomized controlled trials were systematically searched before May 2014 in electronic databases and screening reference lists. Combined and stratified (diabetics and non-diabetics trials) meta-analyzes were performed. RESULTS: Thirteen trials, representing 513 adult participants with Body Mass Index ≥25 kg/m² were included. Prebiotic supplementation reduced plasma total cholesterol (SMD -0.25; 95% CI -0.48, -0.02) and LDL-c (SMD -0.22; 95% CI -0.44, -0.00) concentrations in overall analysis, and reduced triglycerides (SMD -0.72; 95% CI -1.20, -0.23) and increased HDL-c (SMD 0.49; 95% CI 0.01, 0.97) concentrations in diabetic trials. Synbiotic supplementation reduced plasma fasting insulin (SMD -0.39; 95% CI -0.75, -0.02) and triglycerides (SMD -0.43; 95% CI -0.70, -0.15) concentrations. CONCLUSIONS: The improvement of the evaluated parameters supports prebiotics and synbiotics supplementation as an adjuvant therapy in obesity-related comorbidities, such as dyslipidemia and insulin resistance.