Dementia and other chronic diseases in older adults in Havana and Matanzas: the 10/66 study in Cuba.

INTRODUCTION: Chronic non-communicable diseases are the leading cause of death worldwide, except in Sub-Saharan Africa. Nonetheless, one of these conditions, dementia, is the major contributor to disability-adjusted life years in people aged ≥60 years. Few epidemiological studies exist of the prevalence and impact of dementia and selected chronic diseases in older adults in Latin America. OBJECTIVE: Describe prevalence of dementia, other chronic vascular diseases and cardiovascular risk factors, as well as resulting disabilities and care needs generated in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba. METHODS: The 10/66 study is a prospective longitudinal study involving a cohort of 3015 adults aged ≥65 years in municipalities of Havana City and Matanzas provinces, divided into two phases: a cross-sectional door-to-door study conducted in 2003-2006, and a follow-up and assessment phase in 2007-2010. This article reports findings from the first phase. Hypertension diagnosis was based on criteria from the International Society for Hypertension; diabetes mellitus on American Diabetes Association criteria; stroke according to WHO definitions; and dementia according to criteria of the American Psychiatric Society's Diagnostic and Statistical Manual of Mental Disorders DSM-IV and the 10/66 International Dementia Research Group. Ischemic heart disease was defined by self-report of previous physician diagnosis. Study variables included age, sex, educational level, substance use (alcohol, tobacco) and dietary habits. A structured physical and neurological exam, including blood pressure measurement, was performed on all participants. Laboratory tests included complete blood count, fasting blood glucose, total cholesterol and lipoprotein fractions, triglycerides and apolipoprotein E genotype. Prevalence and standardized morbidity ratios (crude and adjusted) were calculated for chronic diseases studied with 95% confidence intervals, using a Poisson regression model and indirect standardization. RESULTS: The study assessed 2944 older adults (response rate 97.6%) and found high prevalence of vascular risk factors and of chronic non-communicable diseases: hypertension 73.0% (95% CI 71.4-74.7), diabetes mellitus 24.8% (95% CI 22.9-26.5), ischemic heart disease 14.1% (95% CI 12.9-15.4), dementia 10.8% (95% CI 9.7-12.0) and stroke 7.8% (95% CI 6.9-8.8). The majority of participants (85%) had more than one cardiovascular risk factor. The main cause of disability and dependency in the study population was dementia. CONCLUSION: The high prevalence of chronic diseases observed in the elderly--with the consequent morbidity, disability and dependency--highlights the need for prevention, early diagnosis and risk factor control, particularly given the demographic and epidemiologic transition faced by Cuba and other developing countries.

Dietary fish and meat intake and dementia in Latin America, China, and India: a 10/66 Dementia Research Group population-based study.

BACKGROUND: Evidence of an association between fish and meat consumption and risk of dementia is inconsistent and nonexistent in populations in developing countries. OBJECTIVE: The objective was to investigate associations between fish and meat consumption with dementia in low- and middle-income countries. DESIGN: One-phase cross-sectional surveys were conducted in all residents aged > or =65 y in 11 catchment areas in China, India, Cuba, the Dominican Republic, Venezuela, Mexico, and Peru. A total of 14,960 residents were assessed by using the 10/66 standardized protocol, which includes face-to-face interviews for dietary habits and a cross-culturally validated dementia diagnosis. RESULTS: Dietary intakes and the prevalence of dementia varied between sites. We combined site-specific Poisson regression prevalence ratios (PRs) for the association between fish and meat consumption and dementia in 2 fixed-effect model meta-analyses adjusted for sociodemographic and health characteristics and fish and meat consumption as appropriate. We found a dose-dependent inverse association between fish consumption and dementia (PR: 0.81; 95% CI: 0.72, 0.91) that was consistent across all sites except India and a less-consistent, dose-dependent, direct association between meat consumption and prevalence of dementia (PR: 1.19; 95% CI: 1.07, 1.31). CONCLUSIONS: Our results extend findings on the associations of fish and meat consumption with dementia risk to populations in low- and middle-income countries and are consistent with mechanistic data on the neuroprotective actions of omega-3 (n-3) long-chain polyunsaturated fatty acids commonly found in fish. The inverse association between fish and prevalent dementia is unlikely to result from poorer dietary habits among demented individuals (reverse causality) because meat consumption was higher in those with a diagnosis of dementia.