| 1. |
- Faxén Irving, Gerd, et al.
(författare)
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Lukt, smak och aptit
- 2016
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Ingår i: Geratrisk nutrition. - Lund : Studentlitteratur AB. ; :2, s. 67-78
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 2. |
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| 3. |
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| 4. |
- Cederholm, Tommy, et al.
(författare)
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SBU-rapport "missar" övertygande evidensläge : Kosttillägg förlänger livet på undernärda äldre
- 2014
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 111:51-52, s. 2299-2300
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Tidskriftsartikel (refereegranskat)abstract
- Tvärtemot slutsatserna i en ny SBU-rapport anser Tommy Cederholm och medförfattare att det finns övertygande evidens för att kosttillägg är gynnsamt för undernärda äldre. Ordination ska dock ske först efter utredning, göras patientsäkert, dokumenteras och utvärderas individuellt.
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| 5. |
- Donat-Vargas, Carolina, et al.
(författare)
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Urinary phosphate is associated with cardiovascular disease incidence.
- 2023
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Ingår i: Journal of Internal Medicine. - 0954-6820 .- 1365-2796. ; 294:3, s. 358-369
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Elevated phosphate (P) in urine may reflect a high intake of inorganic P salts from food additives. Elevated P in plasma is linked to vascular dysfunction and calcification.OBJECTIVE: To explore associations between P in urine as well as in plasma and questionnaire-estimated P intake, and incidence of cardiovascular disease (CVD).METHODS: We used the Swedish Mammography Cohort-Clinical, a population-based cohort study. At baseline (2004-2009), P was measured in urine and plasma in 1625 women. Dietary P was estimated via a food-frequency questionnaire. Incident CVD was ascertained via register-linkage. Associations were assessed using Cox proportional hazards regression.RESULTS: After a median follow-up of 9.4 years, 164 composite CVD cases occurred (63 myocardial infarctions [MIs] and 101 strokes). Median P (percentiles 5-95) in urine and plasma were 2.4 (1.40-3.79) mmol/mmol creatinine and 1.13 (0.92-1.36) mmol/L, respectively, whereas dietary P intake was 1510 (1148-1918) mg/day. No correlations were observed between urinary and plasma P (r = -0.07) or dietary P (r = 0.10). Urinary P was associated with composite CVD and MI. The hazard ratio of CVD comparing extreme tertiles was 1.57 (95% confidence interval 1.05, 2.35; P trend 0.037)-independently of sodium excretion, the estimated glomerular filtration rate, both P and calcium in plasma, and diuretic use. Association with CVD for plasma P was 1.41 (0.96, 2.07; P trend 0.077).CONCLUSION: Higher level of urinary P, likely reflecting a high consumption of highly processed foods, was linked to CVD. Further investigation is needed to evaluate the potential cardiovascular toxicity associated with excessive intake of P beyond nutritional requirements.
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| 6. |
- Elgestad Stjernfeldt, Per, et al.
(författare)
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The Relation between Masticatory Function and Nutrition in Older Individuals, Dependent on Supportive Care for Daily Living
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:10
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Associations between masticatory function and nutritional status have been suggested. Masticatory function can be divided into two subdomains, the objective capacity of an individual to mix solid food and the individual's subjectively assessed ability to masticate solid food. Aim: The aims of this study were to assess the relationship between these subdomains and nutritional variables in older, care-dependent individuals. Materials and methods: From a group of 355 individuals with care dependency and functional limitations, individuals aged 60 and older were selected. By home visits, the subjects underwent an oral examination and answered chewing related questions. Nutritional status was assessed using the Mini Nutritional Assessment. A total of 196 individuals met the age requirement of 60 years or older. Of these, 86 subjects were able to answer the questions. Results: We could not find any concluding significant associations between the subdomains of masticatory function or the nutritional variables. Conclusions: The absence of associations could be explained by the lack of standardized and validated methods to assess masticatory function and they possibly reflect varying underlying constructs. Self-reported questionnaires seem less useful among older and care-dependent individuals, while an objective clinical measurement will be needed when evaluating masticatory function.
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| 7. |
- Eriksdotter, Maria, et al.
(författare)
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Plasma Fatty Acid Profiles in Relation to Cognition and Gender in Alzheimer's Disease Patients During Oral Omega-3 Fatty Acid Supplementation : The OmegAD Study
- 2015
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 48:3, s. 805-812
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: ω3 fatty acids (ω3 FAs) may slow the rate of decline in cognitive performance in mild forms of cognitive impairment and Alzheimer's disease (AD). However, the relationship between changes of plasma ω3 FA levels and cognitive performance, as well as effects of gender, are poorly known.OBJECTIVE: To study the effect of 6-month administration of DHA-rich ω3 FA supplementation on plasma FA profiles in patients with mild to moderate AD in relation to cognitive performance and gender. This investigation is part of the OmegAD Study.METHODS: 174 AD patients (74 ± 9 years) were randomized to a daily intake of 2.3 g ω3 FA or placebo for 6 months; subsequently all received the ω3 FA preparation for the next 6 months. Baseline as well as changes in plasma levels of the main ω3 FAs in 165 patients, while receiving ω3 FA supplementation for 6 months, were analyzed for association to cognitive performance (assessed by ADAS-cog and MMSE scores) as well as to gender.RESULTS: Preservation of cognitive functioning, assessed by ADAS-cog or its sub-items (but not MMSE) scores, was significantly associated to increasing plasma ω3 FA levels over time. Thus, the higher ω3 FA plasma levels rose, the lower was the rate of cognitive deterioration. This effect was not related to gender; since although females displayed higher ω3 FA plasma levels than did males after 6 months of supplementation, this difference disappeared when adjusted for body weight.CONCLUSIONS: Since our study suggests dose-response relationships between plasma levels of ω3 FA and preservation of cognition, future ω3 FA trials in patients with mild AD should consider exploring graded (and body weight adjusted) doses of ω3 FA.
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| 8. |
- Faxen-Irving, Gerd, et al.
(författare)
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Does Fatty Acid Composition in Subcutaneous Adipose Tissue Differ between Patients with Alzheimer's Disease and Cohabiting Proxies?
- 2018
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 61:2, s. 515-519
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Tidskriftsartikel (refereegranskat)abstract
- Low tissue levels of the major marine ω3 fatty acids (FAs) DHA and EPA are found in Alzheimer's disease (AD). We investigated if healthy proxies to AD patients have higher levels of these ω3 FAs. We observed lower levels of EPA and DHA in subcutaneous adipose tissue biopsies from 64 AD patients compared with 16 cognitively healthy proxies. No significant difference was observed when pairwise comparisons were made between a subset of 16 AD patients and their co-habiting proxies. Larger studies are needed to replicate these findings and to determine if they could depend on FA intake or differences in metabolism.
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| 9. |
- Faxén-Irving, Gerd, et al.
(författare)
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Effects on transthyretin in plasma and cerebrospinal fluid by DHA-rich n - 3 fatty acid supplementation in patients with Alzheimer's disease : the OmegAD study
- 2013
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 36:1, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Transthyretin (TTR) binds amyloid-β (Aβ) and may reduce brain Aβ, a pathological feature in Alzheimer's disease (AD). N - 3 fatty acids (FA), docosahexaenoic (DHA), and eicosapentaenoic acid (EPA) may increase TTR transcription in rat hippocampus. We studied effects of n - 3 FA supplementation on TTR-levels in patients with AD. Outpatients were randomized to receive 1.7 g DHA and 0.6 g EPA (n - 3/n - 3 group) or placebo (placebo/n - 3 group) during 6 months. After 6 months, all patients received n - 3 FA for another 6 months. TTR and FA were measured in plasma in all subjects, whereas TTR in cerebrospinal fluid (CSF) was measured in a subgroup. The study was completed by 89 patients in the n - 3/n - 3 group (75 y, 57% w) and 85 in the placebo/n - 3 group (75 y, 46% w). Baseline plasma-TTR was within normal range in both groups. After 6 months, plasma-TTR decreased in the placebo/n - 3 group (p < 0.001 within and p < 0.015 between the groups). No changes were observed in CSF TTR. From 6 to 12 months when both groups were supplemented, plasma-TTR increased significantly in both groups. Repeated measures ANOVA indicated an increase in TTR over time (p = 0.04) in those receiving n - 3 FA for 12 months. By linear regression analyses, n - 3 FA treatment was independently associated with increased plasma-TTR at 6 months (β = -0.172, p = 0.028). Thus, n - 3 FA treatment appeared to increase plasma-TTR in patients with AD. Since TTR may influence Aβ deposition in the brain, the results warrant further exploration.
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| 10. |
- Faxén-Irving, Gerd, et al.
(författare)
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Energy dense oleic acid rich formula to newly admitted geriatric patients - Feasibility and effects on energy intake
- 2011
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 30:2, s. 202-208
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: Old patients seldom reach their energy requirements. The effects of an oleic acid rich formula on energy intake and appetite were studied. Methods: Recently admitted geriatric patients (n = 71), likely to stay > 1 week were randomised to receive 30 ml of a fat emulsion (Calogen (R)) 3 times daily, i.e., 420 kcal, at the regular medication rounds (intervention group (IG)) or to standard care (control group (CG)). Food intake and self-rated appetite were registered at baseline, i.e., 2-3 days after admission and on day 8 or the day prior to discharge. Nutritional risk screening (NRS) 2002, serum lipids and fatty acid profiles were analysed. Results: Fifty-one subjects fulfilled the study, i.e., 24 in the IG (83 +/- 7 y) and 27 controls (85 +/- 7 y). NRS showed that two thirds were at risk of malnutrition. Per-protocol analyses indicated that the daily energy intake was around 50% higher in IG compared to CG at the two measurements, respectively (p < 0.0001). The IG displayed a significantly improved appetite compared with the CG (P = 0.021). Serum lipids and fatty acid profile changed favourably by the intervention. Conclusions: An energy dense oleic acid rich liquid supplement given three times daily at medication rounds to geriatric patients may result in increased energy intake and better appetite with positive effects on serum lipids. ClinicalTrials.gov Identifier: NCT01042340.
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| 11. |
- Faxén Irving, Gerd, et al.
(författare)
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Geriatrisk nutrition
- 2016. - 2
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Geriatrisk nutrition utkom första gången 2010. Denna bok är en reviderad upplaga, som har förändrats på flera sätt både avseendeinnehåll, struktur och lay-out. Boken riktar sig både till studenter inom olika vårdutbildningar och till yrkesverksamma inomvård och omsorg av äldre. Den har ambitionen att ge en förståelse för hur åldrandet påverkar kroppens funktioner och hälsan.Fokus i boken ligger på mat, näring och nutrition och de specifika nutritionsproblem som följer med åldrandet. Boken vill ävenge en medicinsk bakgrund till olika sjukdomar som är vanliga hos äldre, vilket är förutsättningen för att förstå sjukdomsspecifiknutritionsbehandling. Boken tar också upp regelverk, organisation och kvalitet samt etiska och kulturella aspekter på nutritionsomhändertagandeav äldre. Helt nytt är ett kapitel om centrala begrepp och termer samt ett separat kapitel om kulturella aspekteroch ett utökat avsnitt som behandlar D vitamin. Boken är faktagranskad av personer med specifika kompetenser inom olikaområden som boken tar upp.
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| 12. |
- Faxén Irving, Gerd, et al.
(författare)
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Geriatrisk nutrition
- 2010
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Bok (övrigt vetenskapligt/konstnärligt)
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| 13. |
- Faxén Irving, Gerd, et al.
(författare)
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Geriatrisk nutrition
- 2016
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Geriatrisk nutrition utkom första gången 2010. Denna bok är en reviderad upplaga, som har förändrats på flera sätt både avseendeinnehåll, struktur och lay-out. Boken riktar sig både till studenter inom olika vårdutbildningar och till yrkesverksamma inomvård och omsorg av äldre. Den har ambitionen att ge en förståelse för hur åldrandet påverkar kroppens funktioner och hälsan.Fokus i boken ligger på mat, näring och nutrition och de specifika nutritionsproblem som följer med åldrandet. Boken vill ävenge en medicinsk bakgrund till olika sjukdomar som är vanliga hos äldre, vilket är förutsättningen för att förstå sjukdomsspecifiknutritionsbehandling. Boken tar också upp regelverk, organisation och kvalitet samt etiska och kulturella aspekter på nutritionsomhändertagandeav äldre. Helt nytt är ett kapitel om centrala begrepp och termer samt ett separat kapitel om kulturella aspekteroch ett utökat avsnitt som behandlar D vitamin. Boken är faktagranskad av personer med specifika kompetenser inom olikaområden som bokentar upp.
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| 14. |
- Faxén Irving, Gerd, et al.
(författare)
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Lukt, smak och aptit
- 2016. - 2
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Ingår i: Geratrisk nutrition. - Lund : Studentlitteratur AB. - 9789144099965 ; , s. 67-78
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 15. |
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| 16. |
- Faxén Irving, Gerd
(författare)
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Nutritional status and cognitive function in frail elderly subjects
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Longevity, frailty and chronic disease are often associated with protein energy-malnutrition (PEM). Subjects with dementia are at particular risk for PEM. The overall aims of this thesis were to evaluate relationships between nutrition, cognition and functional capacity and to assess interventional means of developing the nutritional care of elderly. In study I and II, the nutritional status and the cognitive function were examined in 28 and 80 service flat (SF) residents. Furthermore, the effect of a nutrition education programme to SF care staff was evaluated. In study III, 22 and 14 subjects living in two group living units for demented (GLD) participated and the effects of nutritional supplementation and education to care personnel were evaluated. In study IV, possible relationships between weight, weight change and cognitive function were studied in 231 patients, admitted to a geriatric ward for examination of cognitive dysfunction. Seven-year mortality in relation to dementia diagnosis and nutritional status was also studied (IV). The nutritional status was assessed by Body mass index (BMI=kg/M2), triceps skin fold (TSF), and arm muscle circumference (AMC). Study I and II included a modified Subjective Global Assessment (SGA). Muscle strength was measured with a Harpenden Grip Strength Dynamo-Meter@ (I, II). As biochemical nutritional markers in serum, albumin, transferrin, haemoglobin, C-reactive protein (CRP), vitamin B 12, folic acid and insulin-like growth factor-1 (Igf-1) (I-III) were analysed. Cognitive and functional status was assessed by the Mini Mental State Examination (MMSE) (0-30p, I-IV), Clinical Dementia Rating Scale (CDR) (0-3, 111) and Katz' ADL-index (I-III). Care personnel at the SF (I-III) complexes attended 12-hour nutritional education program. The care personnel answered a questionnaire before and after the education that reflected their knowledge and attitudes about nutrition in elderly (I, II). Oral supplements (410 kcal/1720 kJ) were given daily during 5 months to residents in one of the two GLD units and the personnel attended a nutritional education programme (III). Mortality data (IV) were obtained from Swedish population records. Up to one third of the SF residents were assessed as malnourished or at risk for PEM according to SGA (I-II). The education program tended to improve the knowledge of the care personnel in study I. In study II there was no significant difference in improvement between the staff at the two SF complexes. Objective measures of nutritional status and cognitive function in the residents was not changed at 5- and 6-months follow-ups, whereas SGA appeared to improve after the educational intervention (II). The combined intervention in study III resulted in a weight gain of 3.4 ±11.2 kg (p=0.00 1) 6 months later, that was not seen in the control group. The weight gain was not related to an improvement in ADL capacity or cognitive function (MMSE). A BMI <23 was noticed in more than half of 231 patients admitted for diagnostic evaluation of cognitive function (IV). The weight increased by 0.5 kg (p<0.001) during a 3-week hospital stay. Concurrently, an increase in MMSE by 1 point was noticed (p=0.0001). The changes in weight and MMSE did not correlate. BMI <23 seemed to predict shorter survival (OR 3, 95% Cl 1.3-6.7), even after adjustment for age, gender and comorbidity, whereas type and degree of dementia were not related to 7-year mortality. In conclusion, a limited nutrition education programme to care personnel did not affect the nutritional status of SF residents 5-6 months later. No overt improvements in the knowledge of the care staff were observed. Nutritional status was related to cognitive function. Care staff education and oral supplementation resulted in weight gain in GLD residents. A BMI <23 seemed to predict mortality in individuals with cognitive failure. More studies are needed to settle the relationships between nutrition and cognition in elderly individuals.
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| 17. |
- Fjellström, Christina, et al.
(författare)
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To Be a Good Food Provider : An Exploratory Study Among Spouses of Persons With Alzheimer's Disease
- 2010
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Ingår i: American Journal of Alzheimer’s Disease and Other Dementia. - : Sage Publications. - 1533-3175 .- 1938-2731. ; 25:6, s. 521-526
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Tidskriftsartikel (refereegranskat)abstract
- Large proportions of people with dementia live at home and need help from a relative. The aim of the current study was to examine how people living with persons with Alzheimer's disease (AD) perceived everyday life aspects of food choices, cooking, and food-related work. The analyses are based on focus group interviews including women and men acting as caregivers to people with AD and living in Sweden. The main results identified from the data, were how cohabitants to persons with AD struggle with either taking on a new role as a food provider or extending it, but also how they tried to cope as carer, which entailed food being an important part of the treatment of the disease. Those expressing greatest concern were those perceiving themselves as inexperienced food providers and carers, which in this study were all men.
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| 18. |
- Freund-Levi, Yvonne, 1956-, et al.
(författare)
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Effects of omega-3 fatty acids on inflammatory markers in cerebrospinal fluid and plasma in Alzheimer's disease : the OmegAD study
- 2009
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger. - 1420-8008 .- 1421-9824. ; 27:5, s. 481-490
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: omega-3 fatty acids (omega-3 FAs) found in dietary fish or fish oils are anti-inflammatory agents that may influence Alzheimer's disease (AD).OBJECTIVE: To study the effects of dietary omega-3 FA supplementation on inflammatory markers in cerebrospinal fluid (CSF) and plasma from patients with mild to moderate AD.METHODS: Thirty-five patients (70.3 +/- 8.2 years) were randomized to a daily intake of 2.3 g omega-3 FAs or placebo for 6 months. The inflammatory markers interleukin (IL)-6, tumour necrosis factor-alpha and soluble interleukin-1 receptor type II (sIL-1RII) were analysed in CSF and plasma at baseline and at 6 months. The AD markers tau-protein, hyperphosphorylated tau-protein and beta-amyloid (Abeta(1-42)) were assessed in CSF. High-sensitivity C-reactive protein was assessed in plasma. A possible relation to the APOE genotype was investigated.RESULTS: There was no significant treatment effect of omega-3 FAs on inflammatory and AD biomarkers in CSF or on inflammatory markers in plasma, nor was there any relation with APOE. A significant correlation was observed at baseline between sIL-1RII and Abeta(1-42) levels in CSF.CONCLUSIONS: Treatment of AD patients with omega-3 FAs for 6 months did not influence inflammatory or biomarkers in CSF or plasma. The correlation between sIL-1RII and Abeta(1-42) may reflect the reciprocal interactions between IL-1 and Abeta peptides.
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| 19. |
- Freund-Levi, Yvonne, 1956-, et al.
(författare)
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Effects of supplementation with omega-3 fatty acids on oxidative stress and inflammation in patients with Alzheimer's disease : the OmegAD study
- 2014
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 42:3, s. 823-831
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Oxidative stress and inflammation are two key mechanisms suggested to be involved in the pathogenesis of Alzheimer's disease (AD). Omega-3 fatty acids (ω-3 FAs) found in fish and fish oil have several biological properties that may be beneficial in AD. However, they may also auto-oxidize and induce in vivo lipid peroxidation.OBJECTIVE: The objective of this study was to evaluate systemic oxidative stress and inflammatory biomarkers following oral supplementation of dietary ω-3 FA.METHODS: Forty patients with moderate AD were randomized to receive 1.7 g DHA (22:6) and 0.6 g EPA (20:5) or placebo for 6 months. Urinary samples were collected before and after supplementation. The levels of the major F2-isoprostane, 8-iso-PGF2α, a consistent in vivo biomarker of oxidative stress, and 15-keto-dihydro-PGF2α, a major metabolite of PGF2α and biomarker of inflammatory response, were measured.RESULTS: F2-isoprostane in urine increased in the placebo group after 6 months, but there was no clear difference in treatment effect between supplemented and non-supplemented patients on the urinary levels of F2-isoprostanes and 15-keto-dihydro-PGF2α. At baseline, the levels of 15-keto-dihydro-PGF2α showed negative correlative relationships to ω-3 FAs, and a positive correlation to linoleic acid. 8-iso-PGF2α correlated negatively to the ω-6 FA arachidonic acid.CONCLUSION: The findings indicate that supplementation of ω-3 FAs to patients with AD for 6 months does not have a clear effect on free radical-mediated formation of F2-isoprostane or cyclooxygenase-mediated formation of prostaglandin F2α. The correlative relationships to FAs indicate a potential role of FAs in immunoregulation.
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| 20. |
- Freund-Levi, Yvonne, 1956-, et al.
(författare)
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Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease : OmegAD study - A randomized double-blind trial
- 2006
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Ingår i: Archives of Neurology. - : American Medical Association (AMA). - 0003-9942 .- 1538-3687. ; 63:10, s. 1402-1408
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiologic and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids, for example, docosahexaenoic acid and eicosapentaenoic acid, may prevent Alzheimer disease (AD). Objective: To determine effects of dietary omega-3 fatty acid supplementation on cognitive functions in patients with mild to moderate AD. Design: Randomized, double-blind, placebo-controlled clinical trial. Participants: Two hundred four patients with AD (age range [mean +/- SD], 74 +/- 9 years) whose conditions were stable while receiving acetylcholine esterase inhibitor treatment and who had a Mini-Mental State Examination (MMSE) score of 15 points or more were randomized to daily intake of 1.7 g of docosahexaenoic acid and 0.6 g of eicosapentaenoic acid (omega-3 fatty acid-treated group) or placebo for 6 months, after which all received omega-3 fatty acid supplementation for 6 months more. Main Outcome Measures: The primary outcome was cognition measured with the MMSE and the cognitive portion of the Alzheimer Disease Assessment Scale. The secondary outcome was global function as assessed with the Clinical Dementia Rating Scale; safety and tolerability of omega-3 fatty acid supplementation; and blood pressure determinations. Results: One hundred seventy-four patients fulfilled the trial. At baseline, mean values for the Clinical Dementia Rating Scale, MMSE, and cognitive portion of the Alzheimer Disease Assessment Scale in the 2 randomized groups were similar. At 6 months, the decline in cognitive functions as assessed by the latter 2 scales did not differ between the groups. However, in a subgroup (n=32) with very mild cognitive dysfunction (MMSE > 27 points), a significant (P <.05) reduction in MMSE decline rate was observed in the omega-3 fatty acid-treated group compared with the placebo group. A similar arrest in decline rate was observed between 6 and 12 months in this placebo subgroup when receiving omega-3 fatty acid supplementation. The omega-3 fatty acid treatment was safe and well tolerated. Conclusions: Administration of omega-3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline according to the MMSE or the cognitive portion of the Alzheimer Disease Assessment Scale. However, positive effects were observed in a small group of patients with very mild AD (MMSE > 27 points).
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| 21. |
- Freund-Levi, Yvonne, 1956-, et al.
(författare)
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Omega-3 supplementation in mild to moderate Alzheimer's disease : effects on neuropsychiatric symptoms
- 2008
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 23:2, s. 161-169
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiological and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids (ω3), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may have effects in psychiatric and behavioral symptoms in Alzheimer's disease (AD). An association with APOEω4 carriers and neuropsychiatric symptoms in AD has also been suggested. Objective: To determine effects of dietary ω3 supplementation to AD patients with mild to moderate disease on psychiatric and behavioral symptoms, daily functions and a possible relation to APOEgenotype. Methods: Randomized, double-blind, placebo-controlled clinical trial where 204 AD patients (74 ± 9 years) with acetylcholine esterase inhibitor treatment and a MMSE >15 points were randomized to daily intake of 1.7 g DHA and 0.6 g EPA (ω3 group) or placebo for 6 months. Then, all received the ω3 supplementation for 6 more months. Neuropsychiatric symptoms were measured with Neuropsychiatric Inventory (NPI) and Montgomery Åsberg Depression Scale (MADRS). Caregivers burden and activities of daily living (Disability Assessment for Dementia, DAD) were also assessed. Results: One hundred and seventy-four patients fulfilled the trial. 72% were APOEω4 carriers. No significant overall treatment effects on neuropsychiatric symptoms, on activities of daily living or on caregiver's burden were found. However, significant positive treatment effects on the scores in the NPI agitation domain in APOEω4 carriers (p = 0.006) and in MADRS scores in non-APOEω4 carriers (p = 0.005) were found. Conclusions: Supplementation with ω3 in patients with mild to moderate AD did not result in marked effects on neuropsychiatric symptoms except for possible positive effects on depressive symptoms (assessed by MADRS) in non-APOEω4 carriers and agitation symptoms (assessed by NPI) in APOEω4 carriers. ClinicalTrials.gov identifier: NCT00211159.
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| 22. |
- Gronstedt, Helena, et al.
(författare)
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Effect of Sit-to-Stand Exercises Combined With Protein-Rich Oral Supplementation in Older Persons : The Older Person's Exercise and Nutrition Study
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : ELSEVIER SCIENCE INC. - 1525-8610 .- 1538-9375. ; 21:9, s. 1229-1237
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Nursing home (NH) residents are often undernourished and physically inactive, which contributes to sarcopenia and frailty. The Older Person's Exercise and Nutrition Study aimed to investigate the effects of sit-to-stand exercises (STS) integrated into daily care, combined with a protein-rich oral nutritional supplement (ONS), on physical function, nutritional status, body composition, health-related quality of life, and resource use. Design: Residents in 8 NHs were randomized by NH units into an intervention group (IG) or a control group (CG) (n = 60/group). The IG was a combination of STS (4 times/day) and ONS (2 bottles/day providing 600 kcal and 36 g protein) for 12 weeks. Setting and Participants: The participants resided in NH units (dementia and somatic care), were >= 75 years of age, and able to rise from a seated position. Methods: The 30-second Chair Stand Test was the primary outcome. Secondary outcomes were balance, walking speed, dependence in activities of daily living, nutritional status and body composition, health-related quality of life, and resource use. Results: Altogether, 102 residents (age 86 +/- 5 years, 62% female) completed the study. No improvement in the physical function assessments was observed in the IG, whereas body weight increased significantly (2.05 +/- 3.5 kg, P = .013) vs the CG. Twenty-one (of 52) participants with high adherence to the intervention (ie, at least 40% compliance to the combined intervention) increased their fat free mass (2.12 kg (0.13, 4.26 interquartile range), P = .007 vs CG). Logistic regression analyses indicated that the odds ratio for maintained/improved 30-second Chair Stand Test was 3.5 (confidence interval 1.1, 10.9, P = .034) among the participants with high adherence compared with the CG. Conclusions/Implications: Twelve-week intervention of daily STS combined with ONS in NH residents did not improve physical function, but increased body weight. Subgroup analyses indicated that high adherence to the combined intervention was associated with maintained or improved physical function and a gain of fat free mass. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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| 23. |
- Grönstedt, Helena, et al.
(författare)
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A study protocol of Older Person's Exercise and Nutrition Study (OPEN) - a sit-to-stand activity combined with oral protein supplement - effects on physical function and independence : a cluster randomized clinical trial
- 2018
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Ingår i: BMC Geriatrics. - : BIOMED CENTRAL LTD. - 1471-2318. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Poor nutrition and age per see add to the development of sarcopenia, i.e. loss of muscle mass and strength, which contributes to increased risk of impaired activities of daily living (ADL) and reduced independence. Protein deficiency plays an important role in the development of sarcopenia. In order to increase the muscle mass protein intake should be combined with physical exercise. A daily physical activity, the sit-to-stand exercise, has been proven to decrease older persons' dependence in ADL. Our study aims to evaluate the effects of the sit-to-stand exercise in combination with a protein-rich nutritional supplement, on physical function and independence in frail nursing home residents. The resident's perceptions and experiences of the intervention and the staff's experiences of supporting the resident to complete the intervention will also be explored.Methods: The study is a two-arm cluster-randomized controlled trial which will be performed in nursing homes at two municipalities in Sweden. We will recruit 120 residents, age 75 or older and able to stand up from a seated position. Residents (n = 60) randomized to the intervention group will perform the sit-to-stand exercise at four occasions daily and will be offered a protein-rich oral supplement, twice a day. The intervention period will last for 12 weeks and measures of physical function, nutritional status, quality of life and health economy will be performed at baseline and at 12-weeks follow-up. The primary outcome will be the number of chair rises performed in 30 s. The control group will receive standard care. Data will be analysed by intention-to-treat analysis and with mixed effect models. During the last part of the intervention period individual interviews with the residents, on the topic of feasibility with the OPEN concept will be held. Likewise, focus-group-interviews with staff will be performed.Discussion: The residents' physical and mental health could be expected to improve. Even the work situation for staff could be positively affected. One innovative feature of the OPEN study is the simple intervention consisting of a basic daily activity that can be performed by several nursing home residents with the support of existing staff and available resources.
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| 24. |
- Hedman, Sanna, et al.
(författare)
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Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients
- 2016
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 35:3, s. 692-698
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Tidskriftsartikel (refereegranskat)abstract
- Background & aimsMalnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal.MethodsThis study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients.ResultsThe prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff.ConclusionPatients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.
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| 25. |
- Hjorth, Erik, et al.
(författare)
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Omega-3 fatty acids enhance phagocytosis of Alzheimer's disease-related amyloid-β42 by human microglia and decrease inflammatory markers
- 2013
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 35:4, s. 697-713
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Tidskriftsartikel (refereegranskat)abstract
- The use of supplements with omega-3 (ω3) fatty acids (FAs) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) is widespread due to proposed beneficial effects on the nervous and cardiovascular systems. Many effects of ω3 FAs are believed to be caused by down-regulation and resolution of inflammation. Alzheimer's disease (AD) is associated with inflammation mediated by microglia and astrocytes, and ω3 FAs have been proposed as potential treatments for AD. The focus of the present study is on the effects of DHA and EPA on microglial phagocytosis of the AD pathogen amyloid-β (Aβ), on secreted and cellular markers of immune activity, and on production of brain-derived neurotrophic factor (BDNF). Human CHME3 microglial cells were exposed to DHA or EPA, with or without the presence of Aβ42. Phagocytosis of Aβ42 was analyzed by flow cytometry in conjunction with immunocytochemistry using antibodies to cellular proteins. Secreted proteins were analyzed by ELISA. Both DHA and EPA were found to stimulate microglial phagocytosis of Aβ42. Phagocytosis of Aβ42 was performed by microglia with a predominance of M2 markers. EPA increased the levels of BDNF in the culture medium. The levels of TNF-α were decreased by DHA. Both DHA and EPA decreased the pro-inflammatory M1 markers CD40 and CD86, and DHA had a stimulatory effect on the anti-inflammatory M2 marker CD206. DHA and EPA can be beneficial in AD by enhancing removal of Aβ42, increasing neurotrophin production, decreasing pro-inflammatory cytokine production, and by inducing a shift in phenotype away from pro-inflammatory M1 activation.
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| 26. |
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| 27. |
- Irving, Gerd Faxén, et al.
(författare)
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Omega-3 fatty acid supplementation effects on weight and appetite in patients with Alzheimer's disease : the omega-3 Alzheimer's disease study
- 2009
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 57:1, s. 11-17
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study the effects of omega (Omega)-3 fatty acid (FA) supplements on weight and appetite in patients with mild to moderate Alzheimer's disease (AD) in relation to inflammatory biomarkers and apolipoprotein E epsilon4 (APOEepsilon4). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Specialist memory clinics in the Stockholm catchment area. PARTICIPANTS: Two hundred four patients (aged 73+/-9, 52% women) with mild to moderate AD. INTERVENTION: Patients with AD received 1.7 g of docosahexaenoic acid (DHA) and 0.6 g of eicosapentaenoic acid (EPA) (Omega-3/Omega-3 group; n=89, aged 73+/-9, 57% women) or placebo 0.6 g of linoleic acid per day (placebo/Omega-3 group; n=85, aged 73+/-9, 46% women) for 6 months. After 6 months, all patients received DHA and EPA for another 6 months. MEASUREMENTS: Anthropometry, biochemical nutritional and inflammatory markers, and appetite assessed by caregiver. RESULTS: Mean weight and body mass index (kg/m(2)) at baseline were 70.0+/-11.8 kg and 24.3+/-3.0 kg/m(2), respectively. At 6- and 12-month follow-up, weight had increased 0.7+/-2.5 kg (P=.02) and 1.4+/-2.9 kg (P<.001) in the Omega-3/Omega-3 group. In the placebo group, weight was unchanged at 6 months but had increased (P=.01) at 12 months follow-up after Omega-3 supplementation was initiated. Appetite improved in the Omega-3/Omega-3 group over the treatment period (P=.01). In logistic regression analyses, not carrying the APOEepsilon4 allele and high plasma DHA concentrations were independently related to weight gain in the combined group of patients at 6 months follow-up. CONCLUSION: A DHA-enriched Omega-3 FA supplement may positively affect weight and appetite in patients with mild to moderate AD. Not carrying the APOEepsilon4 allele and high DHA were independently associated with weight gain.
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| 28. |
- Jernerén, Fredrik, et al.
(författare)
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Homocysteine Status Modifies the Treatment Effect of Omega-3 Fatty Acids on Cognition in a Randomized Clinical Trial in Mild to Moderate Alzheimer's Disease : The OmegAD Study
- 2019
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 69:1, s. 189-197
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Tidskriftsartikel (refereegranskat)abstract
- Background: Trials of supplementation with omega-3 fatty acids (omega 3-FAs) in patients with mild cognitive impairment or Alzheimer's disease (AD) have produced inconsistent effects on cognitive decline. There is evidence of an interaction between B vitamin status and omega 3-FAs in relation to brain atrophy and cognitive decline.Objective: We investigated whether baseline levels of plasma total homocysteine (tHcy), a marker of B vitamin status, modify the effects of omega 3-FAs supplementation on cognitive performance in moderate AD.Methods: This post hoc analysis of the OmegAD trial included 171 community-based patients with AD (MMSE >= 15): 88 patients received daily doses of 1.7 g docosahexaenoic acid and 0.6 g eicosapentaenoic acid for 6 months. Treatment outcome on cognition was analyzed according to baseline levels of tHcy using a general linear model and ANCOVA.Results: We found significant interactions between omega 3-FA supplementation and tHcy on cognition and clinical stage assessed by MMSE (p = 0.040), global CDR (p = 0.059), and CDRsob (p = 0.023), but not on ADAS-cog (p = 0.649). In patients with tHcy levels <11.7 mu mol/L, omega 3-FA supplementation improved cognitive performance as measured by MMSE (+7.1%, 95% CI: 0.59 to 13.7%, p = 0.033) and clinical status as measured by CDRsob (-22.3%, 95% CI: -5.8 to -38.7%, p = 0.009) compared with placebo.Conclusion: The effect of omega 3-FA supplementation on MMSE and CDR appears to be influenced by baseline tHcy, suggesting that adequate B vitamin status is required to obtain beneficial effects of omega 3-FA on cognition.
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| 29. |
- Karimi, Mohsen, et al.
(författare)
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DHA-rich n-3 fatty acid supplementation decreases DNA methylation in blood leukocytes : the OmegAD study
- 2017
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Ingår i: American Journal of Clinical Nutrition. - : HighWire Press. - 0002-9165 .- 1938-3207. ; 106:4, s. 1157-1165
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dietary fish oils, rich in long-chain n-3 (ω-3) fatty acids (FAs) [e.g., docosahexaenoic acid (DHA, 22:6n-3) and eicosapentaenoic acid (EPA, 20:5n-3)], modulate inflammatory reactions through various mechanisms, including gene expression, which is measured as messenger RNA concentration. However, the effects of long-term treatment of humans with DHA and EPA on various epigenetic factors-such as DNA methylation, which controls messenger RNA generation-are poorly described.Objective: We wanted to determine the effects of 6 mo of dietary supplementation with an n-3 FA preparation rich in DHA on global DNA methylation of peripheral blood leukocytes (PBLs) and the relation to plasma EPA and DHA concentrations in Alzheimer disease (AD) patients.Design: In the present study, DNA methylation in four 5'-cytosine-phosphate-guanine-3' (CpG) sites of long interspersed nuclear element-1 repetitive sequences was assessed in a group of 63 patients (30 given the n-3 FA preparation and 33 given placebo) as an estimation of the global DNA methylation in blood cells. Patients originated from the randomized, double-blind, placebo-controlled OmegAD study, in which 174 AD patients received either 1.7 g DHA and 0.6 g EPA (the n-3 FA group) or placebo daily for 6 mo.Results: At 6 mo, the n-3 FA group displayed marked increases in DHA and EPA plasma concentrations (2.6- and 3.5-fold), as well as decreased methylation in 2 out of 4 CpG sites (P < 0.05 for all), respectively. This hypomethylation in CpG2 and CpG4 sites showed a reverse correlation to changes in plasma EPA concentration (r = -0.25, P = 0.045; and r = -0.26, P = 0.041, respectively), but not to changes in plasma DHA concentration, and were not related to apolipoprotein E-4 allele frequency.Conclusion: Supplementation with n-3 FA for 6 mo was associated with global DNA hypomethylation in PBLs. Our data may be of importance in measuring various effects of marine oils, including gene expression, in patients with AD and in other patients taking n-3 FA supplements. This trial was registered at clinicaltrials.gov as NCT00211159.
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| 30. |
- Karlsson, Emelie S., et al.
(författare)
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Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 22:9, s. 1939-1945.e3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Interindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition. Design: Post-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis. Setting and Participants: Residents >75 years of age from dementia and somatic units in eight NHs in Sweden. Methods: Logistic regressions were performed to define factors associated with response (maintenance/ improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores. Results: Mean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P =.027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores. Conclusions and Implications: NH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.
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| 31. |
- Levak, Nicholas, et al.
(författare)
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Nutrition guidance within a multimodal intervention improves diet quality in prodromal Alzheimer’s disease: Multimodal Preventive Trial for Alzheimer’s Disease (MIND-ADmini)
- 2024
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Ingår i: Alzheimer's Research & Therapy. - : Springer. - 1758-9193. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMultimodal lifestyle interventions can benefit overall health, including cognition, in populations at-risk for dementia. However, little is known about the effect of lifestyle interventions in patients with prodromal Alzheimer’s disease (AD). Even less is known about dietary intake and adherence to dietary recommendations within this population making it difficult to design tailored interventions for them.MethodA 6-month MIND-ADmini pilot randomized controlled trial (RCT) was conducted among 93 participants with prodromal AD in Sweden, Finland, Germany, and France. Three arms were included in the RCT: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management, and social stimulation); 2) multimodal lifestyle intervention + medical food product; and 3) regular health advice (control group). Adherence to dietary advice was assessed with a brief food intake questionnaire by using the Healthy Diet Index (HDI) and Mediterranean Diet Adherence Screener (MEDAS). The intake of macro- and micronutrients were analyzed on a subsample using 3-day food records.ResultsThe dietary quality in the intervention groups, pooled together, improved compared to that of the control group at the end of the study, as measured with by HDI (p = 0.026) and MEDAS (p = 0.008). The lifestyle-only group improved significantly more in MEDAS (p = 0.046) and almost significantly in HDI (p = 0.052) compared to the control group, while the lifestyle + medical food group improved in both HDI (p = 0.042) and MEDAS (p = 0.007) during the study. There were no changes in macro- or micronutrient intake for the intervention groups at follow-up; however, the intakes in the control group declined in several vitamins and minerals when adjusted for energy intake.ConclusionThese results suggest that dietary intervention as part of multimodal lifestyle interventions is feasible and results in improved dietary quality in a population with prodromal AD. Nutrient intakes remained unchanged in the intervention groups while the control group showed a decreasing nutrient density.Trial registrationClinicalTrials.gov NCT03249688, 2017–07-08.
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| 32. |
- Malmgren A, Anna, et al.
(författare)
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Indications for percultaneous endoscopic gastrostomy and survival in old adults
- 2011
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Ingår i: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 55, s. 6037-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Many diseases striking old adults result in eating difficulties. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG) are unclear and everybody may not benefit from the procedure.OBJECTIVE:The aim of this study was to evaluate indications for and survival after PEG insertion in patients older than 65 years.DESIGN AND METHODS:A retrospective analysis including age, gender, diagnosis, indication, and date of death was made in 201 consecutive individuals, 94 male, mean age 79±7 years, who received a nutritional gastrostomy.RESULTS:Dysphagia was present in 86% of the patients and stroke was the most common diagnosis (49%). Overall median survival was 123 days and 30-day mortality was 22%. Patients with dementia and Mb Parkinson had the longest survival (i.e. 244 and 233 days), while those with other neurological diseases, and head and neck malignancy had the shortest (i.e. 75 and 106 days). There was no difference in mortality in patients older or younger than 80 years, except in patients with dementia.CONCLUSIONS:Old age should not be a contraindication for PEG. A high 30-day mortality indicates that there is a need of better criteria for selection and timing of PEG insertion in the elderly.
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| 33. |
- Shakersain, Behnaz, et al.
(författare)
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An Active Lifestyle Reinforces the Effect of a Healthy Diet on Cognitive Function : A Population-Based Longitudinal Study
- 2018
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 10:9
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Tidskriftsartikel (refereegranskat)abstract
- The joint effect of diet and leisure activity on cognitive function remains unknown. We aimed to verify the hypothesis that an active lifestyle reinforces the effect of the Nordic Prudent Dietary Pattern (NPDP) on cognitive function. A total of 2223 dementia-free Swedish adults aged 60 with Mini-Mental State Examination (MMSE) scores 27 were followed for an average of 6 years. MMSE was tested during follow-ups. Diet was assessed by food frequency questionnaire. The NPDP index was calculated and tertiled (low, moderate, and high adherence). Participation in physical, mental and social activities was trichotomised (low, moderate, and intense). An active lifestyle was defined based on the participation in each activity. Data were analyzed using mixed-effects models. Moderate-to-high adherence to NPDP was associated with a reduced decline in the MMSE score (: 0.19, 95% Confidence Interval (CI): 0.14-0.24). This association became stronger when combined with moderate-to-intense physical (: 0.34, 95% CI: 0.2-0.45), mental (: 0.29, 95% CI: 0.21-0.37), or social (: 0.27, 95% CI: 0.19-0.34) activities. An active lifestyle strengthened the effect of NPDP on cognitive function by two times, and further lowered risk of MMSE decline by 30%. Thus, an active lifestyle reinforces the effect of a healthy diet on preserved cognitive function, and further decreases the risk of cognitive decline.
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| 34. |
- Shakersain, Behnaz, et al.
(författare)
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Prudent diet may attenuate the adverse effects of Western diet on cognitive decline
- 2016
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 12:2, s. 100-109
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The influence of mixed dietary patterns on cognitive changes is unknown. Methods: A total of 2223 dementia-free participants aged >= 60 were followed up for 6 years to examine the impact of dietary patterns on cognitive decline. Mini-mental state examination (MMSE) was administered. Diet was assessed by a food frequency questionnaire. By factor analysis, Western and prudent dietary patterns emerged. Mixed-effect models for longitudinal data with repeated measurements were used. Results: Compared with the lowest adherence to each pattern, the highest adherence to prudent pattern was related to less MMSE decline (beta = 0.106, P = .011), whereas the highest adherence to Western pattern was associated with more MMSE decline (beta = -0.156, P < .001). The decline associated withWestern diet was attenuated when accompanied by high adherence to prudent pattern. Discussion: High adherence to prudent diet may diminish the adverse effects of high adherence to Western diet on cognitive decline.
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| 35. |
- Shakersain, Behnaz, et al.
(författare)
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The Nordic Prudent Diet Reduces Risk of Cognitive Decline in the Swedish Older Adults : A Population-Based Cohort Study
- 2018
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 10:2
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Tidskriftsartikel (refereegranskat)abstract
- Appropriate dietary pattern for preserving cognitive function in northern Europe remains unknown. We aimed to identify a Nordic dietary pattern index associated with slower cognitive decline compared to the Mediterranean-DASH Intervention for Neurodegenerative Delay, Mediterranean Diet, Dietary Approaches to Stop Hypertension, and Baltic Sea Diet indices. A total of 2223 dementia-free adults aged 60 were followed for 6 years. Mini-Mental State Examination was administrated at baseline and follow-ups. Dietary intake was assessed by 98-item food frequency questionnaire, and the Nordic Prudent Dietary Pattern (NPDP) was identified. Data were analysed using mixed-effects and parametric survival models and receiver operating characteristic curves with adjustment for potential confounders. Moderate ( = 0.139, 95% CI 0.077-0.201) and high adherence ( = 0.238, 95% CI 0.175-0.300) to NPDP were associated with less cognitive decline compared to other four indices. High adherence to NPDP was also associated with the lowest risk of MMSE decline to 24 (HR = 0.176, 95% CI 0.080-0.386) and had the greatest ability to predict such decline (area under the curve = 0.70). Moderate-to-high adherence to the NPDP may predict a better-preserved cognitive function among older adults in Nordic countries. Regional dietary habits should be considered in developing dietary guidelines for the prevention of cognitive impairment and dementia.
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| 36. |
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| 37. |
- Thunborg, Charlotta, 1965-, et al.
(författare)
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Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer’s disease: the MIND-ADmini randomized controlled trial
- 2024
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Ingår i: Alzheimer's Research & Therapy. - : Springer. - 1758-9193. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed cognitive benefits from a multidomain lifestyle intervention in at-risk older people. The LipiDiDiet trial highlighted benefits of medical food in prodromal Alzheimer’s disease (AD). However, the feasibility and impact of multimodal interventions combining lifestyle with medical food in prodromal AD is unclear.MethodsMIND-ADmini was a 6-month multinational (Sweden, Finland, Germany, France) proof-of-concept randomized controlled trial (RCT). Participants were 60–85 years old, had prodromal AD (International Working Group-1 criteria), and vascular/lifestyle risk factors. The parallel-group RCT had three arms: multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); multimodal lifestyle intervention + medical food (Fortasyn Connect); and regular health advice/care (control). Participants were randomized 1:1:1 (computer-generated allocation at each site). Outcome evaluators were blinded to randomization. Primary outcome was feasibility of the multimodal intervention, evaluated by recruitment rate during a 6-month recruitment phase, overall adherence in each intervention arm, and 6-month retention rate. Successful adherence was pre-specified as attending ≥ 40% of sessions/domain in ≥ 2/4 domains (lifestyle intervention), and consuming ≥ 60% of the medical food (lifestyle intervention + medical food). The secondary outcomes included adherence/participation to each intervention component and overall adherence to healthy lifestyle changes, measured using a composite score for healthy lifestyle. Cognitive assessments were included as exploratory outcomes, e.g. Clinical Dementia Rating scale.ResultsDuring September 2017-May 2019, 93 individuals were randomized (32 lifestyle intervention, 31 lifestyle + medical food, and 30 control group). Overall recruitment rate was 76.2% (64.8% during the first 6 months). Overall 6-month retention rate was 91.4% (lifestyle intervention 87.5%; lifestyle + medical food 90.3%; control 96.7%). Domain-specific adherence in the lifestyle intervention group was 71.9% to cognitive training, 78.1% exercise, 68.8% nutritional guidance, and 81.3% vascular risk management; and in the lifestyle + medical food group, 90.3% to cognitive training, 87.1% exercise, 80.7% nutritional guidance, 87.1% vascular risk management, and 87.1% medical food. Compared with control, both intervention arms showed healthy diet improvements (βLifestyle×Time = 1.11, P = 0.038; βLifestyle+medical food×Time = 1.43, P = 0.007); the lifestyle + medical food group also showed vascular risk reduction (P = 0.043) and less cognitive-functional decline (P < 0.05, exploratory analysis). There were 5 serious adverse events (control group: 1; lifestyle intervention: 3; lifestyle + medical food: 1) unrelated to interventions.ConclusionsThe multidomain lifestyle intervention, alone or combined with medical food, had good feasibility and adherence in prodromal AD. Longer-term cognitive and other health benefits should be further investigated in a larger-scale trial.Trial registrationClinicalTrials.gov NCT03249688.
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| 38. |
- Thunborg, Charlotta, 1965-, et al.
(författare)
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Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer’s disease: the MIND-ADmini randomized controlled trial
- 2024
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Ingår i: Alzheimer's Research & Therapy. - : Springer Nature. - 1758-9193. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed cognitive benefits from a multidomain lifestyle intervention in at-risk older people. The LipiDiDiet trial highlighted benefits of medical food in prodromal Alzheimer’s disease (AD). However, the feasibility and impact of multimodal interventions combining lifestyle with medical food in prodromal AD is unclear.Methods: MIND-ADmini was a 6-month multinational (Sweden, Finland, Germany, France) proof-of-concept randomized controlled trial (RCT). Participants were 60–85 years old, had prodromal AD (International Working Group-1 criteria), and vascular/lifestyle risk factors. The parallel-group RCT had three arms: multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); multimodal lifestyle intervention + medical food (Fortasyn Connect); and regular health advice/care (control). Participants were randomized 1:1:1 (computer-generated allocation at each site). Outcome evaluators were blinded to randomization. Primary outcome was feasibility of the multimodal intervention, evaluated by recruitment rate during a 6-month recruitment phase, overall adherence in each intervention arm, and 6-month retention rate. Successful adherence was pre-specified as attending ≥ 40% of sessions/domain in ≥ 2/4 domains (lifestyle intervention), and consuming ≥ 60% of the medical food (lifestyle intervention + medical food). The secondary outcomes included adherence/participation to each intervention component and overall adherence to healthy lifestyle changes, measured using a composite score for healthy lifestyle. Cognitive assessments were included as exploratory outcomes, e.g. Clinical Dementia Rating scale.Results: During September 2017-May 2019, 93 individuals were randomized (32 lifestyle intervention, 31 lifestyle + medical food, and 30 control group). Overall recruitment rate was 76.2% (64.8% during the first 6 months). Overall 6-month retention rate was 91.4% (lifestyle intervention 87.5%; lifestyle + medical food 90.3%; control 96.7%). Domain-specific adherence in the lifestyle intervention group was 71.9% to cognitive training, 78.1% exercise, 68.8% nutritional guidance, and 81.3% vascular risk management; and in the lifestyle + medical food group, 90.3% to cognitive training, 87.1% exercise, 80.7% nutritional guidance, 87.1% vascular risk management, and 87.1% medical food. Compared with control, both intervention arms showed healthy diet improvements (βLifestyle×Time = 1.11, P = 0.038; βLifestyle+medical food×Time = 1.43, P = 0.007); the lifestyle + medical food group also showed vascular risk reduction (P = 0.043) and less cognitive-functional decline (P < 0.05, exploratory analysis). There were 5 serious adverse events (control group: 1; lifestyle intervention: 3; lifestyle + medical food: 1) unrelated to interventions.Conclusions: The multidomain lifestyle intervention, alone or combined with medical food, had good feasibility and adherence in prodromal AD. Longer-term cognitive and other health benefits should be further investigated in a larger-scale trial.
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| 39. |
- Tofiq, avin, 1996-, et al.
(författare)
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Effects of Peroral Omega-3 Fatty Acid Supplementation on Cerebrospinal Fluid Biomarkers in Patients with Alzheimer's Disease : A Randomized Controlled Trial-The OmegAD Study
- 2021
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Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 83:3, s. 1291-1301
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies have suggested a connection between a decrease in the levels of polyunsaturated fatty acids (PUFAs) and Alzheimer's disease (AD). We aimed to assess the effect of supplementation with omega-3 fatty acids (n-3 FAs) on biomarkers analyzed in the cerebrospinal fluid (CSF) of patients diagnosed with AD.OBJECTIVE: To investigate the effects of daily supplementation with 2.3 g of PUFAs in AD patients on the biomarkers in CSF described below. We also explored the possible correlation between these biomarkers and the performance in the cognitive test Mini-Mental State Examination (MMSE).METHODS: Thirty-three patients diagnosed with AD were randomized to either treatment with a daily intake of 2.3 g of n-3 FAs (n = 18) or placebo (n = 15). CSF samples were collected at baseline and after six months of treatment, and the following biomarkers were analyzed: Aβ 38, Aβ 40, Aβ 42, t-tau, p-tau, neurofilament light (NfL), chitinase-3-like protein 1 (YKL-40), acetylcholinesterase (AChE), butyrylcholinesterase (BuChE), soluble IL-1 receptor type II (sIL-1RII), and IL-6.RESULTS: There were no significant differences between the groups concerning the level of the different biomarkers in the CSF at baseline. Within the treatment group, there was a small but significant increase in both YKL-40 (p = 0.04) and NfL (p = 0.03), while the other CSF biomarkers remained stable.CONCLUSION: Supplementation with n-3 FAs had a statistically significant effect on NfL and YKL-40, resulting in an increase of both biomarkers, indicating a possible increase of inflammatory response and axonal damage. This increase in biomarkers did not correlate with MMSE score.
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| 40. |
- Tylner, Sara, et al.
(författare)
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Effects on Weight, Blood Lipids, Serum Fatty Acid Profile and Coagulation by an Energy-Dense Formula to Older Care Residents : A Randomized Controlled Crossover Trial
- 2016
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 17:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Dietary intake in frail old adults is often lower than estimated needs. The aim of this study was to evaluate the effects of an energy-dense oral supplement on nutritional status, food intake, and physical function in residents living in care residential homes. Design: Randomized controlled intervention trial with a crossover design. Setting: Five care residential homes in the southern Stockholm area. Participants: Older people living at care residential homes: age 65 or older, malnourished or at risk of malnutrition according to Mini Nutritional Assessment-Short Form (MNA-SF). Intervention: Energy-dense formula (oleic and linoleic acid emulsion enriched with protein and micronutrients) (Calogen Extra, Nutricia) 30 mL distributed 3 times daily for 6 weeks. Measurements: Body weight, 3-day food and fluid record, appetite rating, and physical function (ie, Short Physical Performance Battery, grip strength, and peak expiratory flow). Biochemical indicators of nutritional status, blood lipids, and serum phospholipid fatty acid (FA) profile. Results: Twenty-eight participants completed the 2 phases of the crossover study; group A (n = 14, 87 +/- 6 years, 50% women) and group B (n = 14, 82 +/- 8 years, 71% women). The intervention periods combined resulted in significantly (P <.05) increased energy intake (238 +/- 544 kcal), weight gain (1.4 +/- 3.7 kg), improved appetite, relative reduction of saturated FA and increase in polyunsaturated FA, increased apoliporotein A, and reduced serum fibrinogen (-0.9 +/- 1.5 g/L). Conclusion: Distribution of an oleic and linoleic acid based fat emulsion enriched with protein and micronutrients (Calogen Extra) 3 times daily to old people in care residential homes improved nutritional status, had positive effects on fatty acid profile and blood lipids, and a potential antithrombotic effect.
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| 41. |
- Vedin, Inger, et al.
(författare)
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Effects of DHA-rich n-3 fatty acid supplementation on gene expression in blood mononuclear leukocytes : the OmegAD study
- 2012
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Ingår i: PLOS ONE. - : PLOS. - 1932-6203. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dietary fish oil, rich in n-3 fatty acids (n-3 FAs), e.g. docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), regulate inflammatory reactions by various mechanisms, e.g. gene activation. However, the effects of long-term treatment with DHA and EPA in humans, using genome wide techniques, are poorly described. Hence, our aim was to determine the effects of 6 mo of dietary supplementation with an n-3 FA preparation rich in DHA on global gene expression in peripheral blood mononuclear cells.METHODS AND FINDINGS: In the present study, blood samples were obtained from a subgroup of 16 patients originating from the randomized double-blind, placebo-controlled OmegAD study, where 174 Alzheimer disease (AD) patients received daily either 1.7 g of DHA and 0.6 g EPA or placebo for 6 months. In blood samples obtained from 11 patients receiving n-3 FA and five placebo, expressions of approximately 8000 genes were assessed by gene array. Significant changes were confirmed by real-time PCR. At 6 months, the n-3 FAs group displayed significant rises of DHA and EPA plasma concentrations, as well as up- and down-regulation of nine and ten genes, respectively, was noticed. Many of these genes are involved in inflammation regulation and neurodegeneration, e.g. CD63, MAN2A1, CASP4, LOC399491, NAIP, and SORL1 and in ubiqutination processes, e.g. ANAPC5 and UBE2V1. Down-regulations of ANAPC5 and RHOB correlated to increases of plasma DHA and EPA levels.CONCLUSIONS: We suggest that 6 months of dietary n-3 FA supplementation affected expression of genes that might influence inflammatory processes and could be of significance for AD.TRIAL REGISTRATION: ClinicalTrials.gov NCT00211159.
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| 42. |
- Vedin, Inger, et al.
(författare)
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Effects of docosahexaenoic acid-rich n-3 fatty acid supplementation on cytokine release from blood mononuclear leukocytes : the OmegAD study
- 2008
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Ingår i: American Journal of Clinical Nutrition. - : HighWire Press. - 0002-9165 .- 1938-3207. ; 87:6, s. 1616-1622
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dietary fish or fish oil rich in n-3 fatty acids (n-3 FAs), eg, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), ameliorate inflammatory reactions by various mechanisms. Whereas most studies have explored the effects of predominantly EPA-based n-3 FAs preparations, few have addressed the effects of n-3 FAs preparations with DHA as the main FA.OBJECTIVE: The objective was to determine the effects of 6 mo of dietary supplementation with an n-3 FAs preparation rich in DHA on release of cytokines and growth factors from peripheral blood mononuclear cells (PBMCs).DESIGN: In a randomized, double-blind, placebo-controlled trial, 174 Alzheimer disease (AD) patients received daily either 1.7 g DHA and 0.6 g EPA (n-3 FAs group) or placebo for 6 mo. In the present study blood samples were obtained from the 23 first randomized patients, and PBMCs were isolated before and after 6 mo of treatment.RESULTS: Plasma concentrations of DHA and EPA were significantly increased at 6 mo in the n-3 FAs group. This group also showed significant decreases of interleukin (IL)-6, IL-1beta, and granulocyte colony-stimulating factor secretion after stimulation of PBMCs with lipopolysaccharide. Changes in the DHA and EPA concentrations were negatively associated with changes in IL-1beta and IL-6 release for all subjects. Reductions of IL-1beta and IL-6 were also significantly correlated with each other. In contrast, this n-3 FA treatment for 6 mo did not decrease tumor necrosis factor-alpha, IotaL-8, IL-10, and granulocyte-macrophage colony-stimulating factor secretion.CONCLUSION: AD patients treated with DHA-rich n-3 FAs supplementation increased their plasma concentrations of DHA (and EPA), which were associated with reduced release of IL-1beta, IL-6, and granulocyte colony-stimulating factor from PBMCs. This trial was registered at clinicaltrials.gov as NCT00211159.
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| 43. |
- Vedin, Inger, et al.
(författare)
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Reduced prostaglandin F-2 alpha release from blood mononuclear leukocytes after oral supplementation of omega 3 fatty acids : the OmegAD study
- 2010
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Ingår i: Journal of Lipid Research. - : American Society for Biochemistry and Molecular Biology. - 0022-2275 .- 1539-7262. ; 51:5, s. 1179-1185
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Tidskriftsartikel (refereegranskat)abstract
- Omega-3 fatty acids, e. g., dokosahexaenoic acid (DHA) and eikosapentaenoic acid (EPA), ameliorate inflammatory reactions by various mechanisms, but the role of prostaglandins remains unclear. Our aim was to determine if dietary supplementation with a DHA-rich fish oil influenced the release of PGF(2 alpha) from peripheral blood mononuclear cells (PBMC). In the OmegAD study, 174 Alzheimer disease patients received either 1.7 g DHA plus 0.6 g EPA or a placebo daily for six months. PBMCs from the 21 ( 9 on fish oil and 12 on placebo) first-randomized patients were stimulated with either lipopolysaccharide (LPS) or phytohemagglutinin (PHA) before and after 6 months. Our results showed that plasma concentrations of DHA and EPA increased significantly at 6 months in the omega-3 group. PGF(2 alpha) release from LPS- ( but not from PHA-) stimulated PBMC was significantly diminished in this group; no change was noted in the placebo group. PGF(2 alpha) changes correlated inversely with changes in plasma DHA and EPA. Decreased IL-6 and IL-1(beta) levels correlated with decreased PGF(2 alpha) levels. The stimulus-specific PGF(2 alpha) release from PBMC after 6 months of oral supplementation with the DHA-rich fish oil might be one event related to reduced inflammatory reactions associated with omega-3 fatty acid intake.
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| 44. |
- Vikström, Sofia, et al.
(författare)
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A health concept with a social potential : an interview study with nursing home residents
- 2020
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Ingår i: BMC Geriatrics. - : BMC. - 1471-2318. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons' perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS.Methods: In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory.Results: The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others.Conclusions: The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life.
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| 45. |
- Volkert, Dorothee, et al.
(författare)
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ESPEN guideline on nutrition and hydration in dementia : Update 2024
- 2024
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Ingår i: Clinical Nutrition. - : Churchill Livingstone. - 0261-5614 .- 1532-1983. ; 43:6, s. 1599-1626
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS : Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. METHODS : The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. RESULTS : 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. CONCLUSION : Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
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