Data Collection in the CLSA

Short Diet Questionnaire (SDQ)

• Shatenstein B & Payette H. Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Food. Nutrients, 2015

• Developed, pre-tested and validated in the Quebec NuAge cohort in 2006-2007 based on a sample of 396 older adults;

• Short version of a existing food-frequency questionnaire including 78 food items:

• 6 validated questions evaluating the frequency of consumption of fruits and vegetables -developed by the US CDC for the BRFSS (Behavioral Risk Factor Surveillance System Survey)

• 36 items (30 foods and 6 beverages)- the whole diet is not covered

• Frequency of consumption are suggested (per day/week/month/ never or rarely) over the last 12 months

• Portion size is not evaluated (a standard average portion is assumed)

• Available in French and English

• Must be administered by an interviewer

Short Diet Questionnaire (SDQ)

Shatenstein & Payette, Nutrients, 2015

Short Diet Questionnaire (SDQ)

Abbreviated Seniors in the Community Risk Evaluation for Eating and Nutrition II (AB SCREEN II)

• 8 questions included in the abbreviated version: • Weight loss/gain over the last 6 months; • Appetite; • Swallowing; • Meal preparation; • Skipped meals; • Eating alone; • Consumption of fruits and vegetables; • Fluid amount consumed per day

Abbreviated Seniors in the Community Risk Evaluation for Eating and Nutrition II (AB SCREEN II)

CLSA Report on Health and Aging in Canada, 2018

Use of nutritional supplements

CLSA Report on Health and Aging in Canada, 2018

• Questions included in the basic questionnaire (self-reported use)• Assessing the consumption of a given supplement over the last month (YES/NO)• 6 supplements aimed: multivitamins, calcium, vitamin D, vitamin B12, iron, vitamin C• 1 open question: any other supplement (specify)

The CLSA Report on Health and Aging in Canada

https://www.clsa-elcv.ca/clsareport

Example of use of dietary data:

Study on dairy product consumption and cognitive performances in older adults of the CLSA

Funded by Dairy Farmers of Canada• Not involved in study design, data analysis, interpretation and

publication)

Disclosure

50

Threshold

30 70

Global cognition ↓ ~0.75 % / year

Decline in cognitive functions with aging

Lexell et al. J Neuro Sci, 1988; Tessier AJ et al. FASEB J, 2017.

Cog

nitio

n

Age, years

Mild cognitive impairment (MCI):

14-18% of population worldwide (≥70 y)

Dementia:

35.6 million individuals

115.4 million in 2050 (>60 y)

WPA2015 report, www.un.org ; Petersen, R. C. et al. Arch Neurol. 66, 2009; Pince, M. et al. Alzheimers Dement. 2013

http://www.un.org/

Cognitive function in older adults

Adapted from Petersen, R. C. et al. Arch Neurol. 66, 2009; Teng, E. Et al. Am J Geriatr Psychiatry. 20, 2012.; Nishiguchi, S. et al. J Am Med Dir Assoc. 16, 2015.; Gale, C.R. et al. BMJ. 312, 1996.

Potential role of dairy products in cognitive function

Vitamin B12Whey protein

↓ homocysteine levels↑ insulin response

Alpha-lactalbumintryptophan and cysteine

↑ serotonin levels↑ glutathione levels

Milk peptides Calcium

Cognitive health Adapted from Camfield DA. et al. Br J Nutr 106, 2011; Ano Y et al. Int J Mol Sci 19, 2018.

↓ CVD risk↓ blood pressureimproved blood lipid profile

Fermented products

Bacteria culture, fatty acidsVitamin K

Total and specific dairy product intake frequency, is positively and independently

associated with better cognitive function in free-living older adults.

Hypothesis

To examine the association between total dairy product intake frequency and performance of 3

cognitive domains in community-dwelling older Canadians.

Objective

Surrey, BCVictoria, BCVancouver, BC Calgary, AB

Winnipeg, MB

Hamilton, ONOttawa, ON Montreal, QC

Sherbrooke, QCHalifax, NS

St. John’s, NL

Tracking cohortn=21,241

Comprehensive cohortn=30,097

Specific exclusion criteria• < 65 y• Alzheimer's disease• Multiple sclerosis• Parkinson’s disease• Effects from stroke or transient ischemic

attack• Recent surgery, unstable heart condition,

pulmonary embolism, chemotherapy, polio dialysis.

• Traumatic brain injury, post-traumatic stress disorder

• Missing cognitive test results

Canadian Longitudinal Study on Aging

Study populationn=7,945

1. Rey et al. 1964; 2. Lezak et al. 2004 ; 3. Gallacher et al. 2013; 4. MacDonald et al., 2003.

Psychomotor speedSimple and Choice Reaction Times3

• Inconsistency is predictive of cognitive performance4

Cognitive function assessment

MemoryDelayed and Immediate recall Rey Auditory Verbal learning Tests1(RAVLT, score 0-15)

•Good test–retest reliability (.51 ≤ r ≤ .86)2•Extremely sensitive to detecting early cognitive decline

GreenYellowRed

Blue

1. Teng, 1994; 2. Billick et al., 2001; 3. Lezak et al. 2004; 4. Strauss et al., 2006; 5. Read et al. 1987; 6. Tierney et al., 2005.

Cognitive function assessment

Executive functions• Mental Alternation Test (MAT – score 0-51; 30 s)1

• Sensitivity 91% and specificity 100% against MMSE2

• Prospective Memory Test (PMT)• Sensitive to cognitive impairment3

• Stroop Neuropsychological Screening Test4• High interference was calculated as the score for

interference/colored dots and used in models.

• Controlled Oral Word Association Test (COWAT; 60 s)2• Sum of the 3 letters scores, F, A and S.

• Animal Naming (60 s)5• Important predictor of incident Alzheimer’s disease6

• How often do you usually eat all low-fat cheeses? • How often do you usually eat all regular cheeses?

• How often do you usually eat yogurt (low-fat)? • How often do you usually eat yogurt (regular)?

• How often do you usually drink whole milk 3.25% m.f.? • How often do you usually drink 2%, 1%, skim milk?

Semi-quantitative Short Diet Questionnaire

Nutritional Assessment

+

Cheese

Yogurt

Milk

Fermented dairy products

Creation of a diet quality score

Men WomenCanada Food Guide

2007 servings for 51+*Fruits and vegetables (out of 10) 7 7

Fruit (fresh, frozen, canned)Calcium-fortified juices and 100% pure

fruit juicesGreen saladPotatoes (boiled, mashed or baked)

CarrotsOther vegetables (except carrots,

potatoes or salad)

Whole Grains (out of 10) 7 6High fibre breakfast cerealsWhole wheat breads, bran breads,

multigrain breads, rye breads

* Frequencies are treated as servings**Sum of low-fat and regular for all categories

Men WomenCanada Food Guide

2007 servings for 51+*Meats and alternatives (out of 10) 3 2

Legumes (beans, peas, lentils)Beef, pork (ground, hamburgers,

roast beef, steak, cubed…)Chicken, turkeyOther meats (veal, lamb, game…)Omega-3 eggsEgg dishes except omega 3 eggs

(eggs, omelette, quiche,...)Salmon, trout, sardines, herring, tuna,

mackerel (fresh, frozen or canned)

Nuts, seeds and peanut butter

Dairy products** (out of 10) 3 3Yogurt Milk Cheese

Fruits and vegetables

Whole grains

Meat and alternatives

Dairy products

Diet quality total score

10 points

10 points

10 points

10 points

40 points

Score used for adjustment of statisticalmodels 40 points (total) – dairy product score

Creation of a diet quality score

Statistical approach

Multivariate analysis of covariance (MANCOVA)

• By cognitive domain

• For total and each type of dairy product intake

• Adjusted for covariates potentially linked with cognitive performances and dairy product intake

Univariate analysis of covariance (ANCOVA)

• If significant in #1 → analysis by test included under the cognitive domain

• Bonferroni correction for multiple comparison

• Significance p

Mean ± SD RangeSex, % women 48.7 Age, y 72.8 ± 5.6 65-86Education, % post-secondary diploma 73Income, % $50,000-$100,000 41Language, % Francophone 19BMI, kg/m2 27.7 ± 4.7 12.9-63.3Depression scale (CES-D 10), 0-30 4.6 ± 4.1 0-28Nutritional risk (SCREEN II), 0-48 39.3 ± 5.7 5-48Diet quality score, 0-30 15.5 ± 4.1 0-30Consumers of dairy products, % 99.0Total dairy intake, times/d 1.9 ± 1.1 0-9.4

Baseline characteristics of participants

Milk Cheese Yogurt

By product types (times/d)

Low-fat Regular-fat

By fat content (times/d)

Dairy intake frequency distribution

0.47

0.54

• Total dairy intake frequency: 1.9 times/d

0.86

0.6

1.3

Memory Executive function Psychomotor speed

-0.4 -0.2 0 0.2 0.4

Age

Heart condition

Diet quality

Education

Sex

Income

RAVLT-II RAVLT-I

-0.4 -0.2 0 0.2 0.4

Age

Language

Province

Education

Income

Stroop high interference*MATAnimal namingFAS score

-0.4 -0.2 0 0.2 0.4

Age

Heart condition

Education

Physical activity

Income

Choice reaction time*

Strongest determinants of cognitive function by domain and test using bivariate correlations

*Correlation of negative and natural log score

+- +- +-

Total dairy intake is positively associated with executive function from multivariate ANCOVA.

Associations remained significant after adjusting for important covariates including age, sex, education and diet quality.

No associations were found with memory and psychomotor speed domains.

From univariate ANOVA, dairy intake remained significantly associated with COWAT total F-A-S score only.

F-A-S oral word naming score across quartiles of total dairy intake frequency

Individuals with a higher frequency of intake (above 2.5 times/d) were able to name more words than those with a lower intake below 1.1 times/d and between 1.2 and 1.7 times/d (adjusted mean: 1.2 and 1.4 word difference respectively).

For each additional year of age, participants name 0.22 word less (non-adjusted linear regression).

And 0.14 word when adjusting for covariates.

The difference observed in the F-A-S score between highest and lowest consumers of DP is comparable to the difference seen across 10 years of age when adjusting for covariates (4.5 years non-adjusted).

Is a one-word difference meaningful?

Specific dairy product categories are associated with cognitive function

Cognitive domains (multivariate) Cognitive tests (univariate)

Executive function

Cheese

Fermented dairy

Low-fat dairy

Yogurt Memory Not significantly associated with individual tests

From fully-adjusted (model 2) MANCOVAFrom fully-adjusted (model 2) ANCOVA, Bonferroni correction for multiple comparison

F-A-S word namingCheese

Fermented dairy

Low-fat dairy

Animal naming

Summary• Total dairy product intake frequency is positively and independently associated with

executive functions, more specifically with F-A-S oral word association test.

• The difference observed in the F-A-S score between highest and lowest consumers of DP is comparable to the difference seen across 10 years of age (adjusted; 4.5 years non-adjusted).

• Cheese, low-fat dairy and fermented dairy intake is associated with verbal fluency executive functions.

• Yogurt intake is associated with the memory domain, but not with individual memory tests.

Significance and implications

Images: https://petapixel.com/2012/01/13/happy-at-one-hundred-emotive-portraits-of-centenarians/

• One of few large studies to assess different cognitive domains, to investigate the associations with categories of dairy products and as exposure-response.

• Corroborates a potential novel role for fermented dairy products, particularly cheese, in cognitive function.

• Limitations:• No assessment of portion sizes• Cross-sectional associations

Future directions• Dairy product consumption may represent modifiable factor to target in

cognitive impairment prevention.

• Long-term follow-up investigation of:

• Cognitive domains

• Using more precise and accurate dietary assessment (including portion sizes)

Images: https://petapixel.com/2012/01/13/happy-at-one-hundred-emotive-portraits-of-centenarians/

Supervisor• Stéphanie Chevalier, RD,

PhD

Collaborators• Nancy Presse, RD, PhD

• Guylaine Ferland, PhD

• Louis Bherer, PhD

Acknowledgments

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